Hou Ying, Zheng Huitian, Li Jinping, Wang Shujia, Zhang Dongmei, Tang Tong, Xu Mindan, Zhou Hong
Department of Rehabilitation Medicine, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou.
Neurological Rehabilitation Department, Zhangjiagang Gangcheng Rehabilitation Hospital, Zhangjiagang.
Arch Rehabil Res Clin Transl. 2021 Feb 23;3(2):100116. doi: 10.1016/j.arrct.2021.100116. eCollection 2021 Jun.
To demonstrate the effects of a newly designed postural alignment relearning system on postural control dysfunction in a typical patient with cerebral palsy (CP).
Evaluation before and after 8 weeks of Constraint Standing Training 3-dimensional postural alignment relearning system.
Department of Rehabilitation Medicine.
A 6-year-old girl with CP and postural misalignment on Gross Motor Function Classification System level I.
Constraint Standing Training for 8 weeks to correct postural misalignment.
Parameters of lateral plain radiographs in static standing, posturography measurements in standing and walking, motor ability (Gross Motor Function Measure-88 [GMFM-88] scores, manual muscle testing [MMT] scores, muscle architecture), and gait kinematic parameters (40 3-dimensional parameters of arms, trunk, waist, and lower limbs).
Knee hyperextension angle in static standing; peaks of knee flexion angle (KFA) when walking, hip flexion angle and ankle flexion angle in dynamic standing; and the KFA at initial contact in gait cycle all decreased significantly (<.01). Scores of GMFM-88 sections D and E and MMT of 5 core stability muscles improved (<.01). The velocities and range of motion of the arms, the 3-dimensinoal range of motion of the trunk and waist, and most of the parameters of the lower limbs showed statistically significant change (.01). Bilateral muscle thickness did not change significantly after the treatment (.738 left, =.978 right), but the gluteus maximus morphology was changed: the muscle fibers became rounder, the interfiber space decreased, and the border lines of the muscle fibers got clearer.
Postural alignment, motor ability, and gait may be homologous external manifestations of more fundamental core abilities, referring to correct standing posture cognition, muscle activation, and postural unconsciousness. Constraint Standing Training 3-dimensional postural alignment relearning system aimed to improve the static and dynamic standing control ability, may fix postural misalignment and improve motor ability and flexed-knee gait. Future work should use Constraint Standing Training with patients with different kinds of misalignment, choose sensitive indicators, observe the duration of each step, and reveal the mechanism causes postural misalignment.
证明一种新设计的姿势矫正再学习系统对一名典型脑性瘫痪（CP）患者姿势控制功能障碍的影响。
在为期8周的约束站立训练三维姿势矫正再学习系统前后进行评估。
康复医学科。
一名6岁CP女童，粗大运动功能分类系统为I级，存在姿势失调。
进行8周的约束站立训练以纠正姿势失调。
静态站立时的侧位X线片参数、站立和行走时的姿势描记测量、运动能力（粗大运动功能测量-88[GMFM-88]评分、徒手肌力测试[MMT]评分、肌肉结构）以及步态运动学参数（手臂、躯干、腰部和下肢的40个三维参数）。
静态站立时的膝关节过伸角度；行走时的膝关节屈曲角度（KFA）峰值、动态站立时的髋关节屈曲角度和踝关节屈曲角度；以及步态周期中初始接触时的KFA均显著降低（<.01）。GMFM-88的D和E部分评分以及5块核心稳定肌的MMT评分有所改善（<.01）。手臂的速度和运动范围、躯干和腰部的三维运动范围以及下肢的大多数参数均有统计学意义的变化（.01）。治疗后双侧肌肉厚度无显著变化（左侧P =.738，右侧P =.978），但臀大肌形态发生改变：肌纤维变得更圆，纤维间间隙减小，肌纤维边界线更清晰。
姿势矫正、运动能力和步态可能是更基本核心能力的同源外在表现，涉及正确的站立姿势认知、肌肉激活和姿势无意识。旨在提高静态和动态站立控制能力的约束站立训练三维姿势矫正再学习系统，可能纠正姿势失调并改善运动能力和屈膝步态。未来的工作应将约束站立训练应用于不同类型失调的患者，选择敏感指标，观察每个步骤的持续时间，并揭示导致姿势失调的机制。
