盐酸乙哌立松治疗痉挛性脑瘫患儿的临床疗效观察

目的 探讨盐酸乙哌立松治疗痉挛性脑瘫患儿的临床效果。方法 选取84例痉挛性脑瘫患儿作为研究对象,按照随机数字表法分为Ⅰ组(盐酸乙哌立松治疗组)、Ⅱ组(盐酸苯海索治疗组)、Ⅲ组(氯硝西泮治疗组),对比各组治疗效果、肌张力缓解情况以及药物不良反应发生率。结果 Ⅰ组治疗效果显著优于Ⅱ组和Ⅲ组( P <0.05);治疗前, 3组肌张力水平无显著差异( P >0.05),治疗后, 3组患儿肌张力均有所好转,但Ⅰ组和Ⅲ组的肌张力评分显著低于Ⅱ组( P <0.05);治疗期间,Ⅲ组不良反应发生率最高,Ⅰ组不良反应发生率最低,组间差异显著( P <0.05)。结论 采用盐酸乙哌立松治疗小儿痉挛性脑性瘫痪效果佳,不仅能有效改善患儿肌张力障碍,而且具有较高的安全性。

颈8神经根切断的实验研究与临床应用

报告臂丛神经单根切断对上臂功能影响的实验结果以及颈8神经根切断治疗手部痉挛的临床效果。方法:将60只SD大鼠分成6组,作急、慢性实验,分别切断颈6、7、8神经根,通过电生理检查和组织学观察进行自身对照研究;对10个脑瘫或脑外伤后手部痉挛患者实施颈8神经根切断术。结果:实验表明,臂丛神经单根切断后6周,其对应肌群的肌纤维粗细无明显变化(P>0.5),而神经传导速度明显减慢(P<0.001);临床随访显示,颈8神经根切断后,患者手部痉挛明显减轻,功能得到改善。结论:颈8神经根切断不会明显影响上肢的活动功能,分束切断能有效治疗手部痉挛。

CURRENT SITUATION OF CHINESE REHABILITATION TREATMENT OF CEREBRAL PALSY

Analyze present situation of treatment of cerebral palsy at home and abroad, review in detail concrete methods and studies of mechanisms of acupuncture and moxibustion as main therapeutic way adopted at home, probe characteristics and models of Chinese rehabilitation treatment for cerebral palsy. Results indicate that acupuncture and moxibustion treatment of cerebral palsy has very great potential social and economic results. Therefore, it is appropriate to approach establishment of a comprehensive rehabilitation system of cerebral palsy with Chinese characteristics, and with acupuncture and moxibustion used as main way.

A review of the treatment of cerebral palsy in children

Childhood cerebral palsy （CP） is one of the most serious and common diseases of the central nervous system. It results in high morbidity and treatment cost, and cannot be cured. It has a detrimental effect on families of children with CP, seriously affects the quality of life, causes significant mental stress, and places a great economic burden on society. At present, physical training and drug therapy are mainly used to treat CP in children at home and abroad. However, plentiful evidence has shown that the efficacy of drugs, surgery, and therapies used over the previous decades is limited. The use of more appropriate comprehensive treatment that involves improving the quality of life to social participation is helpful and meaningful for children with CP and their carers. Based on the literature and guidelines from home and abroad, this article analyzes the main treatments used, including rehabilitation treatment, drug therapy, stem cell therapy, surgical treatment, and the treatment of complications, and compares the advantages and disadvantages of various treatments. It provides a reference for patients with CP to help choose treatment methods and a new idea for research on the treatment of CP .

