Objective Intellectual disability (ID) is a prevalent comorbidity in children with cerebral palsy (CP), presenting significant challenges to individuals, families and society. This study aims to develop a predictive model to assess the risk of ID in children with CP. Methods We analyzed data from 885 children diagnosed with CP, among whom 377 had ID. Using least absolute shrinkage and selection operator regression, along with univariate and multivariate logistic regression, we identified key predictors for ID. Model performance was evaluated through receiver operating characteristic curves, calibration plots, and decision curve analysis (DCA). Bootstrapping validation was also employed. Results The predictive nomogram included variables such as preterm birth, CP subtypes, Gross Motor Function Classification System level, MRI classification category, epilepsy status and hearing loss. The model demonstrated strong discrimination with an area under the receiver operating characteristic curve (AUC) of 0.781 (95% CI: 0.7504-0.8116) and a bootstrapped AUC of 0.7624 (95% CI: 0.7216-0.8032). Calibration plots and the Hosmer-Lemeshow test indicated a good fit (χ2= 7.9061, p = 0.4427). DCA confirmed the model's clinical utility. The cases were randomly divided into test group and validation group at a 7:3 ratio, demonstrating strong discrimination, good fit and clinical utility; similar results were found when stratified by sex. Conclusions This predictive model effectively identifies children with CP at a high risk for ID, facilitating early intervention strategies. Stratified risk categories provide precise guidance for clinical management, aiming to optimize outcomes for children with CP by leveraging neuroplasticity during early childhood.

目的 探讨脑性瘫痪和智力障碍儿童头颅MRI特征的差异表现.方法 以诊断为依据,回顾性纳入符合标准的1076 例脑性瘫痪和 796 例智力障碍患儿的头颅MRI,分析脑性瘫痪与智力障碍两个病种之间头颅MRI的异常率,以及分别与GMFCS分级和智力分度之间的关系.结果 脑性瘫痪与智力障碍儿童头颅MRI异常率比较,χ2 =543.692,P<0.001,两者差异有统计学意义;脑性瘫痪儿童头颅MRI异常率与GMFCS分级有趋势关系,χ2 =181.88,P<0.0001,头颅MRI异常率随着 GMFCS分级增高而增高,Ⅳ级和Ⅴ级比较(χ2 = 0.414,P =0.52>0.05),两者之间差异无统计学意义,可能与脑性瘫痪发病机制有关;智力障碍儿童头颅MRI异常率与智力障碍分度无关:χ2 =1.536,P =0.214>0.05;脑性瘫痪头颅MRI中异常表现最常见的是脑室周围软化最为多见(468 例),占52.71%;其次为多发软化及萎缩(178 例),占21.76%;智力障碍头颅MRI异常的各种表现中,以脑白质髓鞘化异常最为多见(67 例),占41.88%;其次为脑外间隙增宽和脑室增大(38 例),占23.75%.结论 头颅MRI检查对脑性瘫痪儿童具有推测病理机制、预测预后具有重要价值,比智力障碍儿童有更重要的意义.

Objective:To observe the clinical efficacy and side effects of injecting different doses of botulinum toxin type A (BTX-A) into children with spastic cerebral palsy (CP) and tiptoe deformity.Methods:A total of 107 children with tiptoe deformity resulting from CP were divided into group A ( n=35), group B ( n=36) and group C ( n=36) using a random number table. Group A received 3u/kg injections of BTX-A, group B received 4u/kg injections and group C received 5u/kg. The injections were guided by color Doppler ultrasound and followed by 4 courses of rehabilitation therapy. Before and 1, 3 and 6 months after the treatment, the modified Tardieu scale (MTS) was used to assess gastrocnemius spasms, while sections D and E of gross motor function scale 88 (GMFM-88) and the pediatric balance scale (PBS) were used to evaluate motor functioning and balance. Any side effects were also observed. Results:After the treatment, improvement was observed in all of the measurements, though there were no significant differences in the degree of improvement nor in the incidence of side effects among the three groups.Conclusions:There is no significant difference in clinical efficacy or side effects involved in using different doses of BTX-A to treat tiptoe deformity in children with spastic cerebral palsy. The recommended dosage is therefore 3u/kg.

