【讨论】脑瘫的诊断标准

qianxuguang wrote:就脑瘫的定义和大家做一讨论：　　按1988年全国小儿脑瘫座谈会制定的标准，脑性瘫痪是出生前至出生后28天内发育时期非进行性脑损伤所致的综合征。主要表现为中枢性运动障碍及姿势异常。并符合以下几条，即可诊断：1、婴儿期出现的中枢性瘫痪。2、可伴有智力低下、惊厥、行为异常、感觉障碍及其它异常。3、需除外进行性疾病所致的中枢瘫痪及正常儿一过性运动发育落后。　　其实，脑瘫概念中的大部分内容，国内和国外还是比较统一的，但是时间的限定出入很大。众所周知，脑的发育一直持续到幼儿期都是相对高速的，出生后28天是一个时间截止点，那29天、30天出现的脑损伤呢？　　从1989年到现在，脑瘫的诊断标准已沿用15年了，合理的不合理的都已呈现在了大家面前，很快在昆明将召开脑瘫的会议，是否能有新的更合理的标准就要看专家们的意见了，希望大家积极讨论，也希望意见能让制定标准的前辈们采纳、借鉴。欢迎大家积极参与！脑性瘫痪的诊断主要依靠病史及体格检查、脑电图、CT及MRI等。 　　CT及MRI能了解颅脑结构有无异常,对探讨脑性瘫痪的病因及判断预后可能有所帮助,但不能据此肯定或否定诊断,脑电图可以了解是否合并癫瘸,对治疗有参考价值。诊断脑性瘫痪应符合以下几个条件： 1、婴儿期出现的中枢性瘫痪。2、可伴有智力低下、惊厥、行为异常、感觉障碍及其它异常。3、需除外进行性疾病所致的中枢瘫痪及正常儿一过性运动发育落后。4、致病因素发生在母妊娠时,围产期或新生儿时期脑性瘫痪因其类型，受损部位不同而其临床表现多种多样，即使是同一个人处于不同年龄阶段而表现各异。对患者进行系统的康复评估是了解患者目前存在问题的主要手段，为康复治疗计划的制定打下了科学基础。也为治疗目标的拟订与修正提供了依据。因此，对患者进行康复治疗以前必须对各项功能进行评估。评估方法各家不一。下面根据患者常见存在问题，介绍一种评估方法，供大家考虑。 诊断：出生前，出生过程中或出生后有CP等危险因素的（如缺氧，早产，窒息等）存在，出现了不正常的运动模式及姿势及时常伴有言语，感知，智力等障碍排除其它疾病所致的中枢性瘫痪及一时性运动发育滞后。即可作初步诊断，影像学等辅助检查时探索病因。判断预后可能有一定的参考价值，但不能作为诊断的依据。 分型 （一） 痉挛型 早常见，全身肌张力明显增高，原始反对持续存在，全身“僵硬”主要病变在锥体束 （二） 手足徐动型 ：主要表现为肌张力变化不定，有不随意运动，病理反对一般为阴性，病变在基底核 （三） 共济失调型：少见，主要表现为平衡，协调性差，意向震撼，主要病变在小脑 （四） 弛缓型：以肌张力低下为主 （五） 混合型：以上任何二型或二型以上的症状混合出现。按瘫痪部位可分为：单瘫，双瘫， 截瘫，三肢瘫，四肢瘫。以四肢瘫和双瘫为多见。 功能障碍的评定： 一.体格发育障碍的评定 通过对患儿体格发育的评定可以看出患儿比同年龄小儿发育差别的程度和发育滞后的时间，明确是否有畸形，挛缩等情况。 小儿体重估计： 出生前半年 体重（KG）=出生体重+月龄*0.7 出生后半年 体重（KG）=出生体重+6*0.7+(月龄-6)*0.5 2岁以上 体重（KG）=年龄*2+8 其个体差异不应超过平均数+/-10%。二．运动功能障碍的评定 1． 运动发育障碍的评定 正常小儿的运动和姿势发育有一定时间和顺序如2-3个月时卧位能抬头，4-5个月能主动伸手触物两手各握一玩具。6-7个月能单手或两手支撑坐起。8-10个月能爬。1岁能独自站立，1岁-1岁半能独走。2岁会跑。3岁 会骑三轮车。4岁能爬梯子。脑性瘫痪者在以上年龄阶段，一般达不到正常小儿或表现为主动活动减少。 2． 肌张力及关节活动度的评定 人体肌肉和肌群一直存在着持续的肌张力活动。正常情况下，肌张力的变化是有限度的，否则人体就丧失了运动的可能性。脑瘫者肌张力机制受到损伤。学儿由于反应过激或过迟而表现出肌张力过高或过低的状态。这便决定了对患儿肌张力评估的重要性。 肌张力的异常又对关节活动度发生影响。肌张力增高时，对关节活动产生较大的抵抗感。肢体摆动幅度小，关节伸屈受限，反之，肌张力降低时，活动关节无抵抗等，肢体摆动幅度大，关节屈伸过度，此外，可通过以下关节活动度，间接了解肌张力的情况。 小儿取仰卧位，头和身体居中 A． 内收角：患者两下肢伸直，外展至最大限度，两大腿间的夹角 B． 月国 窝角：将小儿一侧下肢拉直，抬高，屈髋关节，大腿与小腿在间的夹角． 足背屈角：尽量被动背曲踝关节，足背与小腿间的角度 D． 足跟耳试验：牵拉患儿一侧足使尽可能向同侧耳部靠拢，足跟与臀部连线与桌面形成的角度 。正常小孩的关节活动度 关节活动度 内收角 月国窝角 足背屈角 1—3月 40-80 80-100 60-70 4—6月 70-110 90-120 60-70 7—9月 100-140 110-160 60-70 10—12月 130-150 150-170 60-70 3． 协调功能与精细动作的评定 通过对患儿协调功能及精细动作的评定可了解四肢的共济活动，协调能力及手指基本功能状况。较常用有以下几种方法： A． 指一鼻试验：小儿在任何体位将臂伸直再用食指触鼻尖。有共济失调时难以准确完成 B． 对指试验：任何体位患者用拇指与其余指依次对指，有共济失调时难以准确完成 C． 轮臂动作：快速，反复作前臂的旋前，旋后动作，有共济失调时难以准确完成 4． 原始反射与自动反应的评定 这一评定非常重要，通过检查可判断神经发育与动作发育水平，是指导训练的依据 A． 原始反射评定 a. 紧张性迷路反射：头取正中位，上，下肢伸展，仰卧位时头后仰，全身伸肌张力增高，呈“伸展模式”，俯卧位时头前曲，四肢屈曲，全身屈肌张力增高呈“屈曲模式”则为阳性，3-4月消失。持续阳性可阻碍小儿正常的运动发育 b. 紧张性颈反射（TNR） ⑴ ATNR：仰卧，头居中，四肢伸直，将小儿头转向一侧。阳性表现为面朝向侧肢体伸展，枕向侧屈曲。3-4月消失 ⑵ STNR：俯卧，头颈尽量前屈和背伸，前屈时上肢屈曲，下肢伸展，背伸时上肢伸展，下肢屈曲则为阳阴性。5个月左右转阴。 若TNR持续存在则可影响小儿四肢运动发育，平衡能力及抬头。 c. 握持反射：刺激患儿手掌侧，引起小儿手指迅速屈曲，紧握，该反射2-3个月消失 。d. 交叉伸展反射：仰卧，头居中，让一侧下肢屈曲，后伸展，阳性表现为另一侧下肢则与之相反，该反射1-2个月消失 。B． 自动反应评定 自动反应评定包括翻正反应，平衡反应及保护性伸展反应 翻正反应又称调正反应是小儿头和身体位置在空间发生变化时，小儿头颈，躯干和肢体立即恢复到正常姿势和体位的反应，它包括颈旋转翻正反应，迷路，立直反应及躯干翻正反应等 平衡反应包括倾斜反应，坐位反应，立位平衡反应。