ROLE OF ACULASER THERAPY IN CEREBRAL PALSY CHILDERN (INITIAL DATA & RESULTS)

A single, open and non-comparative study was conducted at Anwar Shah’s First C.P. & Paralysis Clinic and Research Center to evaluate the effects of Aculaser (acupoint-laser) Therapy for children suffering from cerebral palsy (CP) of various types. These children were further classified according to their major complaints. Analysis of the data indicated that 11 children with severe spasticity and stiffness all showed marked improvement (100% success rate); of the 8 children with epileptic fits, 6 patients had a significant reduction in the intensity, frequency and duration of epileptic fits, while the rest 2 cases showed no any improvement or aggravation (75% success rate); out of 5 children with cortical blindness, 2 cases showed complete recovery of vision and 3 had marked improvement (40% cure rate); out of 4 children with hearing difficulties, 2 showed marked improvement (50% success rate); out of 14 children with aphasis, 8 showed improvement (57% improvement rate). Results of this study show that Aculaser Therapy has a high improvement rate of CP children, not only improving the spasticity and stiffness but also the cortical blindness, epilepsy, deafness and speech.

痉挛型脑瘫

对１６８例痉挛型脑瘫进行了分析，根据自控能力、肌力和肌痉挛以及病废的程度。可将痉挛型脑瘫分为轻、中、重３级。对我们治疗中的一些经验和体会作了扼要的介绍。

Effects of individualized therapeutic porgram with heatreinforcing needling in combination with Bobath therapy on gross motor dysfunction in children with cerebral palsy:a randomized controlled trial

Objective To explore the effect of heat-reinforcing acupuncture combined with Bobath rehabilita on training for the gross motor func on measurement（GMFM） in children with cerebral palsy. Methods Sixty cases of cerebral palsy were randomized into a heat-reinforcing acupuncture combined with rehabilitation training group（group A） and a rehabilitation group（group B）,30 cases in each group. Rehabilitation training was applied in group B and heat-reinforcing acupuncture was added in group A. Jiāji（夹脊 EX-B 2）,Jiānyú（肩髃 LI 15）,Qūchí（曲池 LI 11）,Hégi（合谷 LI 4）,Yánglíngquán（阳陵泉 GB 34）,Yīnlíngquán（阴陵泉 SP 9）,Xuánzhōng（悬钟 GB 39）,Zúsānli（足三里 ST 36）,Sānyīnjiāo（三阴交 SP 6）,Chéngshān（承山 BL 57）,Tài chōng（太冲 LR 3）,Tàixī（太溪 KI 3） and Shénmén（神门 HT 4） were chosen in group A and the heat-reinforcing acupuncture was applied once a day. For scalp acupuncture,Biihuì（百会 GV 20）,Sìshéncōng（四神聪 EX-HN 1）,Zhìsānzhēn（智三针）,Nǎosānzhēn（脑三针）,Nièsānzhēn（颞三针） and motor area（运动区） were punctured without any manipulation,once every other day,3 months as a treatment course and 2 courses were needed. GMFM were selected to assess the children with cerebral palsy before treatment,a er 3 months treatment and a er 6 months treatment. Results The total eff ec ve rate in group A was 70.00%（21/30）,which is superior to that of 60.00%（24/30） in group B（P0.05）. In group A,the GMFM scores of decubitus position and turn-over of body,creeping and kneeling,sitting,standing,walking,running and jumping after6 months treatment were significantly improved compared with that before treatment and after 3 months treatment（all P0.05）. In group B,above indices a er 6 months treatment were significantly improved compared with those before treatment,the standing score after 6 months treatment was significantly improved compared with that a er 3 months treatment（P0.05）; the GMFM scores of creeping,kneeling,sitting,standing,walking,running and jumping after 6 months treatment in group A were more significantly improved than that in group B（all P0.05）. Conclusion The heat-reinforcing acupuncture combined with Bobath rehabilita on training has a be er eff ect than rehabilitation training on the GMFM scores of creeping and kneeling,si ng,standing,walking,running and jumping of children with cerebral palsy. It can be shown that the combination of heat-reinforcing acupuncture and Bobath rehabilita on training can improve the gross motor func on of children with cerebral palsy.

