目的 分析经颅直流电刺激干预治疗对脑瘫患儿精细运动功能的影响,为临床应用提供理论依据。方法 选取2019年6月—2019年12月在郴州市第一人民医院康复科就诊的60例患者随机分为两组,观察组(30例)采用经颅直流电刺激联合常规康复治疗,对照组(30例)采用常规康复治疗。两组治疗均为1次/d,5次/周,共治疗6周。治疗前后观察两组的Peabody精细运动发育量表(PDMS-FM)与精细运动功能评估量表(FMFM)指数变化,分析疗效差异。结果 观察组和对照组总有效率差异无统计学意义(92.9%vs.82.5%,χ2=0.74,P＞0.05),两组愈显率差异有统计学意义(67.9%vs.37.3%,χ2=5.24,P<0.05);组间比较,治疗后观察组PDMS-FM量表中的抓握、视觉运动整合、粗细运动商(t/t′=4.71、2.54、2.67)与FMFM量表各项目评分(t/t′=4.35、2.74、3.31、2.52、2.15、2.58)均高于对照组,差异有统计学意义(P<0.05或<0.01);组内比较,两组治疗前后的PDMS-FM量表中的抓握、视觉运动整合、精细运动商(观察组t=16.67、23.13、6.59,对照组t=7.42、14.81、2.71)与FMFM量表各项目评分(观察组t/t′＝12.10、13.51、16.16、12.62、9.64、14.28,对照组t/t′＝8.46、12.11、9.26、19.95、12.97、15.79)均高于治疗前,差异均有统计学意义(P<0.01或<0.05)。结论 两种治疗方法对脑瘫患儿精细运动功能改善均有效,但结合经颅直流电刺激干预治疗的总体疗效要优于单一的常规康复治疗。
Abstract
Objective To analyze the effect of transcranial direct current stimulation (tDCS) intervention on fine motor function in children with cerebral palsy, in order to provide theoretical reference for clinical application. Methods A total of 60 children with cerebral palsy aged 4 to 6 years were selected in the rehabilitation department of Chenzhou First People′s Hospital from June to December 2019, and were randomly divided into 2 groups. The control group (n=30) was treated with conventional rehabilitation, while the observation group (n=30) was given tDCS additionally. Both groups were treated for 6 weeks, with a frequency of 1 time/day, 5 days/week. The Peabody Fine Motor Development Scale (PDMS-FM) and Fine Motor Function Evaluation Scale (FMFM) were used to evaluate the changes of the two groups. Then the effect of intervention was compared. Results There was no significant difference in total effective rate between observation group and control group (92.9%vs.82.5%,χ2=0.74, P>0.05). However, difference in recovery rate between the two groups was found significant (67.9%vs.37.3%,χ2=5.24, P<0.01). After treatment, PDMS-FM scores of grasping, visual motor integration, fine motor quotient (t/t′=4.71, 2.54, 2.67) and each item in FMFM scale index (t/t′=4.35, 2.74, 3.31, 2.52, 2.15, 2.58) in observation group was significantly higher than those in control group (P<0.01 or <0.05). In both observation group and control group, PDMS-FM scale index (observation group t=16.67,23.13,6.59 and control group t=7.42, 14.81, 2.71) and each item in FMFM scale index (observation group t/t′=12.10, 13.51, 16.16, 12.62, 9.64, 14.28 and control group t/t′=8.46, 12.11, 9.26, 19.95, 12.97, 15.79) after treatment scored higher than that before treatment (P<0.01 or <0.05). Conclusion Both treatments can effectively improve fine motor function of children with cerebral palsy, but rehabilitation combined tDCS intervention therapy has a better overall efficacy than conventional rehabilitation therapy alone.
关键词
经颅直流电刺激 /
脑瘫 /
康复治疗 /
精细运动
Key words
transcranial direct current stimulation /
cerebral palsy /
rehabilitation treatment /
fine motor
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 徐艳,谢文龙,何凤翔.前馈控制结合躯干训练对小儿脑瘫患儿运动发育恢复及随访的影响[J].中国儿童保健杂志,2019,27(8):889-892.
[2] 贾飞勇.新生儿脑损伤的预后与康复[J].中国儿童保健杂志,2020,28(11):1185-1187,1192.
[3] 李晓捷,陈秀洁,姜志梅.实用小儿脑性瘫痪康复治疗技术[M].2版.北京:人民卫生出版社,2016:245.
[4] FlemingMK,Theologis T,Buckingham R,et al.Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review[J].J Neuroeng Rehabil,2018,15(1):121-128.
[5] 唐久来,秦炯,邹丽萍,等.中国脑性瘫痪康复指南(2015):第一部分[J].中国康复医学杂志,2015,30(7):747-754.
[6] Bikson M,Paulus W,Esmaeilpour Z,et al.Mechanisms of acute and after effects of transcranial direct current stimulation[M]//knotkova H,Nitsche M,Bikson M,et al.Practical guide to Transcranial direct current stimulation.Cham:Springer,2019.
[7] KimYH.Noninvasive brain stimulation: repetitive transcranial magnetic stimulation and transcranial direct current stimulation[J].J Korean Med Assoc,2013,56(1):30-37.
[8] Minhas P,Bikson M,Woods AJ,et al.Transcranial direct current stimulation in pediatric brain:a computational modeling study[J].Conf Proc IEEE Eng Med Biol Soc, 2012,2012:859-862.
[9] 李明,黄真.Peabody运动发育量表[M].北京:北京大学医学出版社,2006:5-7.
[10] 徐东浩,史惟,李惠,等,脑瘫儿童精细运动功能测试量表的效度和反应度研究[J].中国康复医学杂志,2008,23(11):1010-1013.
[11] 赵德智. “补肾健脑针法”联合康复训练对痉挛型脑瘫患儿精细运动功能影响的临床研究[D].南京:南京中医药大学,2018.
[12] 张琼,高喜容.超低出生体重儿神经发育损伤的预防和预后研究进展[J].中国医师杂志,2016,18(1):148-150.
[13] DoyleLW,Clucas L,Roberts G,et al.The cost of long-term follow-up of high-risk infants for research studies[J].J Paediatr Child Health,2015,51(10):1012-1016.
[14] Stagg CJ,Nitsche MA.Physiological basis of transcranial di-rect current stimulation[J].Neuroscientist,2011,17(1):37-53.
[15] Carlsen AN,Eagles JS ,Mackinnon CD.Transcranial direct current stimulation over the supplementary motor area modulates the preparatory activation level in the human motor system[J].Behav Brain Res,2015,279:68-75.
[16] 池林.经颅直流电刺激对严重意识障碍患者的临床疗效研究[D].石家庄:河北医科大学,2017.
[17] 孔红涛,李三松.中药熏洗方联合小脑电刺激对脑瘫儿童的康复效果研究[J].陕西中医,2018,39(8):1098-1100,1104.
[18] Hordacre B,Moezzi B,Ridding MC.Neuroplasticity and network connectivity of the motor cortex following stroke: A transcranial direct current stimulation study[J].Hum Brain Mapp,2018,39(8):3326-3339.
[19] 张洪,刘静,杨未风,等.经颅直流电刺激联合常规言语康复治疗脑卒中后非流畅性失语症的疗效观察[J].康复学报,2017,27(3):39-42,46.
基金
湖南省残疾人康复科研项目(2019XK024)
PDF(470 KB)
