动作观察疗法对脑性瘫痪患儿上肢功能作用的系统综述

doi:10.3969/j.issn.1006-9771.2023.05.010

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (5): 558-564.doi: 10.3969/j.issn.1006-9771.2023.05.010

动作观察疗法对脑性瘫痪患儿上肢功能作用的系统综述

蓝诗玲^1a^,^1b, 庞伟^1a^,^1b^,²(), 李鑫^1a^,^1b^,²^,³, 刘梦云^1a^,^1b, 战玉军⁴

1.佳木斯大学，a.康复医学院；b.儿童康复神经实验室，黑龙江佳木斯市 154007
2.佳木斯大学附属第三医院，黑龙江佳木斯市 154007
3.北京体育大学运动医学与康复学院，北京市 100084
4.深圳大鹏妇幼保健院，广东深圳市 518115

收稿日期:2022-08-15 修回日期:2023-01-06 出版日期:2023-05-25 发布日期:2023-06-19
通讯作者: 庞伟，男，黑龙江佳木斯市人，主任医师，教授，硕士生导师，主要研究方向：小儿脑瘫的综合康复。E-mail：pangwei76@aliyun.com
作者简介:蓝诗玲(1997-)，女，汉族，四川广汉市人，硕士研究生，主要研究方向：康复医学与理疗学。
基金资助:
1.黑龙江省应用技术研究与开发计划项目(GA19C008);2.2022年度黑龙江省自然科学基金联合引导项目(LH2022H092)

Effect of action observation therapy on upper limb function in cerebral palsy: a systematic review

LAN Shiling^1a^,^1b, PANG Wei^1a^,^1b^,²(), LI Xin^1a^,^1b^,²^,³, LIU Mengyun^1a^,^1b, ZHAN Yujun⁴

1. a.Rehabilitation Medical College; b.the Children's Rehabilitation Nerve Laboratory, Jiamusi University, Jiamusi, Heilongjiang 154007, China
2. The Third Affiliated Hospital of Jiamusi University, Jiamusi, Heilongjiang 154007, China
3. School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
4. Shenzhen Dapeng Maternal and Child Health Hospital, Shenzhen, Guangdong 518115, China

Received:2022-08-15 Revised:2023-01-06 Published:2023-05-25 Online:2023-06-19
Contact: PANG Wei, E-mail: pangwei76@aliyun.com
Supported by:
Heilongjiang Applied Technology Research and Development Program(GA19C008);Heilongjiang Natural Science Foundation Joint Guidance Project(LH2022H092)

摘要/Abstract

摘要：

目的系统评价动作观察疗法(AOT)对脑瘫患儿上肢功能的作用。

方法检索PubMed、Embase、Cochrane Library、Web of Science和中国知网等数据库，检索建库至2022年7月9日公开发表的AOT对脑瘫患儿上肢功能作用的相关文献，并进行系统综述。

结果共纳入11篇文献，涉及497例患儿，发表时间集中于近10年，研究包括基于医院且有治疗师监督下开展的AOT和基于家庭且无治疗师监督下开展的AOT，主要评估对脑瘫患儿上肢功能的作用。试验组进行与日常生活活动相关的动作，对照组主要观看不包括动作的视频片段。每天15~120 min，每周3~5 d，干预周期大多为3~4周。AOT对于脑瘫患儿上肢功能的改善作用体现在身体结构与功能、活动和参与两个方面，体现为增加上肢握力、降低肌张力和提高手的灵活性和功能。

结论基于医院且有治疗师监督下开展的AOT对于脑瘫患儿的上肢功能有改善作用。基于家庭且无治疗师监督下开展的AOT对于脑瘫患儿上肢功能的改善作用以及AOT的长期效应需要进一步研究。

关键词: 脑性瘫痪, 动作观察疗法, 上肢, 系统综述

Abstract:

Objective To systematically evaluate the effect of action observation therapy (AOT) on upper limb function in children with cerebral palsy.

Methods Relevant literatures about the effect of AOT on upper limb function in children with cerebral palsy were retrieved from the databases of PubMed, Embase, Cochrane Library, Web of Science and CNKI, from the establishment to July 9, 2022.

Results Eleven articles involving 497 patients were included, which were mainly published in the past ten years. The studies included hospital-based studies with therapist supervision and home-based studies without therapist supervision, mainly related to the improvement of upper limb function of AOT in children with cerebral palsy. Experimental group performed actions related to activities of daily living, while control group mainly watched video clips excluding actions, 15 to 120 minutes a time, three to five times a week, with most of the intervention periods of three to four weeks. AOT improved the upper limb function of children with cerebral palsy in terms of body structure and function, and activity and participation, specifically grip strength, muscle tension, and hand dexterity and function.

Conclusion Hospital-based AOT with therapist supervision can improve upper limb function in children with cerebral palsy, while the effect of home-based AOT without therapist supervision and the long-term effect of AOT need to be further studied.

Key words: cerebral palsy, action observation therapy, upper limb, systematic review

中图分类号:

R742.3

蓝诗玲, 庞伟, 李鑫, 刘梦云, 战玉军. 动作观察疗法对脑性瘫痪患儿上肢功能作用的系统综述[J]. 《中国康复理论与实践》, 2023, 29(5): 558-564.