Clinical observation of cerebral palsy treated with Chinese massage for promoting the Governor Vessel, benefiting the kidney and strengthening the spleen combined with music therapy

Objective To observe the effects on the range of motion （ROM） of ankle joint and muscular spasm of the lower limbs treated with Chinese massage for promoting the Governor Vessel, benefiting the kidney and strengthening the spleen combined with music therapy in infantile cerebral palsy （CP）. Methods In 286 cases of spasmodic CP, 7 kinds of Chinese massage were adopted, named massage on acupoints to promote circulation of the Governor Vessel, massage for strengthening the spleen and benefiting qi, spine-pinching therapy, segmental massage, foot massage, massage for promoting the recovery of muscle strength and massage for promoting ROM of joints. Chinese massage was applied in musical background. Buddha music and five-element music of Chinese medicine （music of the Heart, Liver and Kidney Meridians） were optioned. The treatment was given once or twice a day and 30 days made one course. The angles of femoral adductor and dorsal flexion of foot as well as the score of composite spasticity scale （CSS） were observed before and after treatment so that the therapeutic effect was assessed. Results In 30 days of treatment, 106 cases （37. 1%） were effective markedly, 172 cases （60. 1%） effective and 8 cases （2.8%） failed. The angle of dorsal flexion of foot was （105.64± 12.66）° and （76.58± 9.89）° before and after treatment respectively; the angle of femoral adductor was （119.89±25.47）° and （158.99± 18.66）° before and after treatment respectively; the score of CSS was （12.39±2.56） and （7. 069 ± 2.97） before and after treatment respectivel, there was significant difference before and after treatment （all P〈0.01）. Conclusion Chinese massage for promoting the Governor Vessel, benefiting the kidney and strengthening the spleen combined with music therapy brings the extremely active effect into play on the recovery of sitting, kneeling, standing and walking for children with CP.

Advances of studies on acupuncture and moxibustion for treatment of language disorder in children with cerebral palsy

The literatures about the therapeutic effect of acupuncture and moxibustion on language disorder in children with cerebral palsy were reviewed. The symptoms of language disorder in children with cerebral palsy and the procedures of rehabilitation treatments were analyzed. The acupuncture intervention on language disorder in children with cerebral palsy was investigated. It showed that the acupuncture intervention may markedly improve the condition of language disorder in children with cerebral palsy. However, the effectiveness is compared between comprehensive therapy and single therapy in the current literatures on acupuncture intervention. Therefore, the comparison between comprehensive therapies was lacked, and the advantage of acupuncture intervention combined with other therapies was not demonstrated. In the future, the studies should focus on the combination of various therapies and the different effectiveness of different therapies. Furthermore, the studies should focus on the mechanism of acupuncture. Therefore, it may contribute to build a comprehensive treatment system in which acupuncture is dominant for cerebral palsy in children.

Influence of cluster needling at scalp acupoints combined with rehabilitation training on balance functions of children with cerebral palsy

Objective To observe therapeutic effects of scalp acupuncture at close acupoints combined with rehabilitation training on balance functions of children with cerebral palsy （CP）. Methods Sixty children with CP were randomly divided into a scalp acupuncture combined with rehabilitation training group （group SA＋RT） and a rehabilitation training group （group RT） with 30 cases in each group. Conventional rehabilitation therapy and balance training were applied in group RT, and scalp acupuncture at close acupoints in the parietal region and sub-occipital region was added besides rehabilitation training in group SA＋RT. Balance functions were evaluated by using Berg rating scale, and abilities of daily living were estimated by using rating scale for activities of daily living （ADL）. Results After treatment, both Berg scores for balance and ADL scores were significantly improved in both groups （all P0.05）, and the improvement in group SA＋RT was more obvious than that in group RT （ both P0.05）. Conclusion Combination of scalp acupuncture at close acupoints with rehabilitation training is superior to simple rehabilitation training in improving balance functions and activities of daily living in children with cerebral palsy.

