【学位级别】医学博士

【论文完成日期】2004-04-26

【论文中文题名】注意缺陷多动障碍儿童平衡仪治疗开放性研究

【论文外文题名】An open trial of Balance Master training with attention deficit hyperactivity disorder

【论文著者】姓名：程嘉 cheng jia

【论文著者】学号：B10199762

【论文著者】系别：精神卫生研究所

【论文著者】专业：精神病与精神卫生学

【论文著者】研究方向：精神病与精神卫生学临床

【指导教师】姓名：王玉凤 wang yu feng

【指导教师】学校：北京大学医学部

【指导教师】系别：精神卫生研究所

【指导教师】专业：精神病与精神卫生学

【中文文摘】注意缺陷多动障碍儿童平衡仪治疗开放性研究 在对注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）的研究中显示，有52%的ADHD儿童伴有运动协调障碍，患儿的平衡功能低于正常儿童，智力、记忆力及注意力水平亦低于正常儿童。有研究显示前庭功能与儿童认知功能及行为问题关系密切。感觉统合治疗主要针对12岁以下儿童。然而，有70%儿童的ADHD症状持续到青春期。帮助这部分患儿缓解症状已成为当前儿童精神科领域的重要问题。 目的 探讨平衡仪治疗对ADHD患儿认知功能、行为问题及平衡功能的影响。初步探讨平衡仪训练应用于少年ADHD患儿治疗的可行性。 方法 采用Neurocom公司生产的Balance Master平衡仪，对31例符合美国精神障碍诊断与统计手册第4版（DSM-IV）诊断标准、年龄在10～16岁的ADHD患儿进行治疗，于治疗前、治疗20次及40次后测试韦氏记忆、韦氏智力、数字划消、持续操作性测试（CPT）、STROOP、动态学习能力（DLM）、瑞文、DSM-IV症状问卷、Conner儿童行为问卷、Rutter儿童行为问卷、平衡功能等项目。进行自身对照研究。 结果 1．平衡仪治疗20次后中国韦氏儿童智力量表中C因子、韦氏记忆测试中短时、记忆商分值提高，差异具有非常显著性（P＜0.01）。数字划消测试第一段、第二段、第三段净分提高，第一段、第二段失误率下降，差异具有显著性（P＜0.05）。第三段失误率有下降趋势（P＜0.1）。CPT测试中平均反应时、遗漏率、误击率均无明显变化。Stroop测试中D部分完成时间和字义干扰时明显减少，差异具有显著性（P＜0.05）。DLE测试中总错误数、误按数、漏按数明显下降，分类级别升高，差异具有非常显著性（P＜0.01）。瑞文测试原始分及等级无明显变化。治疗40次后中国韦氏儿童智力量表中全量表分、操作分、B因子、C因子分明显提高差异具有显著性（P＜0.05），变化幅度分别为9.1%、11.7%、10.7%、9.4%。韦氏记忆测试中短时、记忆商分值提高差异具有非常显著性（P＜0.01）。数字划消测试第一段净分提高和失误率下降，差异具有非常显著性（P＜0.01）。CPT测试中各项目无明显变化。Stroop测试中D部分完成时间较治疗前及治疗20次时完成时间减少，差异具有显著性（P＜0.05）。DLE测试中总错误数、漏按数明显下降，分类级别升高差异具有非常显著性（P＜0.01）。瑞文测试中各项目无明显变化。 2．平衡仪治疗20次后Conner测试中多动和多动指数分明显下降； Rutter测试中总分、A行为分明显下降，变化幅度分别为20%、33%；DSM-IV问卷测试中注意缺陷分、多动冲动分、总分均明显下降，差异均具有显著性（P＜0.05），变化幅度分别为17.6%、33.3%、22.7%。治疗40次后Conner测试中行为因子、学习、躯体、多动、多动指数因子评分明显下降；Rutter测试中总分、A行为分、N行为分均明显下降；DSM-IV问卷测试中注意缺陷分、多动冲动分、总分均进一步下降，与治疗前相比差异均具有显著性（P＜0.05）。 3．平衡仪治疗20次后平衡功能测试中海绵垫平面睁眼条件下摇摆速率明显下降；单腿闭眼站立摇摆速率明显下降，差异均具有显著性（P＜0.05）。治疗40次后，平衡功能测试中固定平面睁眼、海绵平面睁眼、海绵平面闭眼条件下稳定性有所提高，与治疗前相比差异具有显著性（P＜0.05）。固定平面闭眼条件下治疗20次时稳定性下降，与治疗前相比差异具有显著性（P＜0.05），治疗40次后状态改善，与治疗前相比无明显变化。左单腿闭眼、右单腿睁眼条件下稳定性明显提高，差异具有显著性（P＜0.05）。 结论 1. 平衡仪治疗对改善儿童认知功能有一定疗效，能提高患儿的智能，尤其是操作智商、B因子、C因子；治疗20次在提高注意力、记忆力、冲动性及选择性抑制能力方面已有较好疗效；治疗40次在保持上述疗效的基础上，选择性抑制能力有进一步的提高；但治疗对患儿计划能力无明显改善。 2. 平衡仪治疗能较全面改善患儿的行为问题。治疗20次患儿的核心症状开始改善，尤其是多动、冲动症状改善更加明显，治疗40次后核心症状进一步改善；治疗20次后患儿的攻击行为减少，治疗40次后患儿焦虑情绪、躯体不适主诉减少，同时学习问题也得到改善。 3. 视反馈平衡功能训练20次患儿姿势稳定性开始提高，特别是在感觉冲突条件下视觉、前庭、本体的整合能力，治疗40次能进一步提高疗效。长期在视反馈条件下进行平衡功能训练，在去除视觉信息时姿态稳定性可能下降，但随着治疗进一步开展问题可以得到纠正。 4．平衡仪治疗能缓解ADHD青少年的平衡功能、认知功能障碍，能改善患儿的行为问题。治疗无副作用，趣味性强，满足青少年的心理特征。训练方案适合于青少年的理解能力和操作能力。为ADHD患儿的非药物治疗开辟了一条新思路。

