跳到主要內容

臺灣博碩士論文加值系統

(3.236.84.188) 您好!臺灣時間:2021/08/06 10:19
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:陳玉瑩
研究生(外文):Yu-Ying Chen
論文名稱:腦性麻痺兒童接受下肢多重軟組織鬆動術後的短期改變
論文名稱(外文):Short-term Changes in Children With Cerebral Palsy After Multiple Soft Tissue Releases in Lower Extremities
指導教授:劉文瑜劉文瑜引用關係
指導教授(外文):Wen-Yu Liu
學位類別:碩士
校院名稱:長庚大學
系所名稱:復健科學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
中文關鍵詞:腦性麻痺粗動作功能量測多重軟組織鬆動術
相關次數:
  • 被引用被引用:1
  • 點閱點閱:429
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
背景和目的:多重軟組織鬆動術(Multiple soft tissue releases, MSTR)是一種經常被應用於改善痙攣型腦性麻痺兒童肌肉骨骼功能及結構問題的骨科手術方式,過去的文獻討論其術後短期變化的相關研究有限。本研究目的探討腦性麻痺兒童接受下肢MSTR的短期改變。方法:以重複量測研究設計追蹤7名下肢接受MSTR的腦性麻痺兒童,並依據診斷、粗動作功能系統(Gross Motor Function Classification System,GMFCS) 層級及年齡徵召另外7名未接受MSTR腦性麻痺兒童配對成控制組。主要量測項目包含有被動關節活動度、痙攣程度、肌力、及粗動作功能量測(Gross Motor Function Measure, GMFM)、行走速度生理耗能指數(physiological cost index, PCI)。兩組的兒童每隔6週接受一次評估,共持續3個月。結果:接受過MSTR後6週肢體的痙攣程度及被動關節活動度呈現改善。接受MSTR的兒童6及12週的肌力及GMFM改變相較於控制組皆未達顯著差異。討論:本研究結果支持MSTR對於肌肉痙攣程度及被動關節活動度的短期改善效果,但兒童動作功能與肌力短期改變個體的差異大,因此建議未來探討MSTR後短期變化時,個體的差異及事件後介入將是值得重視的一環。
Background: Multiple soft tissue releases (MSTR) are common orthopedic procedures in children with spastic cerebral palsy (CP) to improve musculoskeletal function and structures. Previously, short term outcome studies of MSTR were limited. The purpose of this study was to explore the short-term changes in children with CP after MSTR. Method:A repeated measurement research design was used. Seven children with spastic type CP who underwent MSTR were recruited as the MSTR group. The additional seven subjects matched with diagnosis, Gross Motor Function Classification System (GMFCS) level and age of the MSTR group were recruited as the control group. PROM, spasticity, muscle strength, and Gross Motor Function Measure (GMFM) scores, walking velocity and physiological cost index (PCI) were assessed every 6 weeks for 3 months. Result: The significant improvments were noted on spasticity and PROM of the lower extremities after MSTR 6 weeks. No significant difference of muscle strength and GMFM scores was noted between children in the control group and the MSTR group in 6 weeks after MSTR, as well as 12 weeks. Discussion: The immediate positive effect on muscle spasticity and PROM of this study was similar with the previous findings. However, the variable changes of gross motor function and muscle strength among the children in both groups were noted. Therefore, the impact of individual differences and episode of care should be emphasized in further research.