〔目的〕探讨腕手矫形器联合康复训练对脑性瘫痪痉挛型偏瘫患儿腕手关节功能活动的疗效.〔方法〕将我院2018年3月至2019年2月接收的36例脑性瘫痪痉挛型偏瘫患儿随机分成观察组(18例)与对照组(18例).2组均给予常规康复训练,观察组加用腕手矫形器治疗腕手关节异常姿势.分别于治疗前及治疗12周后对2组患儿采用改良Ashworth量表(MAS)、精细运动能力测试量表(FMFM)评分进行评定,并测量患侧腕关节被动掌屈、背伸关节活动度(PROM).〔结果〕治疗后2组患儿MAS、PROM、FMFM评分较治疗前均有明显提高(P<0.01),且观察组明显优于对照组(P<0.01).〔结论〕腕手矫形器联合康复训练可显著改善痉挛型脑瘫患儿腕手屈肌痉挛,改善关节活动度,提高精细运动功能.

[目的]探讨神经节苷脂联合神经康复治疗小儿脑瘫的疗效.[方法]将我院2017年2月至2018年1月接收的90例小儿脑瘫患儿随机分成观察组(45例)与对照组(45例).对照组给予患儿对症治疗,主要是应用神经节苷脂治疗,观察组则应用神经节苷脂联合神经康复治疗,观察2组患儿治疗效果、治疗前后智力发育指数(MDI)、运动发育指数(PDI)及日常生活能力(ADL)及不良反应发生情况.[结果]观察组治疗总有效率为93.33％,明显高于对照组75.55％的总有效率(P＜0.05);治疗后2组患者MDI、PDI、ADL均提高,但观察组提高幅度明显大于对照组(P＜0.05);2组患儿治疗期间不良反应发生率上无显著差异(P＞ 0.05).[结论]应用神经节苷脂联合神经康复治疗小儿脑瘫的疗效显著,可以促进患儿智力发育,提高患儿运动能力及生活质量,因此值得临床推广.

Objective To compare the effectiveness of cerebral palsy rehabilitation patterned on the children and youth version of the international classification of functioning,disability and health (ICF-CY) with traditional patterns.Methods Two children's rehabilitation wards were selected as the ICF-CY group and the control group.The children in the former group were evaluated using the ICF-CY and provided with individual rehabilitation plans according to their evaluation results,while those in the latter group were given traditional rehabilitation without any evaluation.Before and after 3 courses of treatment,both groups were assessed using the pediatric evaluation of disability inventory (PEDI) and the gross motor function measure (GMFM),and their use of assistant devices was assessed.Results After three courses of treatment the ICF-CY group's average PEDI score had improved significantly and was superior to that of the control group.Significant improvement was observed in the GMFM scores in both groups after the treatment,with no significant inter-group differences.Significantly more of the children in the ICF-CY group used the assistive devices (except the lower limb orthoses) compared to the control group.Conclusion Therapy based on the ICF-CY is obviously superior to traditional rehabilitation planning.

Lithium is a widely used and effective treatment for individuals with psycho-neurological disorders, and it exhibits protective and regenerative properties in multiple brain injury animal models, but the clinical experience in young children is limited due to potential toxicity. As an interim analysis, this paper reports the safety/tolerability profiles of low-dose lithium treatment in children with intellectual disability (ID) and its possible beneficial effects. In a randomized, single-center clinical trial, 124 children with ID were given either oral lithium carbonate 6 mg/kg twice per day or the same dose of calcium carbonate as a placebo (n = 62/group) for 3 months. The safety of low-dose lithium treatment in children, and all the adverse events were monitored. The effects of low-dose lithium on cognition was evaluated by intelligence quotient (IQ), adaptive capacity was assessed by the Infant-Junior Middle School Students Social-Life Abilities Scale (IJMSSSLAS), and overall performance was evaluated according to the Clinical Global Impression-Improvement (CGI-I) scale. After 3 months of lithium treatment, 13/61 children (21.3%) presented with mild side effects, including 4 (6.6%) with gastrointestinal symptoms, 4 (6.6%) with neurological symptoms, 2 (3.3%) with polyuria, and 3 (4.9%) with other symptoms—one with hyperhidrosis, one with alopecia, and one with drooling. Four children in the lithium group had elevated blood thyroid stimulating hormone, which normalized spontaneously after lithium discontinuation. Both IQ and IJMSSSAS scores increased following 3 months of lithium treatment (F = 11.03, p = 0.002 and F = 7.80, p = 0.007, respectively), but such increases were not seen in the placebo group. CGI-I scores in the lithium group were 1.25 points lower (better) than in the placebo group (F = 82.66, p < 0.001) after 3 months of treatment. In summary, lithium treatment for 3 months had only mild and reversible side effects and had positive effects on cognition and overall performance in children with ID. Clinical Trial Registration: Chinese Clinical Trial Registry, ChiCTR-IPR-15007518.

