TO WHAT END?
TO WHAT END?
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目的是什么？
DOI：
10.1111/j.1469-8749.1981.tb02014.x
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发表时间：
1981
影响因子：
3.8
通讯作者：
F. P. Sage
中科院分区：
文献类型：
--
作者：
F. P. Sage
评估脑瘫患者治疗效果的END结果研究在科学文献中明显缺乏。在为数不多的几个人中，有些是客观的，覆盖了长时间的观察；另一些是主观的，显然受到主持人的偏见，只覆盖了很短的时间。也有人声称，即使是最轻微的改善，也会被认为是成功的，无论这种改善是年龄、经历还是环境变化的结果。由于几个原因，最终结果研究是困难的。没有两个脑瘫患者是相同的：他们的运动模式可能是相似的，但痉挛或语调的程度可能不同，以及伴随运动丧失的感觉和智力障碍。儿童的情绪稳定性影响他接受指导的能力和动机，也影响治疗的成功，而这可能不会受到给予治疗的人的任何方式的影响。幼儿随着年龄的增长自然会有一定程度的改善，并将由于安全性和由于治疗而导致的改善分开。改善孩子的环境刺激通常会导致一些自发的改善：孩子得到的关注越多，除非患有严重自闭症或反应迟钝，无论采用什么治疗方案，孩子在运动、社交或认知技能的某些领域都会得到更多的改善。毫无疑问，单靠时间就能从大脑损伤中恢复一些，这一点在中风后的成年人身上可以看到，他们在血管事故后的头几周似乎往往有显著的改善。在没有癫痫发作或畸形的新生儿中，人们只能说婴儿是高渗、低渗或有一些吸吮困难，或者是我们认为正常的。那么，谁能说出音调的正常化和运动里程碑的实现是由于新生儿期的早期干预，还是由于大脑本身的恢复？
ENDresult studies evaluating the treatment of cerebral-palsied patients are notably lacking in the scientific literature. Of the few there have been, some are objective and cover a long period of observation; others are subjective, obviously biased by the presenters and cover only a short period of time. There have also been claims to success when even the slightest improvement has occurred, regardless of whether the improvement has been the result of age, experience or environmental change. End-result studies are difficult for several reasons. No two cerebral-palsied patients are the same: they may be alike in their motor patterns but the degree of spasticity or tone may differ, as well as the sensory and intellectual deficits accompanying the motor loss. The child’s emotional stability, which affects his ability to accept instruction and his motivation, also influences the success of treatment, and this may be influenced in no manner whatsoever by the person giving the therapy. A young child naturally improves to some degree with age, and to separate improvement due tomaturity and that due to treatment is difficult. Improving the child’s environmental stimulation often will result in some spontaneous improvement: the more attention a child is given, unless severely autistic or otherwise unresponsive, the more the child will improve in some area of motor, social or cognitive skills, regardless of the therapeutic regimen.There is no doubt that time alone can result in some recovery from brain damage, as can be seen in post-stroke adults who often seem to improve significantly in the first few weeks after the vascular accident. In neonates without seizures or malformations, one can only say that an infant is hypertonic, hypotonic or has some sucking difficulty, or is what we feel to be normal. Who, then, can say whether normalization of tone and achievement of motor milestones are due to early intervention in the neonatal period, or to the recovery of the brain itself?