可通过FUGL—MEYER 评定法了解患者的平衡反应能力 保持性反应：抱住小儿腋下，使他向高处向下接近桌面，小儿出现双上肢支撑床面反应，该反应于6个月出现。 5. 肌力评定 对不同年龄阶段的患者,肌力评定的要求不尽相同,发育前期,患者主动运动较少,对其进行肌力评定,其治疗意义不大,但当患者会坐爬,甚至会站,走路对其进行肌力评定有重要的实用价值.6. 步态分析 对有行走能力但异常步态者必须进行步态分析,通过步态分析的揭示异常的性质和程度为进行行走功能评估和矫正提供必要的依据. 脑瘫病人的异常步态最常见有由于痉挛引起的剪刀步态,垂足(划圈)步态,及各种肌无力步态如臂中肌,臂大肌步态等 三. 特殊感觉障碍的评定 1. 视觉障碍的评定 可以粗略的检查是否有斜视,弱视,散光 视神经萎缩等 2. 听觉障碍的评定 可利用视听反射了解患者听觉,听力等是否有问题. 3.触觉障碍的评定 可触摸患者身体某些部位如口唇 手掌等以了解患者反应是否过敏或迟钝 四. 言语功能评定 CP患者的言语功能障碍有1.发音障碍;患者头部变化多,有些不能控制呼吸,出现发声困难;2.共鸣障碍,多由于发音器官痉挛及言语中枢受损引起;3.语言发音迟缓,主要为智力迟缓所致 五. 智力评估 CP者有些智力正常,其中有些是高智能儿,对有些不正常者可以从以下几方面着手,进行智力测验,个人既往史,作业评定,现场观察,家长或老师介绍情况等. 六. ADL评估(可参见下表) A: 独立完成 B: 少量帮助 C: 大量帮助 D: 完全帮助 E: 能 F: 部分能 G: 不能 疗效评估 疗效评估可利用上表进行，方法如下： 根据学儿障碍和困难，在上表各项中确定应训练项目，对其进行，初，中，末期评估记分。训练效果=末期估分—初期估分 *100% 初期估分 显效：训练效果 大于15% 有效：训练效果 大于1%-14% 无效：训练效果无提高。脑瘫的诊断标准 脑性瘫痪是出生前到生后一个月内各种原因所致的非进行性脑损伤。主要表现为中枢性运动障碍和姿势异常。根据临床特点可分为以下几种类型： 1）痉挛型：约占脑性瘫痪的2/3，是最常见的一种类型，病变波及椎体束系统。主要表现为肌张力增高，腱反射亢进，2岁后babinski症仍为阳性。 2）手足徐动型：约占脑性瘫痪的1/5，主要病变在椎体外系统。表现为难以用意志控制的不自主运动，紧张时或有意识运动时，不自主运动增多。由于颜面肌肉、舌肌、发音器官肌肉运动多有受累，故常伴有语言障碍。单纯手足徐动型患儿腱反射不亢进，babinski症不表现阳性。 3）强直型：本型较少见，主要表现为椎体外系受损症状，肌张力呈铅管状或齿轮状增高，腱反射不亢进。 4）共济失调型：表现为小脑症状，眼球震颤，上肢辨距不良，步态不稳、摇晃。 5）震颤型：此型很少见，表现为四肢震颤，多为静止震颤。 6）肌张力低下型：表现为肌张力低下，但膝反射可引出或亢进。 7）混合型：以上某几种类型同时存在。最常见为痉挛型和手足徐动型同时存在于同一患儿。 其他症状：严重病例可出现下列并发症。 1）癫痫：约25%-30%的患儿出现各种类型的癫痫发作，当并发感染时，抽搐更为频繁。 2）智能迟缓：约有25%-75%的患儿又有不同程度的智能迟缓，尤以混合型脑瘫多见，依次为痉挛型、运动迟缓型及共济失调型。在痉挛型中以四肢瘫痪者智能障碍尤为严重。 3）其他：与额叶、颞叶、顶叶或枕叶有损害时可出现视觉、听觉功能障碍、攻击性行为及失语等。当网状结构有病变时可出现注意力不集中、动作过多等。我的老板对脑瘫诊断有自己的见解发与大家共勉。脑性瘫痪多发生于婴幼儿，系一临床综合征。从临床症状角度主要考虑三大症状：1、运动发育迟缓2、智能发育迟缓3、癫痫发作具有上述两大症状，同时排除其他神经系统变性疾病等进行性发展的疾病，首先考虑诊断脑性瘫痪。发几篇国外学者、专家对脑瘫诊断的方法、意见及其理解，与各位同仁共勉。文章1Cerebral Palsy Diagnosis Typically, doctors diagnose cerebral palsy in infants by testing their motor skills and thoroughly analyzing their medical history. A medical history, diagnostic tests, and regular check-ups may be required to confirm the diagnosis of CP or to eliminate the possibility of other disorders. Unnaturally soft, relaxed, or floppy muscle tone is called hypotonia; muscle tone that is stiff or rigid is called hypertonia. Some infants with CP have hypotonia in the first 2 or 3 months of life and then develop hypertonia. They also might develop an unusual posture or favor one side of the body. A newborn held on its back and tilted so its legs are above its head will automatically respond with the Moro reflex, extending its arms in a gesture that resembles an embrace. This reflex usually disappears after about 6 months. Infants with cerebral palsy often retain it for an abnormally long period. Signs of hand preference are also observed. When an object is held in front and to the side, infants usually do not display a tendency to use either the right or left hand. This is normal during the first 12 months of life. Infants with spastic hemiplegia, however, often develop hand preference