2013年CPN课件.pptVIP

* * * * * * * * * * We’ll talk about this later, but remember – function should stay stable between ages 25 and 40 years- if there is sudden onset of weakness- look for a medical cause. * * * * * * * * * * Children and adults with CP are often on both ends of the weight spectrum * * * * * * There are not a lot of studies yet describing how persons with CP age. This study is often cited as it involves such a large number of patients (904) who were followed over a 40 year span. There are some potential biases in this study as the enrollees had applied for disability benefits in the State of California. Therefore more affected individuals may have been selected. Another thing to keep in mind is that in the general population function can decline with aging- so prognosis for our patients with CP may not be as negative as portrayed in this study. * Overall, those walking at the highest level of independence decreased by age 60. * Feeding ability appears to stay consistent over a 40 years span. * Again, those in the highest level of independence with bathing decline. * But does speaking ability actually improve with aging? What we’re likely seeing here (and to some degree on the other charts) is a “Healthy Survivor” Effect- in which the most impaired individuals may die off. * * When individuals were tracked over the 40 year span- the “Healthy Survivor” Effect could be eliminated, and it became apparent that function overall did decline. * For example GROUP A at 20 years 100% could walk independently, climb stairs without using handrail 75% are still in this state 15 years later. * * * * * * * * Conclusions结论 Preserving mobility is beneficial and is associated with better survival（移动能力的保留对其更好的生存非常有益） But…some individuals will lose the ability to walk regardless of treatment（但是…尽管在进行治疗，也有部分患者失去行走能力） Cannot focus exclusively on independent walking but on on an independence-oriented therapeutic approach（不能仅仅关注如何提高患者独立的步行能力更要照眼于合适的康复训练方法） Strengthening-avoid surger