目的 比较不同频率全身振动疗法(WBVT)对痉挛型脑瘫患儿上肢运动功能及日常生活活动能力(ADL)的影响,为脑瘫患儿康复提供依据。 方法 选取2023年12月—2024年10月在西南医科大学附属医院就诊的91例6~12岁痉挛型脑瘫患儿为研究对象,按随机数字表法分为对照组(n=23)、10Hz组(n=22)、15Hz组(n=24)及20Hz组(n=22)。4组均进行常规康复训练,10Hz组、15Hz组及20Hz组分别额外接受振动频率为10Hz、15Hz及20Hz的WBVT,均治疗6周。治疗前后使用改良Ashworth量表(MAS)、Carroll双上肢功能评定量表(UE-FT)以及儿童功能独立性量表(WeeFIM)对所有患儿进行测定。结果 治疗6周后,4组儿童MAS评分(F=8.014)、UE-FT(F=15.737)、WeeFIM(F=17.525)得分比较,差异有统计学意义(P<0.05);LSD事后比较,10Hz组、15Hz组及20Hz组各项得分均优于对照组,其中20Hz组改善最显著(P<0.05)。 结论 常规康复训练联合WBVT可降低痉挛型脑瘫儿童上肢肌张力,改善上肢运动功能,并提高ADL,且20Hz的WBVT效果最佳。
Abstract
Objective To compare the effects of whole-body vibration training (WBVT) at different frequencies on upper limb motor function and activities of daily living (ADL) in children with spastic cerebral palsy (CP), in order to provide evidence for rehabilitation strategies. Methods A total of 91 children with spastic CP (aged 6 - 12 years) from the Affiliated Hospital of Southwest Medical University were enrolled between December 2023 and October 2024.Participants were randomly assigned to four groups: control group (n=23), 10Hz group (n=22), 15Hz group (n=24), and 20Hz group (n=22).All groups received conventional rehabilitation training, while the 10Hz, 15Hz, and 20Hz groups additionally underwent WBVT at their respective frequencies for 6 weeks.Outcomes were assessed pre- and post-intervention using the Modified Ashworth Scale (MAS), Carroll Upper Extremity Function Test (UE-FT), and Functional Independence Measure for Children (WeeFIM). Results After 6 weeks of treatment, significant differences were observed among the four groups in MAS scores (F=8.014), UE-FT scores (F=15.737), and WeeFIM scores (F=17.525) (P<0.05).Post-hoc LSD tests revealed that the 10Hz, 15Hz, and 20Hz groups showed superior outcomes compared to the control group, with the 20Hz group demonstrating the most significant improvements (P<0.05). Conclusions Conventional rehabilitation combined with WBVT can reduce upper limb muscle tone, improve motor function, and enhance ADL in children with spastic CP.Notably, WBVT at 20Hz appears to be the most effective frequency.
关键词
全身振动训练 /
痉挛型脑瘫 /
上肢运动 /
日常生活活动
Key words
whole body vibration /
spastic cerebral palsy /
upper extremities function /
activity daily living
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参考文献
[1] 中国康复医学会儿童康复专业委员会,中国残疾人康复协会小儿脑性瘫痪康复专业委员会,中国医师协会康复医师分会儿童康复专业委员会,等.中国脑性瘫痪康复指南(2022)第一章:概论[J].中华实用儿科临床杂志,2022,37(12):887-892.
Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al.Chinese rehabilitation guidelines for cerebral palsy (2022) part 1: Overview[J].Chin J Appl Clin Pediatr, 2022, 37(12):887-892.(in Chinese)
[2] Paul S,Nahar A, Bhagawati M, et al.A review on recent advances of cerebral palsy[J].Oxid Med Cell Longev, 2022, 2022(1):2622310-2622330.
[3] Oliva-Sierra M, Ríos-León M, Abuín-Porras V, et al.Effectiveness of mirror therapy and action observation therapy in infantile cerebral palsy: A systematic review[J].An Sist Sanit Navar, 2022,45(2):e1003-e1016.
[4] Shih TY, Wang TN, Shieh JY, et al.Comparative effects ofkinect-based versus therapist-based constraint-induced movement therapy on motor control and daily motor function in children with unilateral cerebral palsy: A randomized control trial[J].J Neuroeng Rehabil,2023,20(1):13-23.
[5] Pulay Má, Nagy R, Kói T, et al.The effect of additional whole-body vibration on musculoskeletal system in children with cerebral palsy: A systematic review and Meta-analysis of randomized clinical trials[J].J Clin Med,2023,12(21): 6759-6773.
[6] Cai X, Qian G, Cai S, et al.The effect of whole-body vibration on lower extremity function in children with cerebral palsy: A Meta-analysis[J].PLoS One, 2023,18(3):e0282604-e0282622.
[7] Tekin F, Kavlak E.Short and long-term effects of whole-body vibration on spasticity and motor performance in children with hemiparetic cerebral palsy[J].Percept Motor Skill,2021,128(3):1107-1129.
[8] Ali MS, Abd El-Aziz HG.Effect of whole-body vibration on abdominal thickness and sitting ability in children with spastic diplegia[J].J Taibah Univ Med Sci, 2020,16(3):379-386.