【外文文摘】An open trial of Balance Master training with attention deficit hyperactivity disorder Background The studies about ADHD show that there is 52% ADHD children has development coordination disorder. The balance functions of these children lower than control and so as their intelligence, memory and attention. There are also studies show that balance function has a close relationship with cognitive and behavior problem. Sensory integration therapy is suitable for children younger than 12 years. However the symptom of 70% children will last to adolescent. To help these children to alleviate symptom has become the key problem of pediatric psychiatry. Objective To discuss the effect of Balance Master training on cognitive, behavior and balance functions. And also to discuss the feasibility of Balance Master training applied to ADHD adolescence. Methods We adopted the Balance Maser manufactured by Neurocom. Thirty-seven cases diagnosed according to the DSM-IV criteria for ADHD, with an age range from 10 to 16 years, were given Balance Master training. C-WISC, Wechsler Memory Scale, Number Cancellation Test, CPT, Stroop Test, DLM, Raven s Standard Progressive Matrices, DSM-IV Symptom questionnaire, Conner’s Behavior Rating Scale-parent questionnaire, Rutter Scale and balance function were administered pre and post-training(20 and 40 sessions). Results (1) After 20 sessions of treatment, the scores of the WMS short-term memory, memory Quotient and Free from Distractibility Factor were improved. The net score of Number Cancellation Test were improved, false rate of the first and second section were decreased and false rate of the third section has a decreased tendency. There is no significant change in CPT test. In Stroop test, the finishing time and time for eliminate the interference of word in D part decreased significantly. Total false number was decreased and DLM classification score improved. There is no significant change in Raven S Test. After 40 sessions training, the full scale score, performance score, B factor score and C factor score of C-WISC were improved. The changing ranges were 9.1%,11.7%,10.7%,9.4%. The scores of the WMS short-term memory, memory Quotient were improved. In Number Cancellation Test, the net score and false rate of the first segment were improved. In CPT test, there is no significant change. In Stroop Test, the finishing time of D part decreased compared with base line and 20 secessions. Total false number was decreased and DLM classification score improved. There is no significant change in Raven S Test. (2) After 20 sessions of treatment, the scores of hyperactivity factor and index of Conner’s Behavior Rating Scale decreased significantly. Total score and A scores of Rutter Scale decreased significantly. The changing ranges were 20%, 33%. The inattention, hyperactivity-impulse and total scores of DSM-IV questionnaire were decreased. The changing ranges were 17.6%, 33.3%, 22.7%. After 40 sessions training, the scores of behavior, learning factors, body, hyperactivity, hyperactivity index of Conner’s Behavior Rating Scale decreased significantly. Total score and A , N scores of Rutter Scale all decreased significantly. The inattention, hyperactivity-impulse and total scores of DSM-IV questionnaire decreased continuously. (3) After 20 sessions of treatment, Eyes Open Foam Surface and Eyes Close Unilateral Stance sway velocity decreased. After 40 sessions training, Eyes Open Firm Surface, Eyes Open Foam Surface, Eyes Close Foam Surface stability increased. After 20 sessions of treatment, Eyes Close Firm Surface condition sway velocity increased and after 40 sessions of treatment the stability recovered. After 40 sessions of treatment Left Eyes Close Unilateral Stance and Right Eyes Open Unilateral Stance stability increased. Conclusions 1） Balance Master training can improve cognitive function of ADHD children in a certain degree. After training children’s intelligence improved, especially performance quotient, B factor, C factor. After 20 sessions of training, children’s attention, memory, impulsive, selective inhibition has already improved. After 40 sessions of training, the effect was maintained and the selective inhibition ability improved continuously. Training has no effect on planning ability. 2) Balance Master training can improve children’s behavior problem. After 20 sessions of training, the core symptom began to improve, especially hyperactivity-impulsive symptom. After 40 sessions of training it improved continuously. After 20 sessions of training aggressive behavior has decreased. After 40 sessions of training children’s anxiety, body uncomfortable complaining decreased and also learning problem improved. 3) After visual biofeedback balance training of 20 sessions, the posture stability has improved, especially sensory integration on the condition of conflict. After 40 sessions of training the effect improved continuously. After sessions of training under visual biofeedback, the posture stability may decrease when vision wiped off, but it can be revised when training continue. 4) Balance Master training can improve ADHD children’s balance disorder, cognitive problem and behavior problem. Training has no adverse effect, it is interesting, and can apply to the psychotic of adolescent. It make a new way for none medicine therapy of ADHD children.