Effect of acupuncture and tuina plus rehabilitative therapy on lower limb motor dysfunction in infants with spastic cerebral palsy

Objective： To observe the effect of acupuncture, tuina plus rehabilitative therapy on lower limb motor dysfunction in infants with spastic cerebral palsy. Methods： A total of 60 infants with spastic cerebral palsy were randomly divided into a treatment group and a control group by random digital table, 30 cases in each group. The treatment group was treated with acupuncture, tuina therapy plus rehabilitative therapy of Western medicine. The control group was simply treated with rehabilitative therapy of Western medicine, as same as that for the treatment group. The assessment was respectively given to the sick infants before the treatment and after the treatment of six months, to evaluate lying and rolling scores in dimension A, to evaluate sitting score in dimension B, to evaluate crawling and kneeling scores in dimension C, and evaluate standing score in dimension D in the gross motor functions and determine the muscle tone of the gastrocnemius muscle by modified Ashworth scale （MAS）. Results： The differences were not statistically significant in comparison of the gross motor functions and the muscle tone of the gastrocnemius muscle between the two groups of sick infants before the treatment （P〉O.OS）; after the treatment of six months, the above items were obviously improved in the two groups （P〈O.01）, better in the treatment group than in the control group, with the statistical significance in the differences between the groups （P〈O.01）. Conclusion： Acupuncture, tuina plus rehabilitative therapy of Western medicine are remarkable in the therapeutic effects in the treatment of motor disorders of the lower limbs in the sick infants with spastic cerebral palsy. This therapeutic method is safe, simple and convenient and needs to be clinically popularized and applied.

Clinical observation on spleen-invigorating and qi-benefiting pediatric massage for treating recurrent respiratory tract infection in children with cerebral palsy due to qi deficiency of spleen and lung

Objective:To observe the clinical efficacy of spleen-invigorating and qi-benefiting pediatric massage(tuina)for treating recurrent respiratory tract infection in children with cerebral palsy due to qi deficiency of spleen and lung.Methods:A total of 70 children with cerebral palsy who suffered from recurrent respiratory tract infection due to qi deficiency of spleen and lung were randomized into an observation group and a control group by the random number table method,with 35 cases in each group.Both groups were treated with conventional rehabilitation training,while the observation group was given additional spleen-invigorating and qi-benefiting pediatric massage,and the control group additionally took oral Yu Ping Feng granule.The clinical efficacy was evaluated by the total effective rate,traditional Chinese medicine(TCM)symptom score,and serum levels of immunoglobulin(Ig)A,IgM and IgG.Results:The difference in total effective rate between the two groups after treatment was statistically significant(P<0.05).After treatment,the TCM symptom scores in both groups decreased to varying degrees than those before treatment,and the intra-group differences were statistically significant(all P<0.01);the differences in the scores of various TCM symptoms between the two groups were statistically significant(all P<0.05).After treatment,the levels of IgA,IgM and IgG of the children in both groups increased to varying degrees,and the intra-group differences were statistically significant(all P<0.05).The between-group differences in the IgA,IgM and IgG levels after treatment were statistically significant(all P<0.05).Conclusion:Spleen-invigorating and qi-benefiting pediatric massage can effectively treat recurrent respiratory tract infection due to qi deficiency of spleen and lung in children with cerebral palsy,relieve the clinical symptoms and improve immune function,and thus is worthy of clinical promotion and application.

