【摘要】 目的:观察对孤独症儿童在有效完成训练计划后,可否提高运动协调能力和与人对视的能力及其注意力,减少恐惧,改善交往与情感障碍。方法:选择1999-01/2003-12新乡市第二人民医院儿科就诊的儿童孤独症患儿22例,均为男性,年龄3～8岁。①康复干预:对所有患儿进行感觉统合训练,以运动训练和感觉刺激为主,训练项目为运动协调训练及划数字、走迷津、指五官3项特殊训练,并注意方式方法。每天训练1次,每次2.0～3.0h,每周5～7次,20d为1个疗程。根据患儿的语言水平和交流能力,采用初级、中级和高级的一对一训练方案,并结合波特奇早期教育法、应用行为分析疗法及干预矫正技术,通过呼吸、发音训练患儿的语言交流能力及行为规范,1次/d,30～50min/次,每周3～5次。有合并症的患儿接受相应的药物治疗。②疗效评估标准:语言交流:①显效:从无主动言语交流到有主动言语交流;从无交流性语言到有交流性语言;从重复模仿性语言到自主语言。②有效:从有主动言语交流到重复模仿性语言;词汇量增大;理解人称代词(你、我、他)。③无效:无改变。人际关系:①显效:从无目光对视到目光对视超过20s;从叫名字无反应到距离2m远叫名字有应答;从不合群到主动参与多人游戏。②有效:有短时间的目光对视;近距离叫名字有反应;可被动参与游戏不反抗。③无效:无改变。动作行为:①显效:从强令协助完成感统训练到自行完成;从自伤行为频发到无自伤行为。②有效:能在帮助下完成部分感统训练项目;自伤行为明显减少。③无效:无改变。个人能力:①显效:从二便失禁到便前有表示;从便前有表示到主动去厕所排便。②有效:从便前有表示到知道蹲下排便。③无效:无改变。对其治疗方案监护人知情同意参加。结果:孤独症患儿22例均进入结果分析。①治疗效果随疗程的增加而提高,经6个疗程干预,显效率(显效例数/总例数):语言交流为91%;人际关系为91%;动作行为为86%;个人能力为82%。②经过6个疗程的治疗,22例患儿除运动协调能力明显提高外,交往及注意力也有较好的改善。其中划数字操作训练初在语言引导下持续2min,训练后能持续18min;走迷津从持续3min提高到25min,从被动暂短对视一两秒钟到主动对视30s;唤名反应从唤10次反应一两次到应答七八次。训练前烦躁、不听指令、不主动与他人接触,训练后能叫愉快的听指令并常有主动与训练员接近的动作。结论:①随着康复干预疗程的增加,显效率逐渐提高。②康复干预有助于提高孤独症患儿语言交流能力、动作行为能力、个人能力,改善人际关系。更多还原

【Abstract】 AIM: To investigate whether the programmed effective training for autistic children can improve the children’s movement and coordination ability, enhance the ability to looking at each other with people, promote attention and reduce fear to improve communication with others and affective disorder. METHODS: From January 1999 to December 2003, 22 male children with autism at the age of 3 to 8 years who were hospitalized in the Department of Pediatrics, Xinxiang Second People’s Hopsital were selected for our investigation. 1Rehabilitative intervention: All the children received sensory integration training, which was centralized by movement exercise and sensory stimulation, including motor coordination exercise, and 3 kinds of special exercise, dividing digitals, playing mazes and pointing out five organs, and the manner of exercise should be attended highly. They exercised once a day, 2.0 to 3.0 hours once, for 5 to 7 times every week and 20 days as a course. According to the level of speaking and ability to communication, the children received one-to-one exercise program in primary, middle and senior grade, combined with Boteqi early education method, applied behavior analysis and interventional correction technique by training the linguistic communication ability via breath and pronunciation exercise and the behavior norm once a day, 30 to 50 minutes once, and 3 to 5 times every week. The children with combined symptoms received corresponding drug treatment. 2Evaluation criteria of outcomes: linguistic communication: 1remarkable effectiveness: from no active linguistic communication to active linguistic communication, from no communication language to communication language, from repeated imitative language to independent language; 2effectiveness: from active linguistic communication to repeated imitative language, increasing glossary, comprehension of personal pronouns(you, I, he); 3ineffectiveness: no changes. Interpersonal relationship: 1remarkable effectiveness: from no looking at face to face to looking at face to face over 20 seconds, from no response to calling name to response to calling name at a distance of 2 meters, from being not willing to join group to join in playing games with others actively; 2effectiveness: short-time looking at with each other face to face, having response to calling name at a short distance, joining in games passively but not mutinously, 3ineffectiveness: no changes. Action and behaviors: 1remarkable effectiveness: from being forced to finish the exercise to finishing the exercise actively, from frequent autolesionism to no autolesionism; 2effectiveness: finishing partial exercise by assistance, decreasing autolesionism; 3ineffectiveness: no changes. Individual ability: 1remarkable effectiveness: incontinence of relieving the bowels to indication before relieving the bowels, from indication before relieving the bowels to relieving the bowels in the toilet actively; 2effectiveness, from indication before relieving the bowels to squatting down to relieve the bowels; 3ineffectiveness: no changes. All the guardians were told and consent about our treatment programs. RESULTS: All the 22 children with autism were analyzed in the result. 1The therapeutic effect was promoted as the courses were prolonged. After 6 courses, the remarkably effective rate(remarkable effective cases/total cases): linguistic communication was 91%, interpersonal relationship 91%, action and behaviors 86%, individual ability 82%. 2After 6 courses of exercise, the motor coordination ability was improved in all the 22 children, and the communication and attentions were also improved. The exercise of dividing digitals was increased from the 2 consecutive minutes under linguistic instruction at the beginning of exercise to 18 consecutive minutes after exercise; Playing mazes was increased from 3 minutes to 25 minutes, from short-time looking at each other face to face passively to looking at each other for 30 seconds actively; response to calling name was increased from 1 to 2 times to 7 to 8 times within 10 times. Before exercise, the children were boring, disobedient, not communicating with others actively, but after exercise, they were obedient to the instruction agreeably, and often closed to the instructors actively. CONCLUSION: 1The remarkably effective rate was increased along with the increasing courses of rehabilitative intervention.2Rehabilitative intervention is helpful to enhance the linguistic communication ability, ability of action and behaviors, individual ability, and improve the interpersonal relationship.更多还原