論文指導教授推薦書
論文口試委員會審定書
授權書…………………………………………………………………… iii
誌謝……………………………………………………………………… vi
中文摘要………………………………………………………………… vi
英文摘要………………………………………………………………… vii
圖表目錄………………………………………………………………… xiv
第一章 簡介 ………………………………………………………… 1
1 .1 背景與動機……………………………………………………… 1
1 .2 研究問題及研究假設…………………………………………… 6
1 .3 研究的重要性…………………………………………………… 7
第二章 文獻回顧……………………………………………………… 9
2.1 簡介……………………………………………………………… 9
2.2 腦性麻痺兒童常接受的下肢多重軟組織鬆動術…………… 10
2.3 決定腦性麻痺兒童接受下肢多重軟組織鬆動術的常見原因…11
2.4 評量腦性麻痺兒童下肢多重軟組織鬆動術療效的方法………13
2.5下肢多重軟組織鬆動術對於腦性麻痺兒童的身體結構影響… 15
2.6下肢多重軟組織鬆動術對於腦性麻痺兒童的活動影響……… 22
2.7名詞定義………………………………………………………… 29
第三章 研究方法……………………………………………………… 34
3.1 受試兒童 ……………………………………………………… 34
3.2 測量工具與方法 ……………………………………………… 35
3.3 研究步驟 ……………………………………………………… 37
3.4 統計分析 ……………………………………………………… 38
第四章 結果 ………………………………………………………… 43
4.1 身體結構與功能面向上的改變……………………………… 43
4.2 活動面向上的改變…………………………………………… 46
4.3 其他相關因子………………………………………………… 47
第五章 討論…………………………………………………………… 59
第六章 結論…………………………………………………………… 72
參考文獻 ………………………………………………………………73
附錄一 痙攣程度之重測信度量測……………………………………83
附錄二 手握測力器之校正 ………………………………………… 86
附錄三 粗動作功能評量表之重測信度量測…………………………89
附錄四 生理耗能指數之重測信度量測………………………………91
附錄五 人體試驗委員會同意書 …………………………………… 94
附錄六 兒童個別下肢肌肉痙攣程度變化量測值 ………………… 95
附錄七 兒童個別下肢被動關節活動度變化 ……………………… 96
附錄八 所有兒童下肢肌力變化值……………………………………97
附錄九 兒童個別GMFM變化量測值………………………………98
1.Beals KR: Treatment of knee contracture in cerebral palsy by hamstring lengthening, posterior capsulotomy, and quadriceps mechanism shortening. Developmental Medicine & Child Neurology. 43(12):802-5, 2001.
2.Bohannon RW, Smith MB: Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Terapy 67:206-7, 1987.
3.Borton DC, Walker K, Pirpiris M, et al.: Isolated calf lengthening in cerebral palsy. Outcome analysis of risk factors.Journal of Bone & Joint Surgery – British Volume83(3):364-70, 2001
4.Cusick BD: Progressive Casting and Splinting for Lower Extremity deformities in Children with Neuromotor Dysfunction. Texas, Therapy Skill Builders, 1990.
5.Fixen J. Orthopaedic surgery of the hip in cerebral palsy .In: Bottos M, Scrutton D, Ferrari A, Neville BGR, editors. The Restored Infant. Jesolo: Fisioray Pub. Pozzolatico; 1993.
6.Karol LA.: Surgical management of the lower extremity in ambulatory children with cerebral palsy. Journal of the American Academy of Orthopaedic Surgeons. 12:196-203, 2004.
7.Mayers CA: Defining and assessing Quality of life. British Journal of Occupational Therapy. 58: 146-50, 1995.
8.Russell DJ, Rosenbaum PL, Avery L, Land M. Gross Motor Function Measure (GMFM-66 and GMFM-88) User's Manual. London: Mac Keith Press; 2002.
9.Abel M.F., Damiano D.L., Pannunzio M., et al.: Muscle-Tendon Surgery in Diplegic Cerebral Palsy: Functional and Mechanical Changes. Journal of Pediatric Orthopedics, 19(3):366-75, 1999.
10.Baddar A, Granata K, Damiano D, et al.: Ankle and knee coupling in patients with spastic diplegia: effects of gastrocnemius-soleus lengthening. Journal of Bone & Joint Surgery – American Volume. 84(5):736-44, 2002.
11.Bell KJ, Õunpuu S, Deluca PA, et al.: Natural progression of gait in children with cerebral palsy. Journal of Pediatric Orthopedics. 22: 677-82, 2002.
12.Blasier RD and White R: Duration of Immobilization After Percutanneous Sliding Heel-Cord Lengthening. Journal of Pediatric Orthopaedics. 18(3): 299-303, 1998.
13.Bleck EE. Orthopaedic Management in Cerebral Palsy. Philadelphia, J.B. Lippincott, 1987.
14.Bloom KK, Nazar GB: Functional assessment following selective posterior rhizotomy in spastic cerebral palsy. Child’s Nerve System. 10: 84-6, 1994.
