手-臂双侧强化训练联合重复经颅磁刺激对痉挛偏瘫型脑瘫患儿精细运动功能的影响

Effect of Hand-arm Bilateral Intensive Training Combined with Repetitive Transcranial Magnetic Stimulation on Fine Motor Function in Children with Spastic Hemiplegic Cerebral Palsy

目的:探讨痉挛偏瘫型脑瘫患儿应用手-臂双侧强化训练(HABIT)联合重复经颅磁刺激(rTMS)对其上肢精细运动功能的影响。方法:回顾性分析2022年1月—2023年3月泉州市妇幼保健院·儿童医院康复科收治的84例痉挛偏瘫型脑瘫患儿的临床资料,按照不同治疗方案分为两组,各42例。两组均予常规康复训练,对照组采用rTMS治疗,观察组在对照组治疗基础上联合HABIT。比较两组治疗前后精细运动功能评估量表(FMFM)评分百分数及Peabody运动发育量表评分。结果:治疗前,两组FMFM评分及Peabody运动发育量表评分比较,差异无统计学意义(P>0.05);治疗后,两组FMFM中A区、B区评分及总分百分数比较,差异无统计学意义(P>0.05);治疗后,观察组FMFM量表中C区、D区、E区评分百分数高于对照组,差异有统计学意义(P<0.05)。治疗后,两组抓握、视觉-运动整合、精细运动商评分均高于治疗前,且观察组明显高于对照组,差异有统计学意义(P<0.05)。结论:痉挛偏瘫型脑瘫患儿应用HABIT联合rTMS治疗能够改善其上肢精细运动功能。

Objective:To investigate the effects of hand-arm bilateral intensive training(HABIT)combined with repetitive transcranial magnetic stimulation(rTMS)on the fine motor function of upper limbs in children with spastic hemiplegic cerebral palsy.Method:Clinical data of 84 children with spastic hemiplegic cerebral palsy admitted to the Department of rehabilitation of Quanzhou Woman's and Children's Hospital from January 2022 to March 2023 were retrospectively analyzed.They were divided into two groups according to different treatment plans,with 42 cases in each group.Both groups were given routine rehabilitation treatment,the control group was treated with rTMS,and the observation group was treated with HABIT on the basis of the control group.The scores of fine motor function measure scale(FMFM)percentage and Peabody motor development scale before and after treatment were compared between the two groups.Result:Before treatment,there were no significant differences in FMFM score and Peabody motor development scale score between the two groups(P>0.05).After treatment,there were no significant differences in the scores of A area,B area and total percentage of FMFM between the two groups(P>0.05).After treatment,the scores in C area,D area and E area of FMFM scale in observation group were higher than those in control group,and the differences were statistically significant(P<0.05).After treatment,the scores of grasping,visual-motor integration and fine motor quotient in both groups were higher than those before treatment,and which in the observation group were significantly higher than those in the control group,the differences were statistically significant(P<0.05).Conclusion:HABIT combined with rTMS can improve the fine motor function of upper limbs in children with spastic hemiplegic cerebral palsy.