经颅磁刺激术联合康复训练对脑性瘫痪患儿日常精细动作及认知功能发育的影响

Effects of Transcranial Magnetic Stimulation Combined With Rehabilitation Therapy on the Daily Fine Motor and Cognitive Development of Cerebral Palsy Children

目的：探究经颅磁刺激术联合康复训练对脑性瘫痪患儿日常精细动作及认知功能发育的影响。方法选取2014年7月—2015年10月徐州市儿童医院康复科收治的脑性瘫痪患儿55例，采用随机数字表法将其分为研究组（28例）和对照组（27例）。研究组患儿给予经颅磁刺激术联合康复训练治疗，对照组患儿给予康复训练治疗。观察研究组患儿完成治疗情况；治疗前及治疗3个月后，采用 Peabody 运动发育量表评分评定两组患儿日常精细动作（包括抓握能力评分及视觉-运动综合能力评分），采用 Gesell 发育诊断量表发育商数（DQ）评定两组患儿认知功能发育情况（包括个人-社交能区、适应性能区、语言能区、精细运动能区、大运动能区 DQ）。结果研究组患儿均完成经颅磁刺激术，少数患儿开始治疗时出现哭闹，2-3次后可安静接受治疗，脑电图复查均未见异常；治疗过程中无患儿出现头疼、头晕、异常病理反射。治疗前两组患儿抓握能力及视觉-运动综合能力评分比较，差异无统计学意义（ P〉0.05）；治疗后研究组患儿抓握能力及视觉-运动综合能力评分均高于对照组（ P 〈0.05）。治疗前两组患儿个人-社交能区、适应性能区、语言能区、精细运动能区、大运动能区 DQ 比较，差异无统计学意义（P 〉0.05）；治疗后两组患儿语言能区 DQ 比较，差异无统计学意义（P 〉0.05）；治疗后研究组患儿个人-社交能区、适应性能区、精细运动能区、大运动能区 DQ 均高于对照组（P 〈0.05）。结论经颅磁刺激术联合康复训练能改善脑性瘫痪患儿日常精细动作及认知功能发育，简单易行，且安全性较高。

Objective To investigate the effects of transcranial magnetic stimulation combined with rehabilitation therapy on the daily fine motor and cognitive development of cerebral palsy children. Methods We selected 55 cerebral palsy children who were hospitalized in the Rehabilitation Department of Xuzhou Children′s Hospital between July 2014 and Octber 2015 as subjects,and divided them into treatment group（28 cases）and control group（27 cases）in accordance with random number table. Transcranial magnetic stimulation combined with rehabilitation training was given to the treatment group, while rehabilitation training was given to the control group. Before treatment and after 3 - month treatment,we evaluated the daily fine motor（including grasping ability and vision - move comprehensive ability）of the two groups by Peabody Developmental Motor Scale,and evaluated the cognitive development （ including individual - social skills area, adaptability area, linguistic competence area,fine motor area,gross motor area）of the two groups in accordance with Gesell developmental diagnosis scale. Results All the children in the treatment group finished transcranial magnetic stimulation treatment. Some of them cried or screamed at the beginning,but after 2 to 3 times,they calmed down and received the treatment quietly. Electroencephalogram＆amp;nbsp;review didn′t show any abnormal signs. In the process of the treatment,no children had headache,dizziness,or other abnormal pathological reflex. Before the treatment,the evaluation on the grasping ability and vision - move comprehensive ability showed no statistically significant difference between the two groups（P 〉 0. 05）. After the treatment,the grades of the grasping ability and vision - move comprehensive ability of the treatment group were both higher than those of the control group（P 〈 0. 05）. Before the treatment,the development quotients of the individual - social skills area,adaptability area,linguistic competence area, fine motor area,gross motor area showed no statistically significant difference between the two groups（ P 〉 0. 05）. After the treatment,the two groups were not significantly different in the development quotient of linguistic competence area（P 〉 0. 05）;the development quotients of individual - social skills area,adaptability area,fine motor area,gross motor area of the treatment group were all higher than those of the control group（P 〈 0. 05）. Conclusion Transcranial magnetic stimulation combined with rehabilitation training has positive clinic effects on the daily fine motors and cognitive development of the cerebral palsy children. It is easy and safe to be implemented.