功能性电刺激改善脑性瘫痪儿童下肢及躯干功能的Meta分析

doi:10.3969/j.issn.1006-9771.2021.04.006

摘要/Abstract

摘要： 目的

评估功能性电刺激(FES)治疗脑瘫的有效性及长期疗效。

方法

检索PubMed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库(CBM)、CNKI、万方数据库、维普有关FES治疗脑瘫儿童的随机对照试验，检索时限从建库至2020年3月26日。至少2名评价员独立提取数据，采用Cochrane 5.1.0偏倚风险评估工具对纳入研究的质量进行评估，数据分析采用Review Manager 5.3软件。

结果

最终纳入11篇文献，共计513例患儿。FES组在粗大运动功能测试88项(GMFM-88) D、E区评分(MD= 8.14, 95%CI6.26~10.02, P < 0.001)、GMFM-88 B区评分(MD= 8.77, 95%CI4.00~13.53, P < 0.001)、改良Ashworth量表(MAS)评分(MD= -1.05, 95%CI-1.25~-0.84, P < 0.001)、Kyphosis角(MD= -10.67, 95%CI-12.21~ -9.13, P < 0.001)、Cobb角(MD= -2.66, 95%CI-3.38~-1.93, P < 0.001)、步长(MD= 3.35, 95%CI1.81~4.90, P < 0.001)、步速(MD= 0.09, 95%CI0.05~0.14, P < 0.001)、随访6周时GMFM评分(MD= 4.84, 95%CI1.90~7.77, P = 0.001)等方面均明显优于对照组。随访6周时FES组与对照组的MAS评分无显著性差异(MD= 0.04, 95%CI-0.30~0.37, P = 0.84)。

结论

FES能够改善脑瘫儿童下肢、躯干功能，但解除肌肉痉挛的长期疗效不显著。

关键词: 脑性瘫痪, 功能性电刺激, 下肢功能, 长期疗效, Meta分析

Abstract: Objective

To evaluate the efficacy and long-term effect of functional electrical stimulation (FES) on cerebral palsy.

Methods

Literature retrieval was carried out in the electronic databases of PubMed, Embase, Web of Science, Cochrane Library, China Biology Medicine Disc (CBM), CNKI, Wanfang Database and VIP. The time limit was from the establishment of these databases to March 26th, 2020. According to the inclusion and exclusion criteria, randomized controlled trials about FES for children with cerebral palsy were included. At least two evaluators extracted the data independently and used Cochrane 5.1.0 bias risk assessment tool to evaluate the quality of included studies. The data was analyzed with Review Manager 5.3 software.

Results

A total of eleven studies with 513 children were included. The Gross Motor Function Measure-88 (GMFM-88) D/E scores (MD= 8.14, 95%CI6.26 to 10.02, P < 0.001), GMFM-88 B score (MD= 8.77, 95%CI4.00 to 13.53, P < 0.001), modified Ashworth Scale (MAS) score (MD= -1.05, 95%CI-1.25 to -0.84, P < 0.001), Kyphosis angle (MD= -10.67, 95%CI-12.21 to -9.13, P < 0.001), Cobb's angle (MD= -2.66, 95%CI-3.38 to -1.93, P < 0.001), step length (MD= 3.35, 95%CI1.81 to 4.90, P < 0.001), walking speed (MD= 0.09, 95%CI0.05 to 0.14, P < 0.001) and GMFM score at six weeks follow-up (MD= 4.84, 95%CI1.90 to 7.77, P = 0.001) were better in FES group than in the control group. There was no significant difference in MAS score between two groups after six weeks of follow-up (MD= 0.04, 95%CI-0.30 to 0.37, P = 0.84).

Conclusion

FES could improve the lower-limb and trunk function of children with cerebral palsy, however, the long-term effect of relieving muscle spasm was not significant.

Key words: cerebral palsy, functional electrical stimulation, lower-limb function, long-term effect, meta-analysis

中图分类号:

R742.3

汪乐,徐林,胡传宇,张厚君,徐杰,赵毅,任敬佩,曾杰,于睿钦,穆晓红. 功能性电刺激改善脑性瘫痪儿童下肢及躯干功能的Meta分析[J]. 《中国康复理论与实践》, 2021, 27(4): 420-428.

Le WANG,Lin XU,Chuan-yu HU,Hou-jun ZHANG,Jie XU,Yi ZHAO,Jing-pei REN,Jie ZENG,Rui-qin YU,Xiao-hong MU. Effects of Functional Electrical Stimulation on Lower-limb and Trunk Function in Children with Cerebral Palsy: A Meta-analysis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(4): 420-428.