Clinical observation on acupuncture plus occupation therapy for fine motor functions in children with spastic cerebral palsy

Objective： To observe the clinical effect of acupuncture plus occupation therapy for fine motor functions in children with spastic cerebral palsy. Methods： A total of 80 cerebral palsy kids with fine motor dysfunction were allocated into two groups by envelop, 40 cases in each group. Cases in the control group were treated with occupation therapy. Based on the therapy given to the control group, cases in the treatment group were supplemented with acupuncture at the points of the three yang meridians of hand. The treatment was done every other day and 10 times for a course. There was a 15-day interval between two courses, and 3 courses in total. The therapeutic efficacies were evaluated using Peabody developmental motor scale 2 （PDMS-2） and modified Ashworth scale （MAS） before and after treatment. Results： After treatment, the standard score for grasping （Grs）, standard score for visual-motor integration （Vis）, fine motor quotient （FMQ） and modified Ashworth scale （MAS） were significantly improved in both groups （P〈0.05）. The improvement in the treatment group was more obvious than that in the control group （P〈0.01）. Conclusion： Acupuncture plus occupation therapy can achieve better effect than occupation therapy alone in improving fine motor functions of upper limbs in cerebral palsy kids.

Clinical observation on Governor Vessel-unblocking and brain-refreshing scalp acupuncture for cerebral palsy complicated with intellectual disabilities

Objective：To observe the clinical efficacy of Governor Vessel-unblocking and brain-refreshing scalp acupuncture for cerebral palsy （CP） complicated with intellectual disabilities. Methods：A total of 300 CP cases aged between 1 and 5 years were randomly allocated into a treatment group （n=150） and a control group （n=150）. Patients in the treatment group were treated with Governor Vessel-unblocking and brain- refreshing scalp acupuncture combined with rehabilitation training, whereas patients in the control group received rehabilitation training alone. The Beijing Gesell developmental （Gesell） scale and gross motor function measure （GMFM） scale were used to assess the motor and intellectual development before and 3 months after the treatment. In addition, the head CT/MRI examination was applied to assess the brain nerve repair before and after the treatment. Results：After the treatment, the total effective rate in the treatment group was 78.0%, versus 42.7% in the control group, showing a statistical significance （P〈0.05）. As for scores of five subscales in the Gesell scale, there were significant intra-group differences in the treatment group （allP〈0.05）; and the scores in the treatment group were significantly better than those in the control group （allP〈0.05）. As for scores of five dimensions in GMFM scale, there were significant intra-group differences in the treatment group （allP〈0.05）; and the scores in the treatment group were significantly better than those in the control group （allP〈0.05）. According to the head CT/MRI findings, the total effective rate was 73.3% in the treatment group, versus 62.0% in the control group, showing a statistical significance （P〈0.05）. Conclusion：When used in combination with rehabilitative training, Governor Vessel-unblocking and brain-refreshing scalp acupuncture can significantly improve the clinical efficacy for cerebral palsy complicated with intellectual disabilities. It can also improve the patients＆#39; motor function, intelligence and language ability.

Clinical Observation on Treatment of Spastic Cerebral Palsy with Tuina plus Music Therapy

Objective： To observe the effect of tuina plus music therapy on range of motion of ankle joints and muscle spasm of lower limbs in children with spastic cerebral palsy. Method： All of 286 cases that conformed to the diagnostic criteria of infantile cerebral palsy were treated with 7 types of tuina manipulations respectively to unblock the Governor Vessel, reinforce the kidney and strengthen the spleen, pinch along the spine, stimulate specific foot-reflex area and different spinal segments, accelerate recovery of muscle strength and increase joint range of motion, 25-30 min each treatment, once or twice a day, 30 d constitute a course of treatment. After this, the efficacy on femoral medial adduction and dorsiflexion angle and composite spasticity score （CSS） was evaluated. Result： The statistical analysis showed significant differences in dorsiflexion and femoral medial adduction angle and CCS scores （P〈0.01） after the treatments. Conclusion： Tuina plus music therapy can lubricate the joints, relax contraction of tendons, alleviate muscle spasm and improve scissors and toe-walking gaits, thereby benefiting the gross motor function of infants in sitting, kneeling, standing and walking.

