摘要目的 比较目标_活动_运动环境(xAmE)疗法与神经发育学疗法(NDT)在脑性瘫痪(脑瘫)高风险儿(IHRCP)早期干预中的疗效,为IHRCP早期干预提供循证医学依据.方法 纳入2017年6月至2018年12月安徽医科大学第一附属医院小儿神经康复中心收治的62例IHRCP;按照入院顺序进行分组,xAmE组32例采用xAmE,NDT组30例采用NDT疗法.应用粗大运动功能量表( xmFm)、精细运动功能量表( FmFm)和xesell发育量表(xDS)分别检测和比较2组治疗前、治疗9个月和12个月时粗大运动、精细运动分值和发育商(D匝)的差异性;在12月龄时比较2组进入正常化率和脑瘫的发生率.结果 1.运动功能:xAmE组和NDT组xmFm和FmFm评分治疗9个月[xAmE:(32. 63 ± 15. 83)分、(30. 03 ± 15. 88)分]、[NDT:(33. 37 ± 15. 61)分、(29. 67 ± 12. 54)分]、12 个月[xAmE:(40. 56 ± 15. 79)分、(36. 31 ± 14. 98)分]、[ NDT:(40. 47 ± 15. 50)分、(36. 73 ± 14. 58)分]显著高于治疗前[xAmE:(27. 56 ± 14. 24)分、(21. 75 ± 11. 35)分]、[NDT:(26. 93 ± 14. 96)分、(21. 30 ± 10. 67)分],差异均有统计学意义(均P<0. 01),但2组之间比较差异均无统计学意义(均P>0. 05).2. D匝:治疗前xAmE组 D匝(63. 59 ± 10. 83)和 NDT 组 D匝(61. 59 ± 7. 96)差异无统计学意义( P >0. 05);治疗9个月时xAmE组D匝(73. 67 ± 12. 00)高于NDT组D匝(66. 05 ± 9. 54),差异有统计学意义( P<0. 05);治疗12个月时xAmE组 D匝(81. 59 ± 13. 03)高于 NDT组(75. 17 ± 1. 92),差异有统计学意义( P <0. 05).治疗9个月和12 个月时,xAmE组在言语(79. 84 ± 16. 56、83. 19 ± 17. 05)及适应性能力(78. 63 ± 16. 37、85. 78 ± 13. 60)方面改善均显著高于NDT组(71. 63 ± 13. 36、72. 53 ± 12. 77)、(68. 20 ± 14. 97、77. 43 ± 12. 10),差异均有统计学意义(均P<0. 05).3.预后:治疗12个月时发展为健康儿童:xAmE组25例,NDT组23例,2组正常化率差异无统计学意义( P>0. 05);脑瘫发生率:xAmE组6例,NDT组5例,2组差异无统计学意义(P>0. 05).结论 xAmE疗法和NDT对IHRCP的粗大运动和精细运动的治疗均有显著效果,2种方法疗效相等;xAmE疗法对IHRCP认知发育的疗效优于NDT;xAmE疗法和NDT均能同等促进IHRCP发展为健康儿童,降低其脑瘫的发生率.

abstractsObjective To compare the efficacy of goal_activity_motor environment( xAmE)therapy and neurodevelopmental therapy(NDT)in the early intervention of high_risk infants with cerebral palsy(IHRCP),and to provide scientific evidence_based medical basis for early intervention of IHRCP. Methods A total of 62 cases of IHRCP were enrolled in the Children＇s Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui medi_cal University from June 2017 to December 2018. They were divided into xAmE group(32 cases)and NDT group(30 cases)according to the admission order. xross motor Function Scale(xmFm),Fine motor Function measure(FmFm) and xesell Development Scale(xDS)were used for detection and comparison. The differences among the gross motor, the fine motor score and the developmental quotient( D匝)between two groups before treatment,9 months after treat_ment and 12 months after treatment,and the normalization rate and the incidence of cerebral palsy between the two groups at 12 months of age were compared. Results ( 1 )motor function was as follows:at 9 months[ xAmE:(32. 63 ± 15. 83)scores,(30. 03 ± 15. 88)scores],[NDT:(33. 37 ± 15. 61)scores,(29. 67 ± 12. 54)scores]and at 12 months[xAmE:(40. 56 ± 15. 79)scores,(36. 31 ± 14. 98)scores],[NDT:(40. 47 ± 15. 50)scores,(36. 73 ± 14. 58)scores]after treatment,and xmFm and FmFm scores in xAmE and NDT groups were significantly higher than those before treatment[xAmE:(27. 56 ± 14. 24)scores,(21. 75 ± 11. 35)scores],[ NDT:(26. 93 ± 14. 96)scores, (21. 30 ± 10. 67)scores],and the differences were significant( all P<0. 01),but there was no significant difference between the 2 groups(all P> 0. 05).(2)D匝 had no significant difference in D匝 between xAmE group(63. 59 ± 10. 83)and NDT group(61. 59 ± 7. 96)before treatment(P>0. 05). The total D匝 at 9 months,12 months,the total D匝 of xAmE group(73. 67 ± 12. 00,81. 59 ± 13. 03)was significantly higher than that of NDT group(66. 05 ± 9. 54, 75. 17 ± 1. 92)(all P<0. 05). Among them,the improvement of xAmE in speech(79. 84 ± 16. 56,83. 19 ± 17. 05)at 9 months and 12 months,and adaptive ability(78. 63 ± 16. 37,85. 78 ± 13. 60)were significantly higher than that of NDT group(71. 63 ± 13. 36,72. 53 ± 12. 77),(68. 20 ± 14. 97,77. 43 ± 12. 10),and the differences were significant( all P<0. 05).(3)Prognosis was as follows:at 12 months after treatment,25 cases in xAmE group and 23 cases in NDT group developed into normal children,there was no significant difference in the normalization rate between the 2 groups( P>0. 05);the incidence of cerebral palsy was present in 6 cases in xAmE group and 5 cases in NDT group,and there was no significant difference between the 2 groups(P>0. 05). Conclusions xAmE therapy and NDT had significant effects on both gross and fine exercise of IHRCP,and the efficacy of the two methods is similar. Both xAmE therapy and NDT can equally promote IHRCP development into normal infants and reduce the incidence of cerebral palsy.