节律性听觉刺激联合推拿对痉挛型脑瘫患儿下肢肌张力、关节活动度的影响

Effects of Rhythmic Auditory Stimulation Combined with Massage on Lower Limb Muscle Tension and Joint Range of Motion in Children with Spastic Cerebral Palsy

目的探讨节律性听觉刺激(RAS)联合推拿对痉挛型脑瘫(SCP)患儿下肢肌张力、关节活动度的影响.方法选择我院2019年10月—2021年10月收治的96例SCP患儿为研究对象,随机分为推拿组和联合组,各48例.推拿组采用推拿治疗,联合组采用推拿联合RAS治疗.对比两组的下肢肌张力、痉挛程度、关节活动度、智力发育情况.结果治疗前,两组的综合痉挛量表(CSS)评分、改良Ashworth量表(MAS)评分对比,组间差异无统计学意义(P>0.05);治疗3个月后,联合组的CSS评分、MAS评分分别为(10.58±1.35)分、(1.40±0.18)分,均低于推拿组的(11.40±2.16)分、(1.50±0.20)分,组间差异有统计学意义(P<0.05).治疗3个月后,联合组的左腘窝角、右腘窝角、内收肌角分别为(137.58±14.20)°、(139.97±12.40)°、(110.42±10.71)°,均大于推拿组的(130.64±13.80)°、(134.56±13.11)°、(105.44±11.69)°,左足背屈角、右足背屈角分别为(67.15±6.22)°、(63.55±6.37)°,均小于推拿组的(70.11±5.34)°、(67.40±7.40)°,组间差异有统计学意义(P<0.05).治疗3个月后,联合组的Gesell发育量表中的适应行为、个人-社交行为、语言行为、精细动作行为、大运动行为评分分别为(47.56±7.40)分、(46.80±6.81)分、(48.33±7.50)分、(46.50±6.34)分、(46.33±7.64)分,均高于推拿组的(40.25±6.81)分、(39.46±6.44)分、(41.32±6.15)分、(38.42±5.11)分、(40.25±6.37)分,组间差异有统计学意义(P<0.05).结论RAS联合推拿能显著缓解SCP患儿的下肢肌张力和痉挛程度,改善其关节活动度,且有助于促进其智力发育.

Objective To investigate the effects of rhythmic auditory stimulation(RAS)combined with massage on lower limb muscle tension and joint range of motion in children with spastic cerebral palsy(SCP).Methods 96 children with SCP admitted to the hospital from October 2019 to October 2021 were selected as the observation objects,and randomly divided into a massage group and a combined group,48 cases in each group.The massage group was treated with massage,and the combination group was treated with massage and RAS.The muscle tension of lower limbs,spasticity degree,joint range of motion and intellectual development of the two groups were compared.Results Before treatment,the compopsite spas scale(CSS)score and modified Ashworth scale(MAS)score of the two groups were compared,and the differences between the groups were not statistically significant(P>0.05);after 3 months of treatment,the CSS score and the MAS score of the combined group were(10.58±1.35)points and(1.40±0.18)points,respectively,which were lower than(11.40±2.16)points and(1.50±0.20)points of the massage group,and the differences between the groups were statistically significant(P<0.05).After 3 months of treatment,the left popliteal fossa angle,right popliteal fossa angle and adductor angle in the combined group were(137.58±14.20)°,(139.97±12.40)°and(110.42±10.71)°,respectively,which were greater than(130.64±13.80)°,(134.56±13.11)°and(105.44±11.69)°in the massage group,and the left foot dorsiflexion angle and right foot dorsiflexion angle were(67.15±6.22)°and(63.55±6.37)°,which were smaller than(70.11±5.34)°and(67.40±7.40)°in the massage group,and the differences between the groups were statistically significant(P<0.05).After 3 months of treatment,the scores of adaptive behavior,individual-social behavior,language behavior,fine motor behavior and gross motor behavior in the Gesell developmental scale of the combined group were(47.56±7.40)points,(46.80±6.81)points,(48.33±7.50)points,(46.50±6.34)points and(46.33±7.64)points,respectively,which were higher than(40.25±6.81)points,(39.46±6.44)points,(41.32±6.15)points,(38.42±5.11)points and(40.25±6.37)points in the massage group,and the differences between the groups were statistically significant(P<0.05).Conclusion RAS combined with massage can significantly relieve the lower limb muscle tension and spasticity degree of children with SCP,improve their joint range of motion and contributing to the promotion of intellectual development.