经颅磁刺激配合肌力训练改善脑瘫患儿认知和运动功能的研究

Improvement effect of transcranial magnetic stimulation in combination with functional strength training on cognitive function and motor function in pediatric patients with cerebral palsy

目的探讨经颅磁刺激联合功能性肌力训练对脑瘫患儿认知功能和运动功能的改善作用。方法收集2016年1月至2017年6月于舟山普陀医院康复医学科治疗的64例脑瘫患儿作为观察对象,按照随机数字表法随机分为对照组32例和观察组32例。对照组给予功能性肌力训练,观察组在对照组基础上联合经颅磁刺激治疗。分别采用韦氏幼儿智力量表(WPPSI)评分、粗大运动功能评估量表(GMFM)评分和Peabody精细运动发育量表评分评价患儿的认知功能、粗大运动功能和双手精细运动能力,并进行统计分析。结果治疗前,两组患儿WPPSI评分、GMFM评分、Peabody评分中的抓握和视觉-运动统合评分均无显著性差异(t值分别为1.21、0.82、0.35、0.31,均P>0.05)。治疗后,两组患儿WPPSI评分较治疗前均有所升高(t值分别为3.44、5.66,均P<0.05);与对照组相比,观察组患儿治疗后WPPSI评分显著升高,且差异有统计学意义(t=3.47,P<0.05)。治疗后,两组患儿GMFM评分较治疗前均有所升高(t值分别为5.84、9.63,均P<0.05);与对照组相比,观察组患儿治疗后GMFM评分显著升高,且差异有统计学意义(t=4.29,P<0.05)。治疗后,两组患儿Peabody评分中的抓握、视觉-运动统合评分较治疗前均有所升高(t值分别为4.56、8.26、2.87、6.11,均P<0.05);与对照组相比,观察组患儿Peabody评分中的抓握、视觉-运动统合评分显著升高,且差异均有统计学意义(t值分别为3.96、3.05,均P<0.05)。结论经颅磁刺激联合功能性肌力训练在脑瘫患儿中应用效果良好,能够有效地改善患儿的认知功能和运动功能,临床上值得应用。

Objective To investigate the improvement effect of transcranial magnetic stimulation(TMS)in combination with functional strength training on cognitive function and motor function in pediatric patients with cerebral palsy(CP).Methods Sixtyfour pediatric patients with CP were collected from January 2016 to June 2017 as observational objects in Department of Rehabilitation Medicine in Putuo Hospital of Zhoushan,and they were randomly divided into control group(n=32)and observation group(n=32).The control group was given treatment of functional strength training.Besides that,the observation group was given treatment of TMS.Wechsler Preschool and Primary Scale of Intelligence(WPPSI),Gross Motor Function Measure(GMFM)and Peabody Fine Motor Development Scale were employed to assess cognitive function,gross motor function and fine exercise ability of both hands respectively.Scores of WPPSI,GMFM and Peabody were compared between two groups.Results Before treatment,there were no significant differences in WPPSI score,GMFM score,and score for grasp and for visual motor integration in Peabody Fine Motor Development Scale between two groups(t value was 1.21,0.82,0.35 and 0.31,respectively,all P>0.05).After treatment,WPPSI score increased in two groups(t value was 3.44 and 5.66,respectively,both P<0.05).Comparison with the control group,the observation group had higher score of WPPSI with statistical significance(t=3.47,P<0.05).GMFM scores were higher in two groups after treatment(t value was 5.84 and 9.63,respectively,both P<0.05),and the score in the observation group was significantly higher than in the control group(t=4.29,P <0.05).After treatment,the score for grasp and for visual motor integration in Peabody Fine Motor Development Scale increased(t value was4.56,8.26,2.87 and 6.11,respectively,all P<0.05),and that increased more in the observation group than in the control group(t value was 3.96 and 3.05,respectively,both P<0.05).Conclusion TSM in combination with functional strength training has good application effect on pediatric patients with CP.It can effectively improve cognitive function and motor function,and it is worthy of application in clinics.