上肢功能障碍、动作技能与单侧脑瘫儿童的预后。
Upper limb impairments, process skills, and outcome in children with unilateral cerebral palsy.
机构信息
Paediatric Rehabilitation Department, Women's and Children's Health Network, Women's and Children's Hospital, North Adelaide, SA, Australia.
School of Medicine, Flinders University, Bedford Park, SA, Australia.
出版信息
Dev Med Child Neurol. 2019 Sep;61(9):1080-1086. doi: 10.1111/dmcn.14185. Epub 2019 Feb 18.
AIM
To examine the relationships between upper limb impairments and independence in self-care (ISC) in children with unilateral cerebral palsy (CP).
METHOD
One hundred and eight children with unilateral CP (46 females, 62 males; mean age 8y 7mo, SD 3y 9mo) recruited from a population register were assessed for upper limb muscle power, spasticity, sensation, motor control, and process skills, and for ISC as the functional outcome using structural equation modelling.
RESULTS
The model showed good fit indices and explained 90% of the variance in ISC. Direct effects were significant between manual ability and ISC (β=0.47), and process skills and ISC (β=0.63). Sensation had a significant positive indirect effect on ISC through manual ability (β=0.24) and a positive but marginally non-significant indirect effect through process skills (β=0.21, bootstrapped 95% confidence interval -0.05 to 0.55). Spasticity had a significant negative indirect effect on ISC through its effect on manual ability (β=-0.21). Age had a significant positive indirect effect on ISC, as did intellect, through their effect on process skills (β=0.34 and 0.21 respectively).
INTERPRETATION
ISC is affected by upper limb impairments and process skill. Sensation influences ISC through its effects on manual and process skill abilities. Both sensation and process skills require further evaluation to assist ISC in children with unilateral CP.
WHAT THIS PAPER ADDS
Process skills and manual ability most strongly positively influence independence in self-care (ISC) in children with unilateral cerebral palsy. Sensation influences ISC through manual ability and process skill.
目的
研究上肢功能障碍与单侧脑瘫儿童日常生活自理（ISC）独立性的关系。
方法
从人群登记处招募了 108 名单侧脑瘫儿童（46 名女性，62 名男性；平均年龄 8 岁 7 个月，标准差 3 岁 9 个月），使用结构方程模型评估其上肢肌肉力量、痉挛、感觉、运动控制和过程技能，并将 ISC 作为功能结果进行评估。
结果
模型显示出良好的拟合指数，解释了 ISC 方差的 90%。手动能力与 ISC 之间存在显著的直接影响（β=0.47），过程技能与 ISC 之间也存在显著的直接影响（β=0.63）。感觉通过手动能力对 ISC 有显著的正间接影响（β=0.24），通过过程技能有正向但边缘非显著的间接影响（β=0.21，bootstrap 95%置信区间-0.05 至 0.55）。痉挛通过对手动能力的影响对 ISC 有显著的负间接影响（β=-0.21）。年龄和智力通过对过程技能的影响对 ISC 有显著的正间接影响（β分别为 0.34 和 0.21）。
解释
ISC 受上肢损伤和过程技能的影响。感觉通过对手动和过程技能能力的影响来影响 ISC。在单侧脑瘫儿童中，感觉和过程技能都需要进一步评估，以帮助提高 ISC。
本文添加内容
过程技能和手动能力对单侧脑瘫儿童日常生活自理（ISC）的独立性有最强的正向影响。感觉通过手动能力和过程技能影响 ISC。
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