Objective To observe the clinical efficacy of ankle joint continuous passive motion (CPM) in treatment of gastrocnemius spasticity in children with cerebral palsy.Methods Seventy 11-36 months old children with cerebral palsy and gastrocnemius spasticity in Department of Children's Rehabilitation,the Third Affiliated Hospital of Zhengzhou University from February 2015 to February 2016 were selected and divided into observation group(n =35) and control group(n =35).All patients were given conventional physical rehabilitation treatment;based on this,the patients in observation group were treated by ankle joint CPM.Before treatment and 6 months after treatment,the modified Tardieu scale (MTS) was applied to assess the degree of gastrocnemius spasticity;the gross motor function measure 88 (GMFM-88) was used to evaluate the gross motor function;and the surface electromyography (sEMG) were applied to evaluate the muscle tension of gastrocnemius muscle under the passive state.The results were compared between the two groups before and after treatment.Results There were no significant difference in the value of ankle joint angles R2-R1 and the scores of characteristics of muscle reaction,the GMFM scores,and the sEMG scores of patients between the two groups before treatment (P ＞ 0.05).After 6 months' treatment,the values of R2-R1 of patients in the two groups were significantly smaller than those before treatment (P ＜ 0.05);and the the values of R2-R1 of patients in the observation group were significantly smaller than those in the control group(P ＜ 0.05).After treatment,the scores of characteristics of muscle reaction of patients in the two groups were lower than those before treatment (P ＜ 0.05);the scores of characteristics of muscle reaction of patients in the observation group were significantly lower than those in the control group (P ＜ 0.05).After treatment,the GMFM-88 scores of patients in the two groups were significantly higher than before treatment (P ＜ 0.05);and the GMFM-88 scores of patients in the observation group were significantly higher than those in the control group (P ＜ 0.05).After treatment,the sEMG scores of patients in the two groups were significantlylower than those before treatment (P ＜ 0.05);and the sEMG scores of patients in the observation group were significantly lower than those in the control group (P ＜ 0.05).Conclusion Ankle joint CPM combined with conventional physical rehabilitation training have significant efficacy in the treatment of gastrocnemius spasticity in children(11-36 months) with cerebral palsy;and its effect is better than conventional physical rehabilitation training.

目的:评估中文版上肢技巧质量量表(quality of upper extremity skills test,QUEST)在痉挛型脑瘫患儿上肢功能评定中的信度和效度.方法:将英文版QUEST翻译并完善成中文版,研究对象为75例在我院就诊的痉挛型脑瘫儿童,检测其重测信度及评定者间信度.同时进行Peabody运动发育量表的精细运动部分(peabody developmental motor scale fine motor,PDMS-FM),精细运动能力(fine motor function measure scale,FMFM),分析PDMS-FM原始分、FMFM各区分数与中文版QUEST各分测试项原始分之间的相关性,评估量表的平行效度.结果:中文版QUEST分测试项得分及总分具有优良的重测信度及评估者间信度(ICC值均＞0.890),中文版QUEST分测试项原始分与PDMS-FM、FMFM各区原始分间具有较好的平行效度(Pearson/Spearson秩相关系数分别为r1=0.563-0.816、r2=0.389-0.830).结论:中文版QUEST量表具有良好的信度和效度,可以作为评估痉挛型脑瘫患儿上肢运动功能的首选方法.

Objective To explore the factors affecting the prognosis for a child in a persistent vegetative state (PVS).Methods Forty-three PVS children were selected and provided with comprehensive rehabilitation training.It included physical therapy such as Rood approach and range of joint movement training,medication and hydro-acupuncture at the head points.After three months,each patient's state of consciousness was quantified,and multiple-factor unconditional logistic regression was conducted to identify factors relating to any changes.Results By the end of the intervention,29 of the patients had regained consciousness,a recovery rate of 67％.Logistic regression revealed that age,brainstem auditory evoked potentials (BAEP) and PVS score at admission all were closely related with whether a child regained consciousness.Gender,type of damage,EEG score,and the initial time of intervention had no significant relationship with regaining consciousness.Conclusions Older PVS patients with higher BAEPs and PVS scores at admission are more likely to regain consciousness.