early, indicating one side of their body is stronger than the other. The physician will look for other conditions that can be linked to CP, such as seizures, mental impairment, and vision or hearing problems. Intelligence tests often are administered to a child with CP to evaluate mental impairment, but the results can be misleading and there is a risk of underestimating intelligence. For instance, a child with movement, sensation, or speech problems associated with CP would have difficulty performing well on such tests. Differential Diagnosis If motor skills decline over time there may be genetic disease, muscle or metabolic disorder, or tumor in the nervous system, either coexistent or instead of CP. The physician must rule out other disorders that cause movement problems, identify any coexisting disorder, and determine if the condition is changing. An electroencephalogram (EEG) traces electrical activity in the brain and can reveal patterns that suggest a seizure disorder. Electromyography and nerve conduction velocity (NCV) studies are helpful when a nerve or muscle disorder is suspected. NCV is administered before EMG and measures the speed at which nerves transmit electrical signals. During NCV, electrodes are placed on the skin over a nerve that supplies a specific muscle or muscle group. A mild, brief electrical stimulus is delivered through the electrode and the response of the muscle is detected, amplified, and displayed. The strength of the signal is also measured. Neurological conditions can cause the NCV to slow down or to be slower on one side of the body. EMG measures nerve impulses within the muscles. Tiny electrodes are placed in the muscles in the arms and legs and the electronic responses are observed using an instrument that displays movement of an electric current (oscilloscope). As muscles contract, they emit a weak electrical signal that can be detected, amplified, and tracked, providing information about how well the muscles are working. Lab tests Chromosome analysis may be performed to identify a genetic anomaly (e.g., Down syndrome) when abnormalities in features or organ systems are present. Thyroid function tests may reveal low levels of thyroid hormone, which can produce several congenital defects and severe mental retardation. A high level of ammonia in the blood (hyperammonemia) is toxic to the central nervous system (i.e., brain and spinal cord). A deficiency in any of the enzymes involved in breaking down amino acids can cause hyperammonemia. This may be due to a liver disorder or a defect in metabolism. Imaging tests Imaging tests are helpful in diagnosing hydrocephalus, structural abnormalities, and tumors. This information can help the physician assess the child's long-term prognosis. Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create pictures of the internal structures of the brain. This study is performed on older children. It defines abnormalities of white matter and motor cortex more clearly than other methods. A computed tomography scan (CT scan) can show congenital malformations, hemorrhage, and periventricular leukomalacia in infants. Ultrasound uses the echoes of sound waves projected into the body to form a picture called a sonogram. It is often used in infants before the bones of the skull harden and close to detect cysts and abnormal structures in the brain. 文章2Cerebral Palsy DiagnosisA diagnosis of cerebral palsy is usually made within the first three years of a child's life. Parents are often the first to notice that their child is developing slower than normal. Some of the early signs that a child might have cerebral palsy include: •  Slow to reach developmental milestones - these include rolling over, sitting, crawling, and walking•  Abnormal muscle tone - the infant's body may seem limp or abnormally stiff•  Unusual posture Doctors will carefully examine the child's medical history for signs that cerebral palsy is the root of developmental problems. These signs include:•  Breech birth•  Complicated labor and/or delivery•  Low Apgar score - An Apgar score is determined by monitoring the infant's condition. Babies are rated according to heart rate, breathing, muscle tone, reflexes, and skin color in the first 10-20 minutes after birth•  Premature birth or low birth weight•  Multiple births•  Nervous system defects•  Other physical defects•  Maternal bleeding in the last three months of pregnancy It is important to remember that these are only risk factors for cerebral palsy, and that most children who exhibit one or more of these factors will not develop the disease.In addition to examining the child's medical history, the doctor will also test the child's motor skills. They will check for slow development, abnormal muscle tone, and unusual posture, as well as reflexes and hand preference. After checking these factors, they will then need to rule out other disorders that cause movement irregularity. Specifically, the physician will look to see if the condition is getting progressively worse. Cerebral palsy is not a progressive disease, so if the child's condition is deteriorating, it may be due to some other disorder.文章3Cerebral Palsy DiagnosisDiagnosing cerebral palsy is a difficult process as there other health problems that can mimic the condition. A cerebral palsy diagnosis does not necessarily follow even though a child may exhibit some of the symptoms outlined below. Children under the age of six months may demonstrate some or all of the following indicative symptoms: •  Lethargy •  Irritability •  Abnormal crying •  Trembling of the arms and legs •  Feeding difficulties •  Poor muscle tone •  Abnormal