The examination of 16 items of nervimotion exam on early diagnosis of infant cerebral palsy: 6 years summary 

 

 

“婴儿脑瘫早期诊断神经运动检查16项”发表6年来，大量临床实践证实，该方法更有助于医师在较短的检查时间内认出脑瘫倾向或诊断脑瘫。

In the six years since the publication of the " The examination of 16 items of nervimotion exam on early diagnosis of infant cerebral palsy ", a large number of clinical practices have confirmed that this method is more helpful for doctors to recognize the tendency of cerebral palsy or diagnose cerebral palsy in a short period of time.

   

此法先观察孩子自然状态，然后让家长扶持孩子双腋下迈几步，最后才是医师快速的做几个动作检查，多数孩子还未哭闹即已检查完毕。

This method first observes the child's natural state, and then allows the parents to support the child's two underarms to take a few steps. Finally, the doctor quickly does several movement tests. Most children have not yet cried before they have completed the inspection.

 

该法一般用时5-10分钟,临床证实检查时间越长孩子情绪越不好，结果越远离真实。

The method generally takes 5-10 minutes. The longer the clinical examination time, the worse the mood of the child, and the more the result is far from reality.

 

该检查同时也是初步的肌动学评定方法，根据结果可很快制定出更有针对性的干预方案。

The examination itself is also a preliminary kinesiology assessment method, and based on the results, a more targeted intervention program can be quickly developed.

 

1.自发姿势运动及姿势运动反应(７项)

1.Spontaneous posture movement and posture movement reaction(7 items)

1.1.自发姿势运动

抱位及仰卧位时的自发姿势运动异常，多见为拇指内收或拇指内收达掌心、紧张性头偏斜、头后仰、自发非对称颈肢反射阳性、自发巴氏征阳性、不随意运动、过度松软、一侧或一个肢体活动明显减少或异常、1-2个月的婴儿双下肢僵直、3个月及以后手仍持续握拳等。

1.1.Spontaneous posture movement

Abnormal spontaneous posture movement in the position of the Hold the baby and recumbent position, commonly found in the palm of the thumb inwards or  the thumb in the palm, tension head slant, head back, spontaneous asymmetric neck reflex positive, spontaneous Babinski positive, uncasual exercise, excessively soft, one side or one limb activity significantly reduced or abnormal,  the two lower limbs were stiff for 1-2 months of baby , and the hands continued to clench fists for 3 months and later.

 

1.2.由仰卧位扶持翻成侧卧位激发出头向后仰≥20°显示颈背肌张力增高。

1.2.The supine position supports the flip into a lateral position to stimulate the head and the backward leaning ≥ 20 ° shows an increase in the tension of the dorsal muscle.

 

1.3.扶持孩子呈俯卧位可引出臀部高于头部的异常姿势等。（4个月后查）

1.3.Supporting the child in a prostrate position can lead to the abnormal posture of the buttocks higher than the head. (4 months later)

 

1.4.由仰卧位扶持孩子坐起来，观察头部控制状况。

1.4.The child was pulled up from the supine position to observe the head control.

 

1.5．扶持双腋举起可激发出下肢、上肢、头颈部等姿势运动异常。

1.5.Supporting the double axils to lift the child, can stimulate the lower limbs, upper limbs, head and neck and other posture movement abnormalities.

 

1.6.观察扶持站立位的姿势异常。

1.6.Observe the abnormal posture supporting the standing position.

 

1.7.观察扶持迈步时的异常姿势运动。

1.7.Observe the abnormal posture movements that support walking.

 

2． 肌张力(6项)

2.Muscle tension(6 items)

2.1．足背屈角

仰卧位、下肢伸直，轻缓压足背屈到刚有抵抗时，足背与小腿前侧的夹角为足背屈快角。

小腿三头肌肌张力增高时该角加大。

再逐渐增大力度、缓慢继续压足底背屈到不能压下时，足背与小腿前侧夹角为足背屈慢角。

足背屈慢角检查小腿后侧肌肉、肌腱有挛缩、粘连。

2.1．The angle of the foot toward the back pressure of the foot

The supine position, the lower extremity straightens, gently presses the foot back to just have resistance, the angle between the foot back and the front side of the calf is the fast angle of the foot toward the back pressure of the foot.

