目的 观察分析离心收缩训练联合强制诱导运动疗法(CIMT)对痉挛型偏瘫脑瘫儿童上肢运动功能及表面肌电特征的影响,为临床儿童康复治疗提供参考。方法 选取2020年1月—2021年6月就诊于南通市妇幼保健院的符合纳入标准的42例痉挛型偏瘫脑瘫儿童随机分为联合组和对照组,每组21例。对照组采用常规康复训练及CIMT治疗,联合组在对照组基础上,进行离心收缩训练治疗。比较治疗前和治疗12周后两组儿童的改良Ashworth肌张力评定量表(MAS)、Carroll上肢功能评定量表(UEFT)、改良Barthel指数(MBI)得分以及表面肌电图(sEMG)检测的患侧肱二头肌的均方根值(RMS)。结果 治疗前,两组儿童的MAS评分、UEFT评分、MBI评分及肱二头肌表面肌电RMS组间比较,差异均无统计学意义(P＞0.05);治疗后,联合组和对照组UEFT评分、MBI评分均较治疗前明显提高(P＜0.05),且联合组较对照组的两项评分提高更明显(t=2.641、7.258,P＜0.05);而联合组和对照组MAS评分、肱二头肌表面肌电RMS均较组内治疗前明显降低(P＜0.05),且联合组较对照组降低更明显,差异均有统计学意义(Z=2.706、t＝3.623,P＜0.05)。结论 离心收缩训练联合强制诱导运动疗法可以更显著改善痉挛型偏瘫儿童屈肘肌群痉挛状态,提高上肢运动功能和日常生活活动能力,值得临床推广。
Abstract
Objective To observe the effects of eccentric exercise combined with constraint-induced movement therapy(CIMT) on the upper limb function and activities of daily living in children with spastic hemiplegic cerebral palsy, so as to provide reference for the clinical treatment and rehabilitation. Methods A total of 42 children with spastic hemiplegic cerebral palsy, who were treated in Nantong Maternal and Child Health Care Hospital from January 2020 to June 2021 and met the inclusion criteria, were enrolled in this study and were randomly divided into combined group(n=21) and control group(n=21). Both combined group and control group received traditional rehabilitation and CIMT, while the combined group received eccentric exercise therapy additionally. The upper limb flexor muscle tension, upper limb and hand function and activities of daily living of the two groups were assessed by the modified Ashworth scale(MAS), Carroll upper extremities functional test(UEFT), modified Barthel index(MBI) and root mean square value(RMS) of the surface electromyography of the biceps brachii, and were compared before and after 12-week treatment. Results Before treatment, the MAS score, UEFT score, MBI score and RMS of the surface electromyography of the biceps brachii were not significantly different between combined group and control group(P＞0.05). After 12 weeks of treatment, both UEFT score and MBI score of the two groups were significantly improved than those before treatment(P＜0.05), and the scores of the combined group increased more significantly than the control group(t=2.641, 7.258, P＜0.05). The MAS scores and RMS in the two groups were significantly lower than those before treatment(P＜0.05), and the scores of the combined group were significantly lower than those of the control group(Z=2.706, t=3.623, P＜0.05). Conclusions Eccentric contraction training combined with CIMT can improve the tension of the elbow flexion muscle, the upper limb motor function and activities of daily living in children with spastic hemiplegic cerebral palsy, which is worthy of wide use in clinic.
关键词
离心收缩 /
强制诱导运动疗法 /
痉挛型偏瘫 /
上肢运动功能 /
表面肌电图
Key words
eccentric contraction /
constraint-induced movement therapy /
spastic hemiplega /
upper limb motor function /
surface electromyography
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参考文献
[1] 中华医学会儿科学分会康复学组.儿童脑性瘫痪运动障碍的康复建议[J].中华儿科杂志,2020,58(2):91-95.
[2] 唐久来.脑性瘫痪康复理念和技术的最新进展[J].中国儿童保健杂志,2017, 25(5):433-436.
[3] 胡继红,张惠佳,罗卫红,等.虚拟现实技术结合作业疗法对痉挛型偏瘫脑瘫患儿上肢功能康复的影响[J].中华物理医学与康复杂志,2016,38(12):916-919.
[4] Klevberg GL,Jahnsen R,Elkjaer S,et al. Hand use development in children with unilateral cerebral palsy[J]. Dev Med Child Neurol,2021, 63(12):1462-1468.