LAN Shiling, PANG Wei, LI Xin, LIU Mengyun, ZHAN Yujun. Effect of action observation therapy on upper limb function in cerebral palsy: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(5): 558-564.

图/表 3

图1

表1

表2

纳入文献基本特征"

纳入文献	研究类型	受试者类型	年龄 (E/C)	运动功能	n (E/C)	干预措施 (E/C)	干预时间	康复效果	评价指标
Buccino等^[10] (2018)	RCT	痉挛型偏瘫、痉挛型四肢瘫	5~11岁	MACS ≤ 4	11/7	RR+AOT/ RR+FOT	每天30 min，每周5 d，共3周	手功能改善	AHA； MUUL
Kirkpatrick等^[11](2016)	RCT	痉挛型偏瘫	5岁2个月/ 5岁4个月	手能主动抓握	35/35	AOT/FOT	每天15 min，每周5 d，共3个月	手功能未明显改善	AHA； MA2； ABILHAND-Kids
Quadrelli等^[12] (2019)	随机交叉实验	痉挛型	4~14岁	MACS ≤ 4	4/4	AOT+FOT/ FOT+AOT	每天18 min，每周3 d，共6周	上肢功能改善	AHA； MUUL
Simon-Martinez等^[13](2020)	RCT	痉挛型偏瘫	(9.6±1.1)岁/ (9.6±1.1)岁	HFCS ≥ 4； MACS ≤ 3	22/22	CIMT+AOT/ CIMT+FOT	每次1 h，共15次，在9 d内完成	手功能改善	AHA； MA2； JTHFT；握力； MAS; 9孔钉板测试
Buccino等^[14] (2012)	RCT	痉挛型偏瘫、痉挛型四肢瘫	7岁6个月/8岁	不清楚	8/7	AOT/FOT	每周3次，共3周	上肢运动功能改善	MUUL
Kim等^[15](2014)	RCT	痉挛型偏瘫、痉挛型双瘫、痉挛型四肢瘫	(9.1±2.4)岁/ (9.2±3.1)岁	上肢肌力不低于A+	8/8	AOT+RR/ RR+FOT	每天30 min，每周3 d，共4周	上肢功能改善	握力； MAS； BBT； ABILHAND-Kids； WeeFIM
Sgandurra等^[16](2013)	RCT	痉挛型偏瘫	(9.5±2.1)岁/(9.9±2.8)岁	HFCS:IV~VIII级	12/12	AOT/FOT	每天1 h，连续3周	上肢活动改善	AHA；MUUL； ABILHAND-Kids
Kim^[17](2020)	RCT	痉挛型偏瘫、痉挛型双瘫	(10.2±1.3)岁/ (9.4±1.3)岁	HFCS:IV~VIII级	5/5	AOT/AOT	每天30 min(C)/60 min(E)，每周3 d，共4周	握力和上肢功能改善	握力；QUEST；ABILHAND-Kids
魏亚敏等^[18](2018)	RCT	痉挛型偏瘫	(74.0±16.1)月/(80.7±15.9)月	GMFCS: I~II级；MACS ≤ 3	10/11	RR+AOT/ RR+FOT	每天20 min，每周5 d，共12周	上肢运动功能改善	握力； UEFT； WeeFIM
张晓东等^[19](2020)	RCT	痉挛型	(7.0±2.2)岁/(7.2±2.1)岁	MACS ≤ 3	46/45	RR+AOT/ RR	每天2 h，每周5 d，共1个月	上肢功能改善	UEFT； MAS
马樱等^[20](2020)	RCT	痉挛型	(5.0±0.8)岁/(5.0±0.9)岁	不清楚	90/90	RR+AOT/ RR+FOT	每天18 min，每周5 d，共12周	上肢精细运动功能改善	FMFM； MAS

表2

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纳入文献	资格标准	随机分配	分配隐藏	基线相识	被试施盲	评估者施盲	被试流失率≤15%	意向性分析	组间统计比较	报告点测量和变异量值	总分
Buccino等^[10](2018)	√	√		√	√	√	√	√	√	√	8
Kirkpatrick等^[11](2016)	√	√	√	√	√		√	√	√	√	8
Quadrelli等^[12](2019)	√	√	√	√	√	√	√	√	√	√	9
Simon-Martinez等^[13](2020)	√	√		√		√	√	√	√	√	7
Buccino等^[14](2012)	√	√		√	√	√	√	√	√	√	8
Kim等^[15](2014)	√	√		√			√	√	√	√	6
Sgandurra等^[16](2013)	√	√	√	√		√	√	√	√	√	8
Kim^[17](2020)	√	√		√		√	√	√	√	√	7
魏亚敏等^[18](2018)	√	√		√			√	√	√	√	6
张晓东等^[19](2020)	√	√		√			√	√	√	√	6
马樱等^[20](2020)	√	√		√			√	√	√	√	6

动作观察疗法对脑性瘫痪患儿上肢功能作用的系统综述

Effect of action observation therapy on upper limb function in cerebral palsy: a systematic review

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