步态诱发功能性电刺激联合减重平板训练治疗痉挛型脑性瘫痪儿童临床研究

Rehabilitation Efficacy of Gait Induced Functional Electrical Stimulation Combined with Body-Weight Supported Treadmill Training on Children with Spastic Cerebral Palsy

目的:探讨步态诱发功能性电刺激(FES)联合减重平板训练(BWSTT)对痉挛型脑性瘫痪(SCP)儿童粗大运动功能和步行功能的影响。方法:选择2022年3月—2023年3月在同济大学附属上海市第四人民医院就诊的SCP儿童60例,采用SAS软件随机数字模块产生随机序列分为对照组、减重平板训练组和联合干预组,每组20例。对照组接受常规康复训练,1次/d,40 min/次,5 d/周,共训练8周。减重平板训练组在对照组基础上接受BWSTT,平板坡度0°,初始速度0.09 m/s,以0.03 m/s增量逐渐调整至患儿可承受的适宜速度,初始减重为患儿体质量的30%,逐渐调整至完全支撑患儿自身体质量为宜。联合干预组在减重平板训练组基础上接受步态诱发FES,使用低频电子脉冲刺激仪刺激患儿的腓总神经和胫前肌,刺激强度以出现踝背伸和外翻的理想动作且患儿能够耐受为宜。2组均训练1次/d,20 min/次,5 d/周,共8周。分别于治疗前后采用粗大运动功能评定量表88项(GMFM-88)D区(站立)和E区(走跑跳)评估患儿粗大运动功能;采用六分钟步行试验(6MWT)评估患儿步行功能;采用生理消耗指数(PCI)评估患儿的步行效率;分析患儿跨步长、步宽和步速等步态参数。结果:与治疗前比较,3组治疗后GMFM-D、GMFM-E评分,6MWT,跨步长和步速均明显升高,PCI、步宽均明显降低,差异具有统计学意义(P<0.05)。与对照组比较,减重平板训练组和联合干预组治疗后GMFM-D、GMFM-E评分,6MWT,跨步长和步速均明显更高,PCI、步宽均明显更低,差异具有统计学意义(P<0.05)。与减重平板训练组比较,联合干预组治疗后GMFM-D、GMFM-E评分,6MWT,跨步长和步速均明显更高,PCI、步宽均明显更低,差异具有统计学意义(P<0.05)。结论:步态诱发FES联合BWSTT能改善SCP儿童运动功能,纠正异常步态,提高步行效率,值得在临床推广。

Objective:To observe the effect of gait induced functional electrical stimulation(FES)combined with body-weight supported treadmill training(BWSTT)on gross motor function and walking function of children with spastic cerebral palsy(SCP).Methods:A total of 60 children with spastic cerebral palsy in the Shanghai Fourth People's Hospital Affiliated to Tongji University from March 2022 to March 2023 were randomly divided into control group,BWSTT group and combined intervention group according to a randomized sequence by SAS software,with 20 cases in each group.The control group received conventional rehabilitation therapy,once a day,40 minutes a time,five days a week,lasting for eight weeks.The BWSTT group received body-weight supported treadmill training in addition to the training of the control group.The slope of the plate was 0°,the initial speed was 0.09 m/s,and the increment of 0.03 m/s was gradually adjusted to the appropriate speed that the child could walk with.The initial weight support was 30%of the child's body mass,and it was gradually adjusted to fully support the child's own body mass.The combined intervention group received gait induced FES in addition to the training of the BWSTT group.A low-frequency electronic pulse stimulator was used to stimulate the common peroneal nerve and anterior tibialis muscle of the children,and the stimulation intensity was set at the desirable movements of ankle dorsiflexion and valgus,and could be tolerated by the children,once a day,20 minutes a time,five days a week,lasting for eight weeks.Before and after treatment,D(standing)and E(walking,running and jumping)zones of the 88-item gross motor function measurement 88(GMFM-88)was used to assess the children's gross motor function;six-minute walking test(6MWT)was used to assess walking function;physiological expenditure index(PCI)was used to evaluate walking efficiency;and gait parameters of the children(such as stride length,stride width and stride speed)were analyzed.Results:Compared with that before treatment,GMFM-D and GMFM-E scores,6MWT,stride length and stride speed were significantly higher and PCI and stride width were significantly lower in the three groups after treatment,and the differences were statistically significant(P<0.05).Compared with the control group,GMFM-D and GMFM-E scores,6MWT,stride length and stride speed were significantly higher,and PCI and stride width were significantly lower in the BWSTT group and the combined intervention group after treatment,and the differences were statistically significant(P<0.05).Compared with the BWSTT group,the GMFM-D,GMFM-E scores,6MWT,stride length and stride speed were significantly higher,and PCI and stride width were significantly lower in the combined intervention group after treatment,and the differences were statistically significant(P<0.05).Conclusion:Gait-induced FES combined with BWSTT can improve motor function,correct abnormal gait,and improve walking efficiency in children with SCP,which is recommended for clinical application.