[5] 彭光阳.镜像疗法对痉挛型偏瘫患儿上肢功能的影响[J].中国儿童保健杂志, 2018,26(7):803-805,810.
[6] 吴蕴.强制诱导运动疗法和手-臂双侧强化训练在痉挛型偏瘫儿童上肢功能干预中的运用[J].中国儿童保健杂志,2021,29(4):401-404.
[7] 何小辉,张娜,陆莹,等.上肢力量训练对脑瘫患儿手功能和日常生活活动能力的影响[J].中国康复,2021,36(5):282-285..
[8] Duchateau J,Enoka RM. Neural control of lengthening contractions[J]. J Exp Biol,2016,219(Pt2):197-204.
[9] 徐仁杰,张玉鑫,施加加.小腿三头肌低强度离心收缩与跟腱牵伸训练治疗跟腱挛缩的疗效对比研究[J].中国康复,2021,36(2):102-105.
[10] 黄信萍,李鑫,刘师宇,等.离心运动神经控制的研究进展[J].中国康复理论与实践,2021,27(1):97-101.
[11] Lepley LK,Lepley AS,Onate JA,et al.Eccentric exercise to enhance neuromuscular control[J]. Sports Health,2017,9(4):333-340.
[12] Meseguer-Henarejos AB,Sánchez-Meca J,López-Pina JA, et al. Inter-and intra-rater reliability of the Modified Ashworth Scale:A systematic review and meta-analysis[J]. Eur J Phys Rehabil Med, 2018,54(4):576-590.
[13] 魏亚敏,姜志梅,汤敬华,等.动作观察疗法对痉挛型脑性瘫痪偏瘫患儿上肢功能的效果[J].中国康复理论与实践,2018,24(04):432-436.
[14] 王军,郎永斌,杜江华,等.悬吊运动训练对痉挛型脑瘫患儿运动及平衡功能的影响[J].中国当代儿科杂志,2018,20(06):465-469.
[15] 杨晴,王秋,李娜,等.手功能分级系统在脑性瘫痪中的应用研究[J].中国儿童保健杂志,2020,28(4):419-422.
[16] Kruse A,Schranz C,Tilp M,et al. Muscle and tendon morphology alterations in children and adolescents with mild forms of spastic cerebral palsy[J]. BMC Pediatr,2018,18(1):156.
[17] Van Campenhout A,Bar-On L. Knee contracture in children with cerebral palsy:association with muscle lengths[J]. Dev Med Child Neurol,2018,60(4):335-336.
[18] Reid S,Hamer P,Alderson J,et al. Neuromuscular adaptations to eccentric strength training in children and adolescents with cerebral palsy[J]. Dev Med Child Neurol,2010,52(4):358-363.
[19] Garnier YM,Paizis C,Lepers R. Corticospinal changes induced by fatiguing eccentric versus concentric exercise[J]. Eur J Sport Sci,2019, 19(2):166-176.
[20] Perrey S. Brain activation associated with eccentric movement:A narrative review of the literature[J]. Eur J Sport Sci,2018,18(1):75-82.
[21] Clos P,Lepers R,Garnier YM. Locomotor activities as a way of inducing neuroplasticity:Insights from conventional approaches and perspectives on eccentric exercises[J]. Eur J Appl Physiol,2021,121(3):697-706.
[22] Semmler JG,Hand BJ,Sasaki R,et al. Age-related changes in motor cortex plasticity assessed with non-invasive brain stimulation:An update and new perspectives[J]. Exp Brain Res,2021,239(9):2661-2678.
[23] Howatson G,Taylor MB,Rider P,et al. Ipsilateral motor cortical responses to TMS during lengthening and shortening of the contralateral wrist flexors[J]. Eur J Neurosci,2011,33(5):978-990.
[24] Cash RF,Murakami T,Chen R,et al. Augmenting plasticity induction in human motor cortex by disinhibition stimulation[J]. Cereb Cortex,2016, 26(1):58-69.
[25] Douglas J,Pearson S,Ross A,et al. Chronic adaptations to eccentric training:A systematic review[J]. Sports Med,2017,47(5):917-941.
[26] Kaux JF,Libertiaux V,Leprince P,et al. Eccentric training for tendon healing after acute lesion:A rat model[J]. Am J Sports Med,2017,45(6):1440-1446.
基金
南通市卫生健康委员会科研项目(QA2020033);江苏省预防医学科研课题项目(Y2018041);南通市市级科技计划科研项目(MSZ20009);南通市科技局指令性项目(MS12020038)
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