Vojta and Bobath combined treatment for high risk infants with brain damage at early period

摘要

BACKGROUND: In the process of early screening and interventions to high risk infants with brain damage, the occasion and choosing methods of interventions and the combined application of different interventions are still at the exploratory phase. OBJECTIVE: To observe the efficacy of early intervention using Vojta and Bobath combined treatment in high risk infants with brain damage, and investigate the effect of early rehabilitation on the prognosis. DESIGN: A randomized controlled comparative observation. SETTING: Daqing Oil Field General Hospital of Heilongjiang Province. PARTICIPANTS: Eighty-four high risk infants younger than 1 year were selected from the Department of Pediatrics, Daqing Oil Field General Hospital of Heilongjiang Province from October 2005 to October 2006, including 52 boys (62%) and 32 girls (38%). The treatment started at the age of 0–3 months in 11 cases (13%), 4–6 months in 28 cases (33%), 7–9 months in 35 cases (42%), and 10–12 months in 10 cases (12%). Infants with at least two of the followings were enrolled, including 7 Vojta abnormal postural reflexes, slow or disorder of motor development, increase of muscular tension, postural abnormality, primary reflection residual and CT/MRI abnormalities. Informed consents were obtained from their guardians. The 84 infants were randomly divided into treatment group (n =42) and control group (n =42). METHODS: All the children were intravenously injected with cerebroprotein hydrolysate injection or cattle encephalon glycoside and ignotin injection, 10 times as a course for 2–5 courses; Besides, the infants in the treatment group also received early rehabilitative training of Vojta and Bobath combined treatment, once a day, 40 minutes per time, 5 times a week followed by a 2-day rest, 1 month as a course, and totally 2–5 courses. The Vojta method was to facilitate the automatic regulation by reflexlocomotion. Bobath method was to inhibit abnormal posture but facilitate the normal one, thus it is also called neurodevelopmental therapy realized by reflex inhibition and facilitation. The rehabilitation was evaluated clinically using Gesell Development Schedules (GDS) after the courses when the infants were 1 year old. GDS included five aspects of adaptive behavior, gross motor, refine motor, speech, individual-social behavior. The developmental quotient (DQ) could be calculated according to their development. DQ=developmental age/actual age×100, < 85 points was taken as abnormal; The higher the DQ value, the better the development. ② Evaluation of efficacy: Cured: Developmental order reached normal or generally normal, abnormal posture disappeared, muscular tension ameliorated, symmetric limbs' motor function, free movement, normal intelligence, powerful reaction, and clear speech. Significant effect: Developmental order tended to normal, abnormal posture disappeared incompletely, muscular tension ameliorated incompletely, transient pause in the flexion and extension of limbs, good reaction, and improved intelligence. Effective: Developmental order improved to a certain degree, muscular tension ameliorated, limbs' motor function and posture improved as compared with before treatment, but still under control, intelligence improved a little. Invalid: No obvious changes before and after treatment. Total significant effective rate=(cured cases+cases of significant effect)/total cases ×100%. ③ The enumeration data and measurement data were compared with chi-square test and t test respectively. MAIN OUTCOME MEASURES: Clinical efficacy and GDS results at 1 year old in both groups. RESUTLS: All the 84 infants were involved in the analysis of results. ① Efficacy: The total significant effective rate in the treatment group was higher than that in the control group (93%, 74%, χ2=4.2, P < 0.05). ② Results of GDS evaluation: The DQ values of individual intercourse and social adaptation in the treatment group (93.57±11.23, 95.13±9.32) were higher than those in the control group (88.27±10.18, 90.10±10.67, t =2.267, 2.301, P < 0.05); The DQ values of gross motor, fine motor and speech in the treatment group (90.78±10.20, 98.63±9.23, 93.69±11.31) were higher than those in the control group(84.32±11.33, 87.80±8.61, 85.52±10.61, t =2.746, 5.560, 2.746, P < 0.01). The interventional effects on each functional area were significant, especially the gross motor, fine motor and speech. CONCLUSION: The Vojta and Bobath combined treatment on the basis of drug therapy can improve the general developments of abilities in motor, intelligence, social intercourse, social adaptation and speech of high risk infants with brain damage, also can improve the curative efficacy.