经皮电神经刺激对痉挛型脑性瘫痪患儿运动功能影响的对照研究

Effects of transcutaneous electrical nerve stimulation on motor function in ambulant children with spastic cerebral palsy: a randomized trial

目的观察经皮电神经刺激(TENS)结合功能训练对痉挛型脑性瘫痪(脑瘫)患儿运动功能的影响。方法 78例脑瘫患儿,年龄36～58个月[(45.6±8.5)个月],通过计算机分层(性别、年龄)后随机分为 TENS 组(40例)和对照组(38例)。2组患儿均接受功能训练。TENS 组使用2台TENS 治疗仪(每台2个输出通道),8个表面电极放在下肢痉挛肌群的两端肌腱和拮抗肌肌腹给予电刺激,每次20 min。以上治疗每日1次,每周5次,共治疗30次。之后指导家长实施家庭康复治疗。治疗前,治疗后的6、12、24周随访时进行以下评定:①综合痉挛量表(CSS),②粗大运动功能量表(GMFM)中的 D 和 E 两项,③步行速度。结果两组患儿的 CSS 评分、GMFM 评分及步行速度治疗前差异无统计学意义(P>0.05),治疗后6、12、24周组内差异均有统计学意义(P 均<0.05)。2组患儿的 CSS 评分、GMFM 评分及步行速度在治疗后6、12、24周组间差异均有统计学意义(治疗后24周:t 值分别为8.96、3.14、2.35,P 均<0.05)。结论与对照组比较,在痉挛型脑瘫患儿的患侧肢体上给予 TENS 治疗6周,能明显降低患儿下肢痉挛,提高其站立、步行功能和步行速度。

Objective To investigate the effects of transcutaneous electrical nerve stimulation （TENS） on motor function in children with spastic cerebral palsy （CP）. Methods After signing the informed consent, 78 children with CP, aged 45.6 ± 8.5 months （ 36 to 58 months）, were randomly divided into a TENS group （n =40） and a control group （n =38）. All the subjects received standardized functional exercise program. In TENS group, 2 TENS devices were used and the surface electrodes were applied on the spastic musculotendinous and antagonist muscles in the affected lower extremity. TENS lasted for 20 min per session, 5 days weekly for 6 weeks. After 6 weeks, the functional exercise program was applied by the caregivers. Demographic data were recorded, including age, gender, number of the hemiplegic and diplegic CP, level of gross motor function classification system （GMFCS）. Clinical assessments included the composite spasticity scale （ CSS）, D and E dimensions of the Gross Motor Function Measure （ GMFM）, and walking velocity was determined before treatment and at 6, 12 and 24 weeks after treatment. Results No statistically significant differences were found in age, gender, number of the bemiplegic and diplegic CP, level of GMFCS, as well as clinical assessments （CSS, GMFM and walking velocity） before treatment between the 2 groups （P 〉0. 05）. All the children showed a reduction of spasticity （CSS） after 6, 12 and 24 weeks of treatment （ P 〈 0.05 ）. When compared with the results obtained before treatment, the improvement of standing and walking （GMFM）, walking velocity was statistically significant after 6, 12 and 24 weeks of treatment （P 〈 0. 05 ）. Furthermore, the differences of CSS, GMFM and walking velocity between the two groups at 6, 12 and 24 weeks examination were also statistically significant （ after 24 weeks of treatment： t value was 8.96, 3. 14 and 2. 35, P 〈 0. 05, respectively）. Conclusion When compared with the control group, 6 weeks of TENS treatment on the affected lower extremity was more effective in terms of reducing spasticity and improving functional performance in standing, walking, and walking velocity in ambulant children with the spastic CP.