脑瘫学龄前儿童的自我照顾和手动能力：一项纵向研究。
Self-care and manual ability in preschool children with cerebral palsy: a longitudinal study.
机构信息
Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.
出版信息
Dev Med Child Neurol. 2019 May;61(5):570-578. doi: 10.1111/dmcn.14049. Epub 2018 Oct 7.
AIM
To describe longitudinal development of self-care and its relationship to manual ability in children with cerebral palsy (CP) aged 18 months to 5 years across all functional abilities.
METHOD
This was a prospective longitudinal population-based study of 290 children with CP (178 [61%] males, 112 [39%] females). Self-care was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). At 60 months (n=242), children were classified using the Manual Ability Classification System (MACS); 113 in level I (47%), 61 in MACS level II (25%), 24 in MACS level III (10%), 14 in MACS level IV (6%), and 30 in MACS level V (12%). Measures were taken at 18 months, 24 months, 30 months, 36 months, 48 months, and 60 months of age. Longitudinal analyses were performed using mixed-effects linear regression models.
RESULTS
Self-care development achieved by 60 months was negatively associated with the severity of manual ability impairment. Distinct self-care developmental trajectories were found with estimated changes in PEDI self-care scaled scores per month: 0.61 for MACS level I, 0.46 for MACS levels II, 0.31 for MACS level III, 0.16 for MACS level IV, and 0.03 for MACS level V. Children classified in MACS level V had the lowest level of self-care skills at 18 months and showed no progress in self-care development.
INTERPRETATION
This study reports rate of self-care development in preschool children with CP. Self-care performance was highest in children with greatest manual ability. Clinicians may use rates of change to predict or monitor self-care performance. PEDI trajectories inform goal setting in discussions with families regarding expected levels of independence in self-care.
WHAT THIS PAPER ADDS
Distinct self-care developmental trajectories in children with cerebral palsy were found according to Manual Ability Classification System (MACS) levels. Children in MACS levels IV and V with epilepsy did not show any significant change in self-care. Children in MACS levels IV and V without epilepsy demonstrated small yet significant gains in self-care performance.
目的
描述脑瘫儿童（CP）在 18 个月至 5 岁时自我护理的纵向发展，并研究其与运动能力的关系，该研究涉及所有功能能力的儿童。
方法
这是一项前瞻性的基于人群的纵向研究，共纳入 290 名 CP 患儿（178 名男性，112 名女性）。采用儿童残疾评估量表（PEDI）评估自我护理能力。60 个月时（n=242），根据手动能力分类系统（MACS）对儿童进行分类；其中 I 级 113 例（47%），II 级 61 例（25%），III 级 24 例（10%），IV 级 14 例（6%），V 级 30 例（12%）。在 18 个月、24 个月、30 个月、36 个月、48 个月和 60 个月时进行测量。采用混合效应线性回归模型进行纵向分析。
结果
60 个月时的自我护理发展与运动能力受损的严重程度呈负相关。通过每月 PEDI 自我护理量表评分的估计变化，发现了不同的自我护理发展轨迹：MACS I 级为 0.61，MACS II 级为 0.46，MACS III 级为 0.31，MACS IV 级为 0.16，MACS V 级为 0.03。在 18 个月时被归类为 MACS V 级的儿童自我护理技能水平最低，且自我护理发展没有进展。
解释
本研究报告了学龄前脑瘫儿童自我护理的发展速度。运动能力最强的儿童自我护理能力最高。临床医生可以使用变化率来预测或监测自我护理表现。PEDI 轨迹为临床医生与家属讨论自我护理独立性的预期水平提供信息。
本研究的新发现
根据手动能力分类系统（MACS）水平，发现脑瘫儿童存在不同的自我护理发展轨迹。患有癫痫的 MACS 四级和五级儿童的自我护理能力没有明显变化。没有癫痫的 MACS 四级和五级儿童在自我护理表现方面有较小但显著的提高。
Zotero 插件