15.Bohannon RW, Smith MB. Interrater reliability of a modified Ashworth Scale of muscle spasticity. Physical Therapy. 67:206-7, 1987.
16.Bottos M, Feliciangeli A, Sciuto L, et al.: Functional status of adults with cerebral palsy and implications for treatment of children. Developmental Medicine & Child Neurology. 43(8):516-28, 2001.
17.Bottos M: Ambulatory capacity in cerebral palsy: prognostic criteria and consequences for intervention. Developmental Medicine & Child Neurology. 45: 786–90, 2003.
18.Browne AO, McManus F: One-session surgery for bilateral correction of lower limb deformities in spastic diplegia. Journal of Pediatric Orthopedics. 7(3):259-61, 1987.
19.Buckon CE, Thomas SS, Piatt JH Jr, et al.: Selective dorsal rhizotomy versus orthopedic surgery: a multidimensional assessment of outcome efficacy. Archives of Physical Medicine & Rehabilitation. 85(3):457-65, 2004.
20.Butler P, Engelbrecht M, Major RE, et al.: Physiological cost index of walking for normal children and its use as an indicator of physical handicap. Developmental Medicine & Child Neurology. 26:607-12, 1984.
21.Carroll KL, Moore KR, Stevens PM: Orthopedic procedures after rhizotomy. Journal of Pediatric Orthopedics. 18(1):69-74, 1998
22.Chambers HG: Treatment of functional limitations at the knee in ambulatory children with cerebral palsy. European Journal of Neurology. 8 (Suppl 5):59-74, 2001.
23.Chang CH, Albarracin JP, Lipton GE, et al.: Long-term follow-up of surgery for equinovarus foot deformity in children with cerebral palsy. Journal of Pediatric Orthopedics. 22(6):792-9, 2002.
24.Cook RE, Schneider I, Hazlewood ME, Hillman SJ, Robb JE. Gait analysis alters decision-making in cerebral palsy. Journal of Pediatric Orthopedics. 23:292-5, 2003.
25.Damiano DL, Abel MF, Pannunzio M, et al.: Interrelationships of strength and gait before and after hamstrings lengthening. Journal of Pediatric Orthopedics, 19(3):352-8, 1999.
26.DeLuca P, Õunpuu S, Davis R, et al.: Effect of hamstring and psoas lengthening on pelvic tilt in patients with spastic diplegic cerebral palsy. Journal of Pediatric Orthopedics.18: 712-8, 1998.
27.DeLuca PA, Davis RB, Ounpuu SM, Rose S, Sirkin R. Alterations in surgical decision making in patients with cerebral palsy based on three-dimensional gait analysis. Journal of Pediatric Orthopedics. 17:608-14, 1997.
28.Enwemeka CS: Radiographic verification of knee goniometry. Scandinavian Journal of Rehabilitation Medicine. 18(2):47-9, 1986. 〈abstract〉
29.Gage JR, Perry J, Hicks RR, et al.: Rectus femoris transfer to improve knee function of children with cerebral palsy. Developmental Medicine & Child Neurology. 29:159-66, 1987.
30.Gajdosik CG, Cicirello N: Secondary conditions of the musculoskeletal system in adolescents and adults with cerebral palsy. Physical & Occupational Therapy in Pediatrics. 21(4): 49-67, 2001.
31.Gormley ME, Krach LE, Piccini L: Spasticity management in the child with spastic quadriplegia. European Journal of Neurology. 8(suppl. 5): 127-35, 2001.
32.Gough M, Eve LC, Robinson RO, et al.: Shot-term outcome of multilevel surgical intervention in spastic diplegic cerebral palsy compared with the natural history. Developmental Medicine & Child Neurology. 46:91-7, 2004.
33.Graham HK, Selber P. Musculoskeletal aspects of cerebral palsy. Journal of Bone & Joint Surgery – British Volume. 85:157-66, 2003.
34.Graham HK: Botulinum toxin type A management of spasticity in the context of orthopaedic surgery for children with spastic cerebral palsy. European Journal of Neurology. 8(suppl. 5): 30-9, 2001.
35.Granata KP, Abel MF, Damiano DL: Joint angular velocity in spastic gait and the influence of muscle-tendon lengthening. Journal of Bone & Joint Surgery – American Volume. 82(2):174-86, 2000.
