| Objective: To explore the efficacy of goals-activity-motor enrichment（GAME）therapy combined with posture control in the rehabilitation of motor function in children with severe cerebral palsy（CP）,and to provide clinical evidence for motor rehabilitation in treating severe CP.Methods: This study conducted a prospective cohort studies.Ninety-two children aged2-10 years diagnosed with severe CP and admitted to the Pediatric Neurological Rehabilitation Center of the First Affiliated Hospital of Anhui Medical University from January 2019 to January 2021 were included,all of whom met the diagnostic criteria and classification criteria of the 2015 Chinese Cerebral Palsy Rehabilitation Guidelines.The children were randomly divided into two groups: 46 cases in the control group and46 cases in the study group.Both groups received comprehensive rehabilitation training for 12 months.Bobath therapy was used as the main neurodevelopmental therapy for exercise in the control group,and GAME therapy combined with posture control was used in the study group.The supine/prone position（zone A）and sitting position（zone B）of GMFM-88,visual tracking（zone A）and upper limb joint movement（zone B）of FMFM,sitting ability assessment（LSS）,pain assessment（FLACC）and activity of daily living scale（ADL）were evaluated before treatment,6 months after treatment and 12 months after treatment.SPSS13.0 software was used to analyze the obtained data.Results:1.Gross motor : Scores in zone A of GMFM-88 were higher in the study group than in the control group after 6 months of treatment（t =-2.229,p<0.05）;the difference between the study group and the control group before and after treatment（t=-4.35,p<0.01）was also significant.In GMFM-88,there was significant difference in efficacy between the study group and the control group in zone B score（t=-4.683,p<0.01）.After 12 months of treatment,the scores of GMFM-88 in zone A（t=-5.128,p<0.01）and zone B（t=-3.29,p<0.01）were significantly higher than those in the control group.2.Fine motor: The difference of the pre-and post-treatment in FMFM-zone A（t =-5.036,P<0.01）and zone B（t=-4.066,p<0.01）was significant after 6 months of treatment between the study group and the control group.After 12 months of treatment,the scores in zone A（t=-3.743,p<0.01）and zone B（t=-2.421,p<0.05）of FMFM in the study group were significantly higher than those in the control group,with statistical significance.3.Sitting ability: There was significant difference in LSS score between the study group and the control group after 6 months of treatment（t =-4.573,p<0.01）;LSS score after 12 months of treatment in the study group was significantly higher than control group in LSS（t = 6.489,p<0.01）difference has significant meaning.4.Pain assessment: There was significant difference in FLACC score between the study group and the control group after 6-months treatment（t= 2.667,p<0.01）.The FLACC score of the study group was significantly lower than that of the control group（t= 6.192,p<0.01）after 12 months of treatment,indicating a significant difference.5.Activities of Daily Living ability: The ADL score of the study group was significantly higher than that of the control group after 6 months of treatment（t =-2.652,p<0.01）and after 12 months of treatment（t=-2.213,p<0.05）,the difference was statistically significant.Conclusions:1.Goals-activity-motor enrichment therapy combined with postural control training can improve gross motor function and fine motor function in children with severe cerebral palsy.2.Goals-activity-motor enrichment therapy combined with posture control training can improve the sitting ability and selective posture control ability of children with severe cerebral palsy.3.Goals-activity-motor enrichment therapy combined with posture control training is beneficial to relieve pain and improve the ability of daily living activities of children with severe cerebral palsy,and to help children adapt to and participate in family and social environment. |
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