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参考文献 38

1	Colver A, Fairhurst C, Pharoah P O. Cerebral palsy [J]. Lancet, 2014, 383(9924): 1240-1249.
2	中国康复医学会儿童康复专业委员会,中国残疾人康复协会小儿脑性瘫痪康复专业委员会,«中国脑性瘫痪康复指南»编委会. 中国脑性瘫痪康复指南(2015):第六部分[J]. 中国康复医学杂志, 2015, 30(12): 1322-1330.
	Rehabilitation Committee for Children of Chinese Association of Rehabilitation Medicine, Rehabilitation Committee for Child Cerebral Palsy of Chinese Association of Rehabilitation of Disabled Persons, Editorial Committee of Guidelines for Rehabilitation of Cerebral Palsy in China. Guidelines for Rehabilitation of Cerebral Palsy in China (2015): Part Six [J]. Chin J Rehabil Med, 2015, 30(12): 1322-1330.
3	张定国,朱向阳. 功能性电刺激研究在中国的回顾、现状与展望[J]. 中国康复理论与实践, 2010, 16(9): 848-850.
	Zhang D G, Zhu X Y. Functional electrical stimulation in China: retrospect, current situation and prospect (review) [J]. Chin J Rehabil Theory Pract, 2010, 16(9): 848-850.
4	Peckham P H, Knutson J S. Functional electrical stimulation for neuromuscular applications [J]. Annu Rev Biomed Eng, 2005, 7(1): 327-360.
5	Biasiucci A, Leeb R, Iturrate I, et al. Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke [J]. Nat Commun, 2018, 9(1): 2421.
6	Cuesta-Gómez A, Carratalá-Tejada M, Molina-Rueda F, et al. Functional electrical stimulation improves reaching movement in the shoulder and elbow muscles of stroke patients: a three-dimensional motion analysis [J]. Restor Neurol Neurosci, 2019, 37(3): 231-238.
7	Craven B C, Giangregorio L M, Alavinia S M, et al. Evaluating the efficacy of functional electrical stimulation therapy assisted walking after chronic motor incomplete spinal cord injury: effects on bone biomarkers and bone strength [J]. J Spinal Cord Med, 2017, 40(6): 748-758.
8	Al-Abdulwahab S S, Al-Khatrawi W M. Neuromuscular electrical stimulation of the gluteus medius improves the gait of children with cerebral palsy [J]. NeuroRehabilitation, 2009, 24(3): 209-217.
9	Pool D, Valentine J, Blackmore A M, et al. Daily functional electrical stimulation during everyday walking activities improves performance and satisfaction in children with unilateral spastic cerebral palsy: a randomized controlled trial [J]. Arch Physiother, 2015, 5: 5.
10	Yildizgoren M T, Nakipoglu Yuzer G F, Ekiz T, et al. Effects of neuromuscular electrical stimulation on the wrist and finger flexor spasticity and hand functions in cerebral palsy [J]. Pediatr Neurol, 2014, 51(3): 360-364.
11	Moll I, Vles J S H, Soudant D L H M, et al. Functional electrical stimulation of the ankle dorsiflexors during walking in spastic cerebral palsy: a systematic review [J]. Dev Med Child Neurol, 2017, 59(12): 1230-1236.
12	Mathevon L, Bonan I, Barnais J L, et al. Adjunct therapies to improve outcomes after botulinum toxin injection in children: a systematic review [J]. Ann Phys Rehabil Med, 2019, 62(4): 283-290.
13	Salazar A P, Pagnussat A S, Pereira G A, et al. Neuromuscular electrical stimulation to improve gross motor function in children with cerebral palsy: a meta-analysis [J]. Braz J Phys Ther, 2019, 23(5): 378-386.
14	Karabay I, Dogan A, Arslan M D, et al. Effects of functional electrical stimulation on trunk control in children with diplegic cerebral palsy [J]. Disabil Rehabil, 2012, 34(11): 965-970.
15	Karabay I, Dogan A, Ekiz T, et al. Training postural control and sitting in children with cerebral palsy: Kinesio taping vs. neuromuscular electrical stimulation [J]. Complement Ther Clin Pract, 2016, 24: 67-72.
16	Mukhopadhyay R, Lenka P K, Biswas A, et al. Evaluation of functional mobility outcomes following electrical stimulation in children with spastic cerebral palsy [J]. J Child Neurol, 2017, 32(7): 650-656.
17	Park E S, Park C I, Lee H J, et al. The effect of electrical stimulation on the trunk control in young children with spastic diplegic cerebral palsy [J]. J Korean Med Sci, 2001, 16(3): 347-350.
18	Van Der Linden M L, Hazlewood M E, Aitchison A M, et al. Electrical stimulation of gluteus maximus in children with cerebral palsy: effects on gait characteristics and muscle strength [J]. Dev Med Child Neurol, 2003, 45(6): 385-390.
19	代洋洋,李晓捷,范艳萍,等. 智能助行模式功能性电刺激对痉挛型双瘫脑性瘫痪患儿的疗效研究[J]. 中华实用儿科临床杂志, 2017, 32(17): 1316-1320.
	Dai Y Y, Li X J, Fan Y P, et al. Study on the effect of intelligent assistance model functional electrical stimulation on children with spastic diplegic cerebral palsy [J]. Chin J Appl Clin Pediatr, 2017, 32(17): 1316-1320.
20	孔艳英,刘丽伟,李馨,等. 功能性电刺激对痉挛型双瘫型脑瘫患儿下肢功能的影响[J]. 中国妇幼保健, 2015, 30(26): 4570-4572.
	Kong Y Y, Liu L W, Li X, et al. Effect of functional electrical stimulation on lower limb function in children with spastic diplegic cerebral palsy [J]. Maternal Child Health Care China, 2015, 30(26): 4570-4572.
