接受選擇性背根神經切除術雙邊痙攣腦性麻痹兒童之物理治療：病例報告

近年來，選擇性背根神經切除術已普遍的運用於痙攣性腦性麻痺充童之治療上。本文將探討痙孿型腦性麻痺充童之動作障礙，痙攣對動作控制之影響及痙攣的處理，選擇性背根神經切除術之發展歷史及長期追蹤之結果。並以一位八歲患童做為病例報告，術前術後之評估包含：丹佛充童醫院選擇性背根神經切除術評估表、錄影、三分鐘步行距測試，步行機測試，術後分別在三個月、半年及一年評估。術後患童之肌肉張力下降，但選擇性控制及肌力不良，物理治療之重點在於誘發抗重力肌之去協同作用，各個肌肉獨立而終極角度之訓練以及耐力訓練。患童之動作控制品質有明顯進步，粗動作功能的最大進步是可維持跪姿，主動參與半跪姿；進一步研究之建議包含量化動作品質、平衡、步態之研究，並探討病患選擇及物理治療內容對結果之影響。

關鍵字

選擇性背根神經切除術；雙邊痙攣腦性麻痹；動作控制

並列摘要

Selective dorsal rhizotomy has become a therapeutic intervention for spastic children in recent years. This report will discuss motor disability of spastic children, the influence of spasticity on motor control, the management of spasticity, history of selective dorsal rhizotomy and long-term results. An eight-year-old spastic diplegia is reported. Preoperative and postoperative evaluation included a) evaluation form of selective dorsal rhizotomy from Denver Children Hospital, b) videotaping, c)three minutes walking test, d)treadmill test. The test was performed three months, half year and one year post-operatively. The subject showed decreased muscle tone but the selective control and muscle power was still poor after rhizotomy. Physical therapy emphasized on the facilitation of desynergic motion of antigravity muscle, isolated and terminal range strengthening in each individualized muscle and also the endurance training. The subject showed improvement in motor control. Major gross motor improvements were keeping kneeling position and participating half-kneeling position. Further study on qualitative motor control assessment, balance evaluation and gait analysis is needed. Further study on patient selection, physical therapy program and their impact on final result is suggested.

並列關鍵字

Selective dorsal rhizotomy ； Spastic diplegic cerebral palsy ； Motor control

國際替代計量

接受選擇性背根神經切除術雙邊痙攣腦性麻痹兒童之物理治療：病例報告

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