[9] 吴跃迪,李放,熊莉.改良Ashworth量表及改良Tardieu量表应用于卒中患者屈肘肌评估的信度比较[J].中国康复医学杂志,2013,28(12):1151-1152.
Wu YD, Li F,Xiong L.Comparison of the reliability of the modified Ashworth scale and the modified Tardieu scale applied to the flexor elbow muscle evaluation in stroke patients[J].Chin J Rehabil Med, 2013,28 (12): 1151-1152.(in Chinese)
[10] 何璐,徐开寿,邱晒红,等.Carroll上肢功能试验在痉挛型偏瘫儿童中的信度研究[J].中国康复医学杂志,2011,26(9):822-825.
He L, Xu KS,Qiu SH, et al.Carroll relireliability of upper limb function test in children with spastic hemiparesis[J].Chin J Rehabil Med, 2011,26 (9): 822-825.(in Chinese)
[11] 朱默,史惟.儿童功能独立检查量表的研究及应用[J].中国儿童保健杂志,2006,1(5):500-502.
Zhu M, Shi W.Study and application of Children Functional Independent Scale[J].Chin J Child Health Care, 2006,1(5):500-502.(in Chinese)
[12] Stewart K.Assessing dyskinesia in children with cerebral palsy: Moving forward: A commentary on development of a clinical framework for the assessment of dyskinesia and function in the upper limb in children with cerebral palsy[J].Phys Occup Ther Pediatr,2023,43(1):14-16.
[13] Mohamed MA, El-Dein MS, El-Deen SMN, et al.Sensory integration versus Masgutova neuro-sensorimotor reflex integration program on controlling primitive reflexes and gross motor abilities in children with diplegic cerebral palsy[J].Physiother Res Int,2023,28(4):e2030-e2039.
[14] Cheng HY,Ju YY, Chen CL, et al.Managing spastic hypertonia in children with cerebral palsy via repetitive passive knee movements[J].J Rehabil Med,2012,44(3):235-240.
[15] Peungsuwan P, Chatchawan U, Donpunha W, et al.Different protocols for low whole-body vibration frequency for spasticity and physical performance in children with spastic cerebral palsy[J].Children (Basel), 2023,10(3):458-460.
[16] 吴羽.不同低频全身振动训练对痉挛型脑瘫患儿下肢运动功能的影响[D].苏州:苏州大学,2023.
Wu Y.Effect of different low-frequency whole-body vibration training on lower limb motor function in children with spastic cerebral palsy[D].Suzhou: Soochow University, 2023.(in Chinese)
[17] Krause A,Schönau E, Gollhofer A, et al.Alleviation of motor impairments in patients with cerebral palsy: Acute effects of whole-body vibration on stretch reflex response, voluntary muscle activation and mobility[J].Front Neurol,2017,8(1):416-425.
[18] 康海燕,褚涛,高政,等.全身振动对卒中后踝关节跖屈肌群肌张力的作用分析[J].中国康复医学杂志,2021,36(10):1299-1301.
Kang HY, Chu T, Gao Z, et al.Analysis of the effect of whole body vibration on ankle plantar flexor group after stroke[J].Chin J Rehabil Med, 2021,36 (10): 1299-1301.(in Chinese)
[19] 王曼,肖莹莹,张园园,等.数字OT系统辅助下分析全身振动训练对脑瘫患儿精细运动能力影响的临床研究[J].中国儿童保健杂志,2023,31(5):491-496.
Wang M, Xiao YY, Zhang YY, et al.Clinical study on the effect of whole-body vibration training on fine motor ability in children with cerebral palsy with the assistance of digital OT system[J].Chin J Child Health Care, 2023,31 (5): 491-496.(in Chinese)
[20] Wong ML,Widerstrom-Noga E, Field-Fote EC.Effects of whole-body vibration on neuropathic pain and the relationship between pain and spasticity in persons with spinal cord injury[J].Spinal Cord,2022,60(11):963-970.
[21] Percival S, Sims T, Stebbings GK.Local vibration therapy, oxygen resaturation rate, and muscle strength after exercise-induced muscle damage[J].J Athl Train,2022,57(5):502-509.
[22] Chagas PSC,Magalhães EDD, Sousa Junior RR, et al.Development of children, adolescents, and young adults with cerebral palsy according to the ICF: A scoping review[J].Dev Med Child Neurol,2023,65(6):745-753.
[23] Mailleux L, Feys H.Upper limb strength training and somatosensory stimulation: Optimizing self-care independence for children with unilateral cerebral palsy[J].Dev Med Child Neurol,2019,61(9):998.
[24] 王浩,吴洁,王栋,等.全身振动疗法对痉挛型脑瘫患儿坐位及整体运动平衡能力的影响[J].浙江临床医学,2023,25(9):1304-1306.
Wang H, Wu J, Wang D, et al.Effects of whole body vibration therapy on sitting and overall motor balance in children with spastic cerebral palsy[J].Zhejiang Clin Med, 2023,25 (9): 1304-1306.(in Chinese)
[25] Wuestefeld A, Fuermaier ABM, Bernardo-Filho M, et al.Towards reporting guidelines of research using whole-body vibration as training or treatment regimen in human subjects-A Delphi consensus study[J].PLoS One, 2020, 15(7):e0235905-e0235935.
基金
四川省科学技术厅社会发展项目(23ZDYF2793)
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