posture •  Seizures, staring spells, eye fluttering or body twitching •  Abnormal reflexes •  Changing muscle tone from floppy to very stiff •  Hand held in tight fist •  Asymmetry of movementBrain damaged children over the age of six months usually have obvious difficulties and are often slow to reach developmental milestones, such as rolling over, sitting up, crawling, walking and talking. Parents are more likely to notice developmental delay and abnormal behaviour if this is not their first child. Medical professionals often hesitate to initially reach a diagnosis due to the fact that a child's central nervous system may recover after an injury occurs and instead, they may use broader terms such as: •  Developmental delay •  Neuromotor dysfunction •  Motor disability •  Central nervous system dysfunction •  Static encephalopathyPrior to making a cerebral palsy diagnosis a consultant must rule out other disorders that cause movement problems, identify any coexisting disorder, and determine if the condition is changing. There are a number of techniques available: •  Declining motor skills may indicate genetic disease, muscle or metabolic disorder, or tumour in the nervous system. •  An electroencephalogram (EEG) traces electrical activity in the brain and can reveal patterns that suggest a seizure disorder. •  Electromyography and nerve conduction studies can identify a nerve or muscle disorder. •  Chromosome analysis may be performed to identify a genetic anomaly. •  Thyroid function tests may reveal low levels of thyroid hormone, which can produce several congenital defects and severe mental retardation. •  A high level of ammonia in the blood is toxic to the central nervous system. This may be due to a liver disorder or a defect in metabolism. •  Imaging tests may diagnose hydrocephalus, structural abnormalities, and tumours. •  Magnetic resonance imaging (MRI) defines abnormalities of white matter and motor cortex. •  A head CT scan can show congenital malformations, haemorrhage, and periventricular leukomalacia in infants. •  Ultrasound can detect cysts and abnormal structures in the brain.A cerebral palsy diagnosis is not made quickly or easily because the extent of the child's problems may not become clear for some time. Doctors need to test the child's motor skills and look carefully at the medical history and will look for slow development, abnormal muscle tone, and unusual posture. Intelligence testing is used to help determine if a child has any intellectual impairment, however intelligence testing a child with movement difficulties does not always give a true result. A doctor must move carefully towards a diagnosis after eliminating没有到六个月以上是不能确诊的。我认为现在大家对脑性瘫痪诊断的讨论是很有必要的，因为在早期确诊脑瘫 是比较困难的，特别是在中度以下的脑瘫患儿或偏瘫、单肢瘫儿。更有甚者把一部分重度发育迟滞儿也诊断为脑瘫，如自闭症等，不知大家用vojta的七种姿势做早期或超早期诊断效果如何？不同部位的病变会有不同的表现吗？？