《中国康复理论与实践》

《中国康复理论与实践》 ›› 2023, Vol. 29 ›› Issue (1): 55-63.doi: 10.3969/j.issn.1006-9771.2023.01.008

• 循证研究 • 上一篇    下一篇

脑性瘫痪儿童青少年全身振动干预的健康和功能结局：基于WHO-FICs的系统综述

王筠婷, 宋贝贝, 赵迪, 柏开祥()   

  1. 武汉体育学院运动医学院，湖北武汉市 430079
  • 收稿日期:2022-12-29 修回日期:2022-12-30 出版日期:2023-01-25 发布日期:2023-02-17
  • 通讯作者: 柏开祥(1967-)，男，汉族，湖北钟祥市人，博士，教授，主要研究方向：特殊儿童青少年体育与健康、运动促进、ICF、康复生物力学，E-mail： 347973428@qq.com。
  • 作者简介:王筠婷(1997-)，女，汉族，山东烟台市人，硕士研究生，主要研究方向：特殊儿童、ICF、康复科学。
  • 基金资助:
    1.科技部重点计划项目(2018YFF0300400);2.教育部中国教育学会重点专项课题(16TY1713011ZA)

Health and functional outcome of whole body vibration for children and adolescents with cerebral palsy: a systematic review using WHO-FICs

WANG Yunting, SONG Beibei, ZHAO Di, BAI Kaixiang()   

  1. School of Sports Medicine, Wuhan Sports University, Wuhan, Hubei 430079, China
  • Received:2022-12-29 Revised:2022-12-30 Published:2023-01-25 Online:2023-02-17
  • Contact: BAI Kaixiang, E-mail: 347973428@qq.com
  • Supported by:
    Chinese Academy of Education Key Special Project(2018YFF0300400);Ministry of Science and Technology Key Program(16TY1713011ZA)

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摘要：

目的 基于世界卫生组织国际分类家族(WHO-FICs)的理论与方法，构建脑瘫儿童青少年全身振动训练的健康和功能结局研究架构，系统综述脑瘫儿童青少年的主要健康状况和身体功能、全身振动训练的干预方案以及振动干预的健康和功能结局。

方法 基于WHO-FICs方法，构建系统综述的PICO架构，检索中国知网、万方、PubMed、Web of Science、EBSCO、Embase等数据库，收集建库至2022年9月30日关于全身振动训练对脑瘫儿童青少年健康状况与功能效果的随机对照试验，进行系统综述。

结果 最终纳入文献8篇，其中英文7篇，中文1篇，分别来自5个国家，主要来源于临床康复、神经康复、物理医学与康复等相关领域期刊，发表时间集中在2010年以后，涉及227例参与者(3~12.3岁)。纳入文献物理治疗证据数据库量表评分平均6分。诊断ICD-11编码涉及08神经系统疾病、8D20痉挛型脑瘫、8D20.1痉挛型双侧脑瘫、8D20.10痉挛型四肢瘫脑瘫、8D2Z未特指的脑瘫。主要功能障碍在身体功能方面表现为肌肉痉挛、骨骼发育异常、关节畸形和肌肉无力，选择性运动控制下降以及步态异常；在活动和参与方面表现为行走障碍、活动能力和负重能力下降、身体活动水平较低。主要干预方式为全身振动训练，体位包括卧位、蹲位或站立位，以站立位为主；振动模式以垂直振动为主。频率5~30 Hz，振幅≤ 9 mm；每周3~5次，持续8周~6个月；干预场所包括医疗机构、学校和家庭；干预属性为治疗性康复和恢复性康复。全身振动训练对脑瘫的健康效益体现在s7与运动有关结构、b710关节活动功能、b730肌肉力量功能、b735肌张力功能、b760随意运动控制、d410改变身体的基本姿势、d415保持一种身体姿势、d450步行、d455到处移动、d420移动自身，如改善神经肌肉骨骼和关节功能，缓解肌肉痉挛，提高静态平衡能力，增强肌肉力量，提高运动控制能力，提高身体姿势的控制和行走能力，扩大活动范围，提升患者自理能力。

结论 全身振动训练是治疗脑瘫有效的干预方式。治疗体位主要为站立位，频率5~30 Hz，振幅≤ 9 mm；每周3~5次，持续8周~6个月。干预结局主要体现在改善身体运动功能、提高活动和参与水平两个方面。

关键词: 脑性瘫痪, 全身振动训练, 儿童, 青少年, 康复, 系统综述

Abstract:

Objective To construct a research framework for systematic review of health and functional outcomes of whole body vibration training in children and adolescents with cerebral palsy based on the theory and method of World Health Organization Family of International Health Classifications (WHO-FICs), and to systematically review the major health conditions and physical functions, intervention programs of whole body vibration training, and health and functional outcomes of vibration intervention in children and adolescents with cerebral palsy.

Methods Based on the WHO-FICs method, the PICO architecture of systematic reviews was constructed, and the databases of CNKI, Wanfang Data, PubMed, Web of Science, EBSCO, and Embase were searched to collect randomized controlled trials about the health and functional effects of whole body vibration training on children and adolescents with cerebral palsy from the establishment to September 30th, 2022, and a systematic review was conducted.

Results Eight articles, seven in English and one in Chinese, from five countries, were included, mainly from journals in clinical rehabilitation, neurorehabilitation, physical medicine and rehabilitation, etc., published mainly after 2010, involving 227 participants (three to 12.3 years old). The quality of the articles was evaluated using the Physical Therapy Evidence Database scale with a mean score of six. The ICD-11 codes included 08 diseases of the nervous system, 8D20 spastic cerebral palsy, 8D20.1 spastic bilateral cerebral palsy, 8D20.10 spastic quadriplegia cerebral palsy and 8D2Z unspecified cerebral palsy. The primary functioning of cerebral palsy was characterized as muscle spasticity, abnormal skeletal development, joint deformities and muscle weakness, decrease of selective motor control and gait abnormalities; for the activity and participation, the functioning included walking difficulties, decrease of mobility and weight loading, and low levels of physical activities. The main intervention was whole body vibration, in postures of lying, squatting or standing, mainly standing, in the mode of vertical vibration. The frequency was 5 to 30 Hz, and the amplitude was below 9 mm, three to five times a week for eight weeks to six months. The intervention settings include medical institutions, schools and families; mainly for therapeutics and recovery. The health and health-related outcomes were mainly involved s7 structures related to movement, b710 mobility of joint functions, b730 muscle power functions, b735 muscle tone functions, b760 control of voluntary movement functions, d410 changing basic body position, d415 maintaining a body position, d450 walking, d455 moving around, and d420 transferring oneself; such as improvements of neuromusculoskeletal and joint functions, muscle spasm, static balance, muscle strength, and control of movement, the control of body posture and walking, range of activities and self-care.

Conclusion Whole body vibration training is effective on cerebral palsy, mainly in standing position, 5 to 30 Hz, and amplitude below 9 mm; three to five times a week for eight weeks to six months. The outcomes of whole body vibration training are mainly reflected in the improvement of body-motor functions, and activity and participation.

Key words: cerebral palsy, whole body vibration training, children, adolescents, rehabilitation, systematic review

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