36.Harryman SE: Lower-extremity surgery for children with cerebral palsy: physical therapy management. Physical Therapy. 72(1):16-24, 1992.
37.Ijzerman MJ, Nene AV: Feasibility of the physiological cost index as an outcome measure for the assessment of energy expenditure during walking. Archives of Physical Medicine & Rehabilitation. 85(3): 1777-82, 2002
38.Jane SA. Physical Therapy for the Child with Cerebral Palsy. In: Tecklin JS: Pediatric Physical Therapy. 3rd.Philadelphia, J.B. Lippincott, 1999.
39.Jensen GM, Gwyer J, Shepard KF, et al.: Expert practice in physical therapy. Physical Therapy. 80:28–43; 2000.
40.Katz K, Arbel N, Apter N, et al.: Early mobilization after sliding Achilles tendon lengthening in children with spastic cerebral palsy. Foot & Ankle International. 21(12): 1011-4, 2000.
41.Kay RM, Rethlefsen SA, Skaggs D, et al.: Outcome of Medial Versus Combined Medial and Lateral Hamstring Lengthening Surgery in Cerebral Palsy. Journal of Pediatric Orthopedics. 22:169–72, 2002.
42.Keenan M.E., Kozin S.H., Berlet A.C.: Manual of Orthopaedic Surgery for Spasticity. New York, Raven Press, 1993.
43.Koman LA, Smith BP, Shilt JS: Cerebral palsy. Lancet. 363(9421):1619-31, 2004.
44.Kondo I, Hosokawa K, Iwata M, et al.: Effectiveness of selective muscle-release surgery for children with cerebral palsy: longitudinal and stratified analysis. Developmental Medicine & Child Neurology. 46: 540–7, 2004.
45.Lindboe CF and Platou CS: Effect of immobilization of short duration on muscle fiber size. Clinical Physiology. 4:183-8, 1984.
46.Marty GR, Dias LS, Gaebler-Spira D: Selective posterior rhizotomy and soft-tissue procedures for the treatment of cerebral diplegia. Journal of Bone & Joint Surgery – American Volume. 77(5):713-8, 1995.
47.Miller F, Cardoso Dias R, Dabney KW, et al.: Soft-tissue release for spastic hip subluxation in cerebral palsy. Journal of Pediatric Orthopedics. 17(5):571-84, 1997.
48.Murphy KP, Molnar GE, Lankasky K: Medical and functional status of adults with cerebral palsy. Developmental Medicine & Child Neurology. 37: 1075–84, 1995.
49.Nene AV, Evans GA, Patrick JH: Simultaneous multiple operations for spastic diplegia. Outcome and functional assessment of walking in 18 patients. Journal of Bone & Joint Surgery – British Volume. 75(3):488-94, 1993.
50.Norkin CC, White DJ. Measurement of joint motion : a guide to goniometry. Philadelphia: F.A. Davis Company; 2003.
51.Novacheck T.F., Torst J.P., Schwartz M.H.: Intramuscular psoas lengthening improves dynamic hip function in children with cerebral palsy. Journal of Pediatric Orthopedics, 22(2): 158-64, 2002
52.Okawa A, Kajiura I, Hiroshima K: Physical therapeutic and surgery management in spastic diplegia: a Japanese experience. Clinical Orthopaedics and Related Research. 253: 38-44, 1990.
53.Olney SJ, Wright MJ. In Physical Therapy for Children. Edited by Campbell S.K. 2nd. Philadelphia: W.S. Saunders Company, 2000, pp. 533-70.
54.Oppenheim WL: Selective posterior rhizotomy for spastic cerebral palsy. Clinical Orthopaedics and Related Research.253: 20-9, 1990.
55.Palisano RJ, Hanna SE, Rosenbaum PL, et al.: Validation of a Model of Gross Motor Function for Children With Cerebral Palsy. Physical Therapy. 80:974-85, 2000.
56.Reimers J: Functional changes in the antagonists after lengthening the agonists in cerebral palsy: Ⅰ. Triceps Surae Lengthening. Clinical Orthopaedics and Related Research. 253: 30-34, 1990.