在孩子7岁之前的康复你们觉得难吗？请问大家有早期诊断共济失调型脑瘫的经验吗本来现在康复的同仁就不多，为什么还要加密？同意lilyottid的说法，有好的东西大家一起分享呀！Cerebral palsy (CP) is a well-recognized neurodevelopmental condition beginning in early childhood and persisting through the lifespan. Originally reported by Little in 1861 (and originally called ‘cerebral paresis’), CP has been the subject of books and papers by some of the most eminent medical minds of the past hundred years. Beginning at the end of the 19th century Sigmund Freud1 and Sir William Osler2 both contributed important perspectives on the condition. From the mid-1940s the founding fathers of the American Academy for Cerebral Palsy and Developmental Medicine (Carlson, Crothers, Deaver, Fay, Perlstein, and Phelps) in the USA, and Mac Keith, Polani, Bax, and Ingram of the Little Club in the UK, were among the leaders who moved the concepts and descriptions of CP forward, and caused this condition to become the focus of treatment services, advocacy, and research efforts.可以看看 關節活動範圍的訓練.doc (260.0k)今年在湖南召开了第二届儿童康复学术会议，以李树春、晓捷为首（国际交流性质），已对脑瘫的概念有了新的定义，这是自1988年后的第一次权威修改，但因为当时各有各的看法，未能立时决定。但也离不开三要素，（发育早期脑损伤，中枢性的运动障碍、姿势异常）从时间上来说，目前国内的脑瘫定义都比较狭窄，出生前后一个月内发生的脑损伤，但是上次美国专家来讲课的时候讲到他们的脑瘫是指从出生前一个月到一岁这个时间段内发生的脑损伤．如果按照国内的定义，我们这里的一个患儿就不能算是脑瘫，因为他是在一岁左右由于外伤引起的脑损伤，目前已经５岁了，症状主要表现为双下肢肌张力增高，剪刀足，踝关节柘屈，马蹄足内翻，同时存在认知水平相比同龄儿童低很多，记忆力差等症状．但是我们科里都觉得他如果不诊断为脑瘫那又该诊断为什么呢？对了，他还并发癫痫／2004年昆明全国小儿脑瘫研讨会在88年会议制定标准的基础上，已经产生了一个修订的版本。由中华医学会儿科分会神经学组和中华儿科杂志出面，林庆教授撰文发表（见图）。关于时间问题，国内外的文献一直就没有统一。2004年会议记录的讨论结果是“脑瘫不是一种单独的疾病,是一个综合征。它的定义是人为界定的,随着对脑瘫本质了解的逐渐深入,其定义也得到不断的完善,讨论中大家指出,小儿脑瘫的定义应体现出脑瘫的病因出现在脑发育时期,尤其是出生前到出生后1个月这段时间;它所致的病理改变是非进行性的;主要的临床表现是中枢性运动障碍。” （缩略图，点击图片链接看原图）2005年国际脑瘫新定义脑性瘫痪是指一组运动和姿势发育障碍症候群，这种导致活动爱好的症候群是由于发育中的胎儿或婴儿脑部受到非进行性损伤而引起的。脑性瘫痪运动障碍常伴随感觉、认知、交流、感知、和/或抽搐障碍。rosenbaum PL,Leviton A.Paneth N et al.Proposed definition and classification of cerebration of cerebral palsy,April 2005.Developmental Medicine and Child Neurology:2005:8,571-576.PT中运动疗法Vojta的七种姿势在我国不知应用的情况怎么样！相对发达的城市应用的普遍吗？这种评定手段不算过时吧！脑瘫的诊断1、诊断：（1）在出生前至出生后一个月内有致脑损伤的高危因素；（2）在新生儿期及婴儿期出现脑损伤的早期症状；（3）有脑损伤的神经学异常，如中枢性运动障碍及姿势反射异常；（4）常同时伴有智力低下、言语障碍、惊厥、感知觉等多种障碍；（5）排除其它进行性疾病所致的中枢性瘫痪及正常儿的一过性运动发育滞后；（6） 其它辅助检查有助于早期诊断，如头部CT、MRI、B超、EEG、SPECT、脑血流彩色多谱超声、体感诱发电位（SEP）、运动诱发电位（MEP）等。 脑瘫患儿的临床表现大多数都开始于婴儿期，但是，又不是所有的脑瘫患儿都会在早期表现出明显的异常症状，特别是轻症患儿，在6个月前，甚至9个月前，很难做出确切诊断。 对于分型诊断，年龄越小也越有困难，原因为典型的体征尚未充分表现出来。所以，医生需要对婴儿进行仔细的观察和随访，反复多次地全面进行评估，以便及早诊断、早期治疗。治疗原则： 1.早发现、早治疗 2.促进正常运动发育、抑制异常运动和姿势 3.综合治疗康复治疗的方法运动疗法(PT) 1.Bobath法 2.Rood法 3.Vojta法 4.Peto法 5.Doman法作业疗法(OT)特点： 1.以上肢和手的功能训练为重点； 2.与PT的重复性； 3.保持正确性、对称性、稳定性； 4.认知训练与智力开发； 5.生活自理动作训练；语言障碍治疗(ST) 1.接受语言能力的训练 2.表达语言能力训练 3.构音障碍训练 矫形器脑瘫患儿应用矫形器的目的 1.帮助患肢负重 2.保持良好肢位 3.起到局部稳定作用 4.预防和纠正肢体挛缩变形 5.控制不随意运动 6.改善坐、站立和步行能力等手术治疗手术治疗的目的：1.矫正畸形2.改善肌张力、减少肌肉痉挛和挛缩3.恢复或改善肌力平衡1.肌腱切断、肌腱延长、肌腱松解、肌腱移位等手术；2.神经手术如神经的肌支部分切断术，SPR手术；3.骨性手术如切骨术、关节融合术等。4.神经阻滞术：苯酚、BTX-A。5.颈动脉交感神经网剥离术，改善大脑供血。6.CRW立体定向手术。