21	李威,章荣,罗亚玲,等. 步态诱发功能性电刺激改善痉挛型双瘫型脑瘫患儿下肢运动功能的疗效观察[J]. 中国康复医学杂志, 2013, 28(12): 1126-1130.
	Li W, Zhang R, Luo Y L, et al. Effects of gait triggered functional electrical stimulation on motor function of lower extremities in children with spastic diplegia cerebral palsy [J]. Chin J Rehabil Med, 2013, 28(12): 1126-1130.
22	孙群英,李星慧,汪淼芹,等. 功能性电刺激对痉挛型双瘫型脑瘫患儿下肢运动功能的影响[J]. 现代生物医学进展, 2015, 15(15): 2894-2896.
	Sun Q Y, Li X H, Wang M Q, et al. Effect of functional electrical stimulation on lower extremity motor function in children with spastic cerebral palsy [J]. Progress Modern Biomed, 2015, 15(15): 2894-2896.
23	武淑敏,张晓宇,尚清. 功能性电刺激对痉挛型双瘫型脑瘫患儿下肢运动功能的价值体会[J]. 临床研究, 2019, 27(8): 90-91.
	Wu S M, Zhang X Y, Shang Q. The value of functional electrical stimulation on the motor function of lower extremities in children with spastic diplegic cerebral palsy [J]. Clin Res, 2019, 27(8): 90-91.
24	张进华,杨正,韩玉玲,等. 功能性电刺激对痉挛型脑瘫儿童下肢功能的影响[J]. 中国康复医学杂志, 2009, 24(4): 328-330.
	Zhang J H, Yang Z, Han Y L, et al. Effects of functional electrical stimulation on motor function of lower extremity of cerebral palsy children with spastic diplegia [J]. Chin J Rehabil Med, 2009, 24(4): 328-330.
25	Piccolino M. Animal electricity and the birth of electrophysiology: the legacy of Luigi Galvani [J]. Brain Res Bull, 1998, 46(5): 381-407.
26	Takeda K, Tanino G, Miyasaka H. Review of devices used in neuromuscular electrical stimulation for stroke rehabilitation [J]. Med Devices (Auckl), 2017, 10: 207-213.
27	Tefertiller C, Gerber D. Step ergometer training augmented with functional electrical stimulation in individuals with chronic spinal cord injury: a feasibility study [J]. Artif Organs, 2017, 41(11): E196-E202.
28	Pool D, Elliott C, Bear N, et al. Neuromuscular electrical stimulation-assisted gait increases muscle strength and volume in children with unilateral spastic cerebral palsy [J]. Dev Med Child Neurol, 2016, 58(5): 492-501.
29	Sivaramakrishnan A, Solomon J M, Manikandan N. Comparison of transcutaneous electrical nerve stimulation (TENS) and functional electrical stimulation (FES) for spasticity in spinal cord injury: a pilot randomized cross-over trial [J]. J Spinal Cord Med, 2018, 41(4): 397-406.
30	Nakipoğlu Yuzer G F, Köse Dönmez B, Özgirgin N. A randomized controlled study: effectiveness of functional electrical stimulation on wrist and finger flexor spasticity in hemiplegia [J]. J Stroke Cerebrovasc Dis, 2017, 26(7): 1467-1471.
31	谭丽萍,吕智海,谭丽艳,等. 功能性电刺激对痉挛型脑瘫儿童上肢运动功能的影响[J]. 中国康复, 2017, 32(5): 370-372.
	Tan L P, Lu Z H, Tan L Y, et al. Effect of functional electrical stimulation on upper limb motor function in children with spastic cerebral palsy [J]. Chin J Rehabil, 2017, 32(5): 370-372.
32	Lazzari R D, Politti F, Belina S F, et al. Effect of transcranial direct current stimulation combined with virtual reality training on balance in children with cerebral palsy: a randomized, controlled, double-blind, clinical trial [J]. J Mot Behav, 2017, 49(3): 329-336.
33	段华林,张惠佳,颜华,等. 神经肌肉电刺激治疗脑瘫患儿流涎症的临床观察[J]. 中国康复理论与实践, 2010, 16(5): 453-454.
	Duan H L, Zhang H J, Yan H, et al. Effects of neuromuscular electric stimulation on salivation in children with cerebral plasy [J]. Chin J Rehabil Theory Pract, 2010, 16(5): 453-454.
34	Alhusaini A A, Fallatah S, Melam G R, et al. Efficacy of transcutaneous electrical nerve stimulation combined with therapeutic exercise on hand function in children with hemiplegic cerebral palsy [J]. Somatosens Mot Res, 2019, 36(1): 49-55.
35	Satheeskumar D, Dhaneshkumar K, Rajasenthil K. Comparative study to identify the effects of transcutaneous electrical nerve stimulation combined with sensorimotor task oriented training to improve the hand function in hemiplegic cerebral palsy children [J]. J Clin Diagn Res, 2018, 12(1): YC17‐YC21.
36	Qi Y C, Niu X L, Gao Y R, et al. Therapeutic effect evaluation of neuromuscular electrical stimulation with or without strengthening exercise on spastic cerebral palsy [J]. Clin Pediatr (Phila), 2018, 57(5): 580-583.
37	Rodríguez-Reyes G, Alessi-Montero A, Díaz-Martínez L, et al. Botulinum toxin, physical and occupational therapy, and neuromuscular electrical stimulation to treat spastic upper limb of children with cerebral palsy: a pilot study [J]. Artif Organs, 2010, 34(3): 230-234.
38	Ozer K, Chesher S P, Scheker L R. Neuromuscular electrical stimulation and dynamic bracing for the management of upper-extremity spasticity in children with cerebral palsy [J]. Dev Med Child Neurol, 2006, 48(7): 559-563.