Effects of acupuncture plus MOTOmed intelligent motor training in treating children with spastic cerebral palsy

Objective To observe the clinical efficacy of acupuncture plus MOTOmed intelligent motor training in treating children with spastic cerebral palsy,and analyze the effects on lower limb motor function,intelligence development level,immune function and cerebral hemodynamics.Methods A total of 42 children with spastic cerebral palsy were selected as the observation objects,and enrolled into the observation group.Another 42 cases treated in the same period were selected as the control group.Both groups received MOTOmed intelligent motor training,and the observation group was given additional acupuncture therapy,and the control group was given additional conventional rehabilitation treatment.After 2 consecutive treatment courses,the psychomotor development index(PDI)and mental development index(MDI)of Children’s Developmental Center of China(CDCC)scale,the scores of gross motor function measure(GMFM)scale and modified Ashworth scale(MAS),and the changes in CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)were observed.The peak systolic velocity(PSV)and mean flow velocity(MFV)of the anterior cerebral artery(ACA),middle cerebral artery(MCA)and posterior cerebral artery(PCA)were observed and measured.The clinical efficacy was evaluated.Results Compared with the same group before treatment,the scores of GMFM,PDI and MDI,levels of CD3^(+),CD4^(+)and CD4^(+)/CD8^(+),PSV and MFV levels of ACA,MCA and PCA in both groups were significantly increased after treatment(all P<0.05),while the CD8^(+)level had no significant change(both P>0.05).After treatment,the total effective rate of lower limb spasm in the observation group was 90.5%,significantly higher than 71.4%in the control group(P<0.05).The scores of GMFM,PDI and MDI,the levels of CD3^(+)and CD4^(+),PSV and MFV,and the levels of ACA,MCA and PCA in the observation group were all significantly higher than those in the control group(all P<0.05).There were no significant differences in the CD8^(+)level and CD4^(+)/CD8^(+)between the groups(all P>0.05).Conclusion Acupuncture plus MOTOmed intelligent motor training has a better clinical efficacy than conventional rehabilitation plus MOTOmed intelligent motor training in treating children with spastic cerebral palsy,and is also superior in improving lower limb motor function and the level of intellectual development.And the mechanism may be related to the improvement of cerebral hemodynamics.

Clinical observation on scalp acupuncture for diffusion tensor imaging in cerebral palsy children with periventricular leukomalacia

Objective： To observe the effect of Governor Vessel-unblocking and mind-refreshing needling technique on diffusion tensor imaging （DTI） in cerebral palsy （CP） children with periventricular leukomalacia （PVL） and investigate the underlying mechanism. Methods： A total of 18 CP children with PVL received modern rehabilitation training and scalp acupuncture. The before-after study was conducted to compare the fractional anisotropy （FA） of the white matter fiber tracts, gross motor function measure （GMFM） score, Gesell developmental scale and changes in muscle tone. Results： For the comparison before and after the first course of treatment, there were no statistical differences in DTI findings and FA values （both P〉0.05）; there were statistical differences in GMFM dimensions A and B （both P〈0.05） and no statistical differences in dimensions C, D and E （all P〉0.05）; and there were statistical differences in six items of Gesell development test （P〈0.01 or P〈0.05）. For the comparison before and after two courses of treatment, there were statistical differences in DTI findings and FA values in 8 cases between before and after 30 and 60 treatments （both P〈0.05）; there were statistical differences in GMFM dimensions A, B and C between before and after 30 and 60 treatments and between 30 and 60 treatments （all P〈0.05）; there were no statistical differences in GMFM dimensions D and E （all P〉0.05）; and there were statistical differences in six items of Gesell developmental test between before, after 30 and 60 treatments and between 30 and 60 treatments （P〈0.05 or P〈0.01）. Conclusion： The Governor Vessel-unblocking and mind-refreshing scalp acupuncture has no significant efficacy on the repair and regeneration of white matter fibers in children with PVL and CP in a short period of time; however, it gradually works along with the prolonged treatment time. In addition, it can improve the motor function and mental development and the efficacy is closely associated with the time of treatment.