语言发育迟缓在脑性瘫痪儿童中发病率很高，绝大部分合并智力障碍的儿童语言发育迟缓。目前儿童康复机构常见的语言训练形式以一对一训练为主，患儿的主动参与性欠佳，治疗效果不够明显。本次研究探索小组语言训练在脑性瘫痪儿童合并语言发育迟缓治疗方面提高交往及参与性方面的效果，现报告如下。

Objective:To observe the clinical effect of scalp acupuncture combined with exercise therapy for treatment of children with cerebral palsy.Methods:118 cases of cerebral palsy were randomly divided into observation group and control group , each 59 cases, the observation group used Scalp acupuncture and exercise therapy , while the control group only with exercise therapy , before treatment and after 3 course of treatment using the gross motor function measure ( GMFM) were measured , and evaluate the clinical effect .Results:the total effective rate observed significant efficiency , group were significantly higher than those in the control group , the observation group be-fore and after treatment GMFM score increased significantly higher than that in the control group , with significant difference (P<0.01). Conclusion:Scalp acupuncture combined with exercise therapy for treatment of children with cerebral palsy significant curative effect , is worth popularizing in clinic .

Objective To study the impact of the peripheral neurotomy method combined with rehabilitation exercise on gross motor function and balance function of children with cerebral palsy.Methods Matched pair design was used in the study.Thirty children with spastic cerebral palsy hospitalized from May 2011 to Nov.2013 suffering from peripheral neurotomy were assigned as study group,who were conscious and treated by peripheral neurotomy com bined with rehabilitation exercise.In the meanwhile,30 children inpatients at the same time were employed as the control group,who were similar in age and symptoms,with the same gender and the same Gross motor function classification (GMFCS) grade,and the controls were treated only with ordinary rehabilitation exercise.Modified Ashworth score,Gross Motor Function Measure (GMFM) D and E regions scores,physicians rating scale score in the 2 groups were recorded after treatment for 2,4,6,8,10 weeks.Repeated measure analysis of variance method was introduced to analyze the differences between the 2 groups in improved Ashworth muscle tension,gait improvement,gross motor function and balance function.Results The study group was superior over the control group in muscle tension reduction (F =8.177,P =0.006) and gait improvement(F =24.284,P =0.000).The 2 groups were not different statistically in D region evaluation of GMEM (F =0.072,P =0.790) and E region evaluation of GMFM (F =0.000,P =0.985) ; For Berg balance scale,the 2 groups had also no difference(F =0.150,P =0.700).Conclusions Both peripheral neurotomy method combined with rehabilitation exercise and the ordinary rehabilitation exercise method both could improve the gross function and the balance function.Furthermore,the former was superior over the latter in muscle tension reduction and gait improvement.

目的：观察 A型肉毒毒素局部注射对痉挛型脑性瘫痪患儿下肢运动功能和肌张力的影响。方法选择本院符合入选标准的痉挛型脑瘫68例，随机分为对照组和治疗组各34例，2组均进行常规康复训练，治疗组加 A型肉毒毒素局部注射治疗。观察疗程均为3个月。治疗前后分别采用改良的 Ashworth痉挛量表（MSA）和粗大运动功能评定量表（GMFM）进行疗效评定。结果治疗后2组患者下肢痉挛程度和粗大运动功能均有不同程度的改善，治疗组优于对照组，差异有统计学意义（P＜0.05）。结论痉挛型脑瘫在常规康复训练的基础上，同时局部注射 A型肉毒毒素疗效确切，值得临床推广应用。

Objective To observe the effects of conductive education on gross motor function and Gesell development test results in children with cerebral palsy.Methods One hundred and thirty-eight children with cerebral palsy were stratified randomly according to the gross motor function classification system (GMFCS) and sexes into two groups:the conductive education group received conductive education combined with general comprehensive rehabilitation,the control group received general comprehensive rehabilitation only.After 4 months of training,the results of both groups in terms of gross motor function and Gesell development test results were compared.Results The GMFCS evaluation results of the 2 groups were compared through covariance analysis (F =4.479,P =0.036 ＜0.05),the result of conductive education group was better than that of control group; in both groups the result after training was superior to that before training.For Gesell development test results comparison,the differences between conductive education group and control group were statistically significant (P ＜ 0.05) ; the result of conductive education group was better than before the training (t =24.93,P =0.00 ＜ 0.05) ; but in control group the difference between the results before and after training was not significant (t =13.34,P ＞ 0.05).Conclusions Conductive education could improve gross motor function and whole body development.