低频重复经颅磁刺激联合任务导向性训练对痉挛型偏瘫脑瘫患儿下肢粗大运动及其步行功能的疗效分析

张秋; 李卫平; 虞记华; 杜鑫萍; 凌运其; 胥方元

doi:10.11852/zgetbjzz2023-0103

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中国儿童保健杂志 ›› 2023, Vol. 31 ›› Issue (11) : 1248-1253. DOI: 10.11852/zgetbjzz2023-0103

临床研究

低频重复经颅磁刺激联合任务导向性训练对痉挛型偏瘫脑瘫患儿下肢粗大运动及其步行功能的疗效分析

张秋, 李卫平, 虞记华, 杜鑫萍, 凌运其, 胥方元

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Therapeutic effect of low frequency repetitive transcranial magnetic stimulation combined with task oriented training on lower extremity gross motor function and gait function of children with spastic hemiplegic cerebral palsy

ZHANG Qiu, LI Weiping, YU Jihua, DU Xinping, LING Yunqi, XU Fangyuan

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摘要

目的探讨低频重复经颅磁刺激(rTMS)联合任务导向性训练(TOT)对痉挛型偏瘫脑瘫下肢粗大运动及步行功能的影响,为改善痉挛型偏瘫脑瘫运动功能提供新思路。方法选取2021年8月—2022年9月在西南医科大学附属医院康复医学科门诊和/或入院3~6岁痉挛型偏瘫脑瘫75例,按随机数字表法分为常规组(n=25)、TOT组(n=25)以及rTMS+TOT组(n=25)。三组均接受常规康复治疗,其中TOT组额外接受TOT,rTMS+TOT组额外接受低频rTMS联合TOT,三组均治疗6周。在治疗前后分别对三组患儿下肢腓肠肌肌张力采用改良Ashworth量表(MAS)、下肢运动及步行功能选取粗大运动功能测试量表-88项(GMFM-88)D区(站立)、E区(走跑跳)、足印分析法进行评定。结果治疗6周后,三组患儿各项评分均较治疗前有所提高,差异具有统计学意义(P<0.05);其中组间比较,rTMS+TOT组MAS评分(H=20.995)、GMFM-88项D区和E区评分(F=12.348、19.428)、跨步长(F=2.137)、步宽(F=12.160)以及1min步行距离(F=8.705)均优于常规组和TOT组,差异具有统计学意义(P<0.05)。结论低频rTMS联合任务导向性训练可改善痉挛型偏瘫脑瘫下肢腓肠肌肌张力、提高下肢粗大运动和步行功能,且效果优于单独任务导向性训练。

Abstract

Objective To analyze the effect of low frequency repetitive transcranial magnetic stimulation (rTMS) combined with task oriented training (TOT) on lower extremity gross motor and gait function of children with spastic hemiplegic cerebral palsy, in order to provide new ideas for improving the motor function of spastic hemiplegic cerebral palsy. Methods From August 2021 to September 2022, 75 children aged 3 - 6 years with spastic hemiplegic cerebral palsy were selected into this study from the Outpatient and Inpatient Departments of Rehabilitation Medicine in the Affiliated Southwest Medical University, and were randomly divided into routine group (n=25), TOT group (n=25) and rTMS+TOT group (n=25). Children in the three groups all received conventional rehabilitation. Additionally, children in TOT group received TOT, children in rTMS+TOT group received TOT combined with low frequency rTMS. Children in the three groups were assessed with Modified Ashworth Scale (MAS), D and E domains of Gross Motor Function Measure-88(GMFM-88) and footprint analysis before and after treatment. Results After 6-week intervention, scores of the above indicators in the three groups improved significantly than those before intervention (P<0.05). Intergroup comparison showed that performance of MAS (H=20.995), D and E domains of GMFM-88 (F=12.348, 19.428), turnover step length (F=2.137), step width (F=12.160) and 1 minute walk test (1MWT) distance assessment (F=8.705) were significantly better than those in TOT group and routine group (P<0.05). Conclusion Low frequency rTMS combined with TOT could decrease the gastrocnemius muscle tone and improve the lower extremity gross motor and gait function in children with spastic hemiplegic cerebral palsy, and the effect is better than TOT alone.

导出引用

张秋, 李卫平, 虞记华, 杜鑫萍, 凌运其, 胥方元. 低频重复经颅磁刺激联合任务导向性训练对痉挛型偏瘫脑瘫患儿下肢粗大运动及其步行功能的疗效分析[J]. 中国儿童保健杂志. 2023, 31(11): 1248-1253 https://doi.org/10.11852/zgetbjzz2023-0103

ZHANG Qiu, LI Weiping, YU Jihua, DU Xinping, LING Yunqi, XU Fangyuan. Therapeutic effect of low frequency repetitive transcranial magnetic stimulation combined with task oriented training on lower extremity gross motor function and gait function of children with spastic hemiplegic cerebral palsy[J]. Chinese Journal of Child Health Care. 2023, 31(11): 1248-1253 https://doi.org/10.11852/zgetbjzz2023-0103

中图分类号： R742.3

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