The angle increases when the muscle tension of the triceps of the calf increases.

Then gradually increase the strength, slowly continue to press the bottom of the foot back to can not press down, the angle between the foot back and the front side of the calf is the slow angle of the foot toward the back pressure of the foot.

 

2.2.内收角

仰卧位、下肢伸直，向两侧轻缓展开双下肢到刚有阻力，两大腿间的夹角为内收肌快角。

大腿内收肌张力增高时该角减小。

2.2.Angle of the inner thig

The supine position, the lower extremity straightens, to the two sides

gently spread the lower extremities to just have resistance. The angle between the two thighs is the fast angle of the inner thighe.

The angle decreases when the tension in the inner thigh is increased.

 

2.3．腘窝角

仰卧位，屈大腿呈膝胸位，轻缓展开小腿刚有抵抗时，大、小腿间夹角为腘窝快角。腘绳肌张力增高时该角减小。

2.3．The armpit angle

In the supine position, the bent thigh is in the knee chest position. When the calf is just resisting, the angle between the large and the lower legs is the armpit fast angle. The angle decreases when the tension of the hamstring increases.

 

2.4．肩外展角

仰卧位、上臂伸直、轻缓外展上臂到刚有抵抗，上臂与侧胸间的夹角为肩外展快角。胸、背等肌肉张力增高时该角减小。

2.4．The angle of the shoulder outreach

The supine position, the straight upper arm, and the gentle extension of the upper arm to just have resistance, the angle between the upper arm and the lateral chest is the fast angle of the shoulder outreach. The angle decreases when the muscle tension of the chest and back increases.

 

2.5．肘伸展角

尽量屈肘后轻缓伸展，刚有抵抗时上臂与前臂间夹角为肘伸展快角。肱二头肌张力增高时该角减小。

2.5．The angle at which the elbow stretches

 

Try to bend the elbow and stretch gently. When there is resistance, the angle between the upper arm and the forearm is the fast angle at which the elbow stretches. This angle decreases when the biceps tension increases.

 

2.6.前臂旋后90度回弹角

前臂旋前圆肌等张力增高时该角加大。

2.6.The rebound angle after the forearm rotates back 90 degrees

The angle increases when the tension of the anterior circular muscles of the forearm increases.

 

Ø 肌张力检查中肢体六个角均有快、慢之分

In the muscle tension examination, the six corners of the limb are divided into fast and slow.

 

3.反射（3项）

3.Reflection(3 items)

 

3.1．踝阵挛

双侧阳性提示脑瘫是以痉挛为主的类型，双侧锥体束均受累；一侧阳性提示一侧锥体束受累较著。

3.1．Ankle clonic

Bilateral positive indicates that cerebral palsy is a spastic type, and both sides of the cone bundle are affected; One side positive indicates that one side of the cone bundle is affected.

 

3.2．侧弯反射  

6个月前强阳性或6个月后仍阳性，提示脑瘫可能是不随意运动型。其他类型较重脑瘫亦可出现阳性。不对称提示一侧脑损伤较重。

3.2．Side bend reflex

Strong positive 6 months ago or still positive 6 months later, suggesting that cerebral palsy may be uncasual exercise type . Other types of severe cerebral palsy can also appear positive. The asymmetry suggests that the brain damage on one side is heavier.

 

3.3．膝腱反射

主要用于鉴别诊断，如果膝腱反射未引出，要考虑其他疾病。

3.3．Knee tendon reflex

Mainly used for differential diagnosis, if the knee tendon reflex does not lead, consider other diseases.

     

脑瘫可伴有的其他，异常虽不是脑瘫诊断所必须，也应及时查出、正确干预。

Cerebral palsy can be accompanied by other abnormalities, although it is not necessary for the diagnosis of cerebral palsy, it should also be promptly detected and correctly intervened.

 

表：判断肢体肌张力五个快角参考值（单位：度）

Tab：Five fast angle reference values for judging muscle tension in limbs(in degrees)