Study Of Early Limb Function Rehabilitation Care And Intervention In Children With Severe Brain Injury

Background:With the continuous social and economic development,brain injury due to all causes has become the most common cause of death and disability for children.According to statistics,craniocerebral injury accounts for about 15% ～ 20% of all injuries caused by accidents.Severe craniocerebral injury accounts for 13% ～ 20% of craniocerebral injury,and its disability rate ranks first among all injuries.Nearly 80% of the surviving children still had some degree of dysfunction 2 years later.Modern rehabilitation medicine believes that rehabilitation should be started at the same time as the patient is injured,and runs through the whole treatment and nursing activities.Studies show that human muscles and joints begin to atrophy and deform after 4 days of disuse,and the atrophy of limbs can not bear the gravity,which greatly affects the motor function.Children with severe head injury were injured early due to critical condition,coma time is long,the lack of independent movement,as well as the space limitation,can’t be hyperbaric oxygen,instruments,such as system rehabilitation,caused many functional exercise need to be at the end of the nerve surgery,or the patients after waking,missed the best time of rehabilitation intervention,cause many serious physical dysfunction.How to reduce the occurrence of muscle and joint atrophy and deformation in the early stage of limb function rehabilitation and improve the effect of rehabilitation treatment in the later stage is a problem of general concern to medical staff,family members and the society.Studies have shown that the speed of recovery from craniocerebral injury,especially severe craniocerebral injury,is closely related to early and timely effective functional training and rehabilitation nursing.However,there is still a lack of accurate data support for the safety and time of early intervention,which is difficult to provide effective reference for clinical practice.Especially for the special group of children,the specific measures and intervention time of limb function in the early stage of severe craniocerebral injury are still vague,and there is a lack of a complete set of intervention methods.In this context,this study intends to further explore this issue.Objective:By exploring factors affecting early limb dysfunction in children with severe traumatic brain injury,to further investigate the timing and methods of early limb function rehabilitation intervention,reduce sequelae in children,improve the quality of life and reduce the burden on their families and society.Methods:1.Retrospective investigation method: The medical data of children with severe brain injury admitted to and treated at the Department of Neurosurgery in a Grade 3 Class A children’s hospital in Chongqing from January 1,2012 to December 31,2014 were reviewed to analyze the main factors affecting the limb motor function in these children in the first stage.2.Retrospective clinical controlled study: The second stage was a retrospective controlled study.Children with severe brain injury admitted to and treated at the department from March 1,2015 to January 31,2016 were selected as the experimental group,.and data from children in the phase 1 were used as control group.The control group was given traditional treatment and care,while on this basis,the experimental group additionally received early Bobath limb function training.The duration of disturbance of consciousness and muscle strength status were compared between the two groups of children,and the effectiveness,safety and intervention time of early Bobath limb function training were investigated.3.Statistical analysis software SPSS25.0 was employed.Data were described using mean ± standard deviation,frequency,percentage and median.T test and analysis of variance were used for measurement data conforming to normal distribution,rank sum test of two independent samples was used for measurement data not conforming to normal distribution,and chi-square test was used for disordered classification variables.P<0.05 would indicate a statistically significant difference.Factors affecting limb function in children with severe traumatic brain injury were analyzed,and the effect of early limb function rehabilitation measures,intervention time and safety were investigated.Results:1.Retrospective analysis: The medical records of totally 75 patients were included(2 cases were lost to follow-up 3 months after departure from the department).The results showed that the limb functions were all abnormal at four time points,namely at admission(when injured),time of consciousness recovery,time of departure from the department and 3months after departure from the department,and the abnormality rates were74.7%,46.7%,28% and 16%,respectively;the average time to consciousness recovery was 12.43 ± 6.05 days,with the shortest of 1 day and the longest of 67 days;the average time to start receiving rehabilitation was(30.12 ± 2.16)days after injury,with the earliest of 11 days and the latest of 72 days;The long duration of consciousness disturbance and late rehabilitation intervention are correlated with abnormal muscle strength in children(P <0.05).2.Retrospective clinical controlled study: The experimental group included 26 children and the control group 75 children(by reviewing their medical records).The results showed that the duration of disturbance of consciousness in the experimental group was(9.50 ± 5.27 days),significantly shorter than(12.43 ± 6.05 days)in the control group(P<0.05);the differences in the duration of disturbance of consciousness and muscle strength in children in the control group were statistically significant(P<0.05),and the two were negatively correlated,while the differences in the experimental group were not statistically significant(P> 0.05).In the experimental group,the muscle strength was Grade 5(1-5)at the time of consciousness recovery,Grade 5(1-5)at the time of departure from the department and Grade 5(4-5)3 months after departure from the department;their muscle strengths were significantly better than Grad3 4(0-5)at the time of consciousness recovery,Grade 5(0-5)at the time of departure from the department and Grade 5(3-5)3 months after departure from the department in the control group(P <0.05).Conclusion: Early use of Bobath limb function training can effectively shorten the duration of consciousness disorders in children with this type of disorders,and promote the maintenance and recovery of limb muscle strength.Conclusion:1.There is a high incidence of limb dysfunction in children with severe traumatic brain injury.2.There is a correlation between long-term consciousness disturbance and late rehabilitation intervention time and limb motor dysfunction in children with severe craniocerebral injury.3.Under the premise of ensuring safety,Bobath limb function rehabilitation training initiated 72 hours after injury in such children can effectively shorten the duration of disturbance of consciousness,and improve their limb function status.