57.Reimers J: Functional changes in the antagonists after lengthening the agonists in cerebral palsy: Ⅱ. Quadriceps strength before and after distal hamstring lengthening. Clinical Orthopaedics and Related Research. 253: 35-7, 1990.
58.Rose J, Gamble JG, Lee J: The Energy Expenditure Index: A method to quantitate and compare walking energy expenditure for children and adolescents. Journal of Pediatric Orthopedics. 11(5):571-8, 1991.
59.Rose SA, DeLuca PA, Davis RB, et al.: Kinematic and kinetic evaluation of the ankle after lengthening of the gastrocnemius fascia in children with cerebral palsy. Journal of Pediatric Orthopedics.13: 727-32, 1993.
60.Russell DJ, Rosenbaum PL, Avery L, et al.: Gross Motor Function Measure (GMFM-66 and GMFM-88) User’s Manual. Including CD-ROM. London: Mac Keith Press; 2002.
61.Russell DJ, Rosenbaum PL, Cadman DT, et al.: The gross motor function measure: a means to evaluate the effects of physical therapy. Developmental Medicine & Child Neurology. 31(3):341-52, 1989.
62.Saraph V, Zwick E-B, Auner C, et al.: Gait improvement surgery in diplegic children. How long do the improvements last? J Pediatr Orthop 25:263–7,2005.
63.Saraph V, Zwick EB, Zwick G, et al.: Multilevel surgery in spastic diplegia: evaluation by physical examination and gait analysis in 25 childre. Journal of Pediatric Orthopedics. 22(2): 150-7, 2002.
64.Shapiro A, Susak Z, Malkin C, et al.: Preoperative and postoperative gait evaluation in cerebral palsy. Archives of Physical Medicine & Rehabilitation. 71(3): 236-40, 1990.
65.Shapiro BK. Cerebral palsy: A reconceptualization of the spectrum. Journal of Pediatrics. 145:S3-7, 2004.
66.Steinwender G, Saraph V, Zwick EB, et al.: fixed and dynamic equines in cerebral palsy: evaluation of ankle function after multilevel surgery. Journal of Pediatric Orthopaedics. 21(1):102-7,2001.
67.Sutherland DH, Zilberfarb JL, Kaufman KR, et al.: Psoas Release at the Pelvic Brim in Ambulatory Patients with Cerebral Palsy: Operative Technique and Functional Outcome. Journal of Pediatric Orthopaedics. 17:563-71,1997.
68.Turker RJ, Lee R: Adductor tenotomies in children with Quadriplegic cerebral palsy: longer term follow-up. Journal of Pediatric Orthopedics. 20(3):370-4, 2000.
69.Vitale MG, Levy DE, Moskowitz AJ, et al.: Capturing Quality of Life in Pediatric Orthopaedics: Two Recent Measures Compared. Journal of Pediatric Orthopedics, 21(5): 629-35, 2001.
70.Warner WC. Cerebral palsy. In: Canale ST editors. Campbell’s operative orthopaedics. Philadelphia: Mosby; 2003. p.1213-79.
71.Weigl D, Copeliovitch L, Itzchak Y , et al.: Sonographic healing stages of Achilles tendon after tenomuscular lengthening in children with cerebral palsy. . Journal of Pediatric Orthopedics. 21(6): 778-83, 2001.
72.World Health Organization: International Classification of Functioning, Disability and Health. Geneva, World Health Organization. 2001.
73.Yngve D.A., Scarborough N., Goode B., Haynes R.: Rectus and hamstring surgery in cerebral palsy: a gait analysis study of results by functional ambulation level. Journal of Pediatric Orthopedics, 22(5): 672-6, 2002.
74.周珮琪,陳玉瑩,劉文瑜等。兒童下肢肌肉骨骼系統測試之信度。2004年中華民國物理治療學會第四十九屆學術論文研討會(口頭報告)。
75.陳玉瑩,劉文瑜,張嘉獻等。腦性麻痺兒童接受下肢軟組織鬆動手術之文獻及病歷回顧。物理治療2005;30:139-47。
76.廖華芳、黃惠生、李素菁等。臺北市兩醫學機構腦性麻痺兒童復健相關資料之調查。臺灣醫學, 1(3):頁274-88,民86.05。
77.廖華芳:小兒物理治療學。禾楓出版社,民93。
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top