Effects Of Integrated Rehabilitation On Intelligence Structure Of Children With Cerebral Palsy

Objective:To analyze the effect of comprehensive rehabilitation (CR) on motor function in children with different intellectual level who suffered with cerebral palsy (CP), the effect on intelligence in children with different motor level and the effect of initial time of CR on intelligence of them. We attempt to reveal the effect of CR on intelligent structure of CP children and the influence of early therapy on CR effectiveness. Our work may be benefit for clinically guiding CP rehabilitation, providing reliable evidences for prognosis in CP children, helping the parents to improve long-term treatment adherence and form a concept of early treatment.Methods:Using case-control and self-control method, we enrolled CP children under our preset exclusion and inclusion criteria and evaluated them with the methods of Gross Motor Function Measure (GMFM), Fine Motor Function Measure (FMFM), Gesell development scale (GDS). All children accepted CR for 3 months, including physical therapy, occupational therapy, language therapy, hyperbaric oxygen, herb steaming, Chinese massage, meridian guide flat, muscle excited, and cerebral circulation or others. After three months therapy we evaluated them again using GMFM, FMFM and GDS, then compared the changes of these scales after treatment, respectively. We also observed the effect of CR treatment initial time on the therapeutic effectiveness.Results:1, After CR treatment, each ability areas and the total score of FMFM, GMFM, and DA were significantly improved than before (P<0.05). Although there was some improvement in DQ score, it was no statistical significance.2, As for different initial time of CR, the GMFM scales were significantly improved in 4.6～6 months of age group (4.6-6G) compared with 6～12 months of age group (6-12G) and 12～18 months of age group (12-18G) (P<0.05). The scales of FMFM, language area, social area and adaptive area were significantly higher in 4.6-6G and 6-12G than that of 12-18G and 18～22.3 months of age group (18-22.3G) (P<0.05).3, Comparison of motor function alleviation between different type of CP:spastic diplegia> spastic hemiplegia> spastic quadriplegia> dyskinetic> mixed type. The motor function improvement of spastic diplegia and spastic hemiplegia was significantly higher than dyskinetic and mixed type (P<0.05). DQ Improvement:spastic hemiplegia> spastic diplegia> spastic quadriplegia> dyskinetic> mixed type. Significant more increment in DQ scores of social area and adaptive area were found in spastic diplegia and spastic hemiplegia than those of dyskinetic and mixed type (P<0.05). DQ score of speech area was higher in spastic diplegia than that of other CP types, but no statistical difference was found.4, The improvement scores of GMFM and FMFM were significantly higher in CP children with mild or under-mild intelligence deficit than those of children with moderate, severe or very-severe deficit of intelligence (P<0.05).5, The DQ scores improvement of children with GMFCS-Ⅰ～Ⅱgrade of motor function in social area, language area and adaptive area were significantly higher than those of children with GMFCS-Ⅳ～Ⅴgrade (P<0.05).Conclusion:1, The gross motor function, fine motor function and development age of CP children can be significantly improved by CR. Unlike dyskinetic and mixed type, the spastic type of CP usually has the best effectiveness of CR.2, The higher intelligence and motor function level CP children has, the better therapeutic effect will be obtained.3, The earlier intial time of treatment, the better CR outcome will be acquired.