文献	国家	n (T/C)	年龄 (T/C，岁)	干预措施		干预时间	疗程(周)	随访(周)	结局指标
文献	国家	n (T/C)	年龄 (T/C，岁)	T	C	干预时间	疗程(周)	随访(周)	结局指标
Karabay^[14](2012)	土耳其	16/16	5.56/5.43	FES+常规康复	Bobath+常规康复	每次30 min，每周5次	4	无	⑤
Karabay^[15](2016)	土耳其	23/19	5.92/5.70	FES+ Bobath	Bobath	每次75 min，每周4次	4	无	①⑤
Mukhopadhyay^[16] (2017)	英国	15/11	8.50/9.80	FES+常规康复	常规康复	每次60 min，每周5次	12	无	①⑥⑦
Park^[17](2001)	印度	14/12	1.13/1.04	FES+ Bobath	Bobath	每次30 min，每周5次	6	无	①⑤
Linden^[18](2003)	韩国	11/11	8.80/8.20	FES+常规康复	常规康复	每次60 min，每周6次	8	无	④⑥
代洋洋^[19] (2017)	中国	20/20	4.80/4.80	FES+常规康复	常规康复	每次30 min，每周5次	8	无	①②③⑥
孔艳英^[20] (2015)	中国	15/15	4.65/4.56	FES+常规康复	常规康复	每次30 min，每周5次	8	6	①②③
李威^[21] (2012)	中国	14/11	4.35/4.56	FES+康复训练	康复训练	每次30 min，每周5次	6	6	①②③
孙群英^[22] (2015)	中国	73/68	2.45/2.53	FES+康复训练	康复训练	每次30 min，每周5次	12	无	①②③
武淑敏^[23] (2019)	中国	45/45	2.96/2.80	FES+常规康复	常规康复	每次40 min，每周5次	6~8	无	①②③
张进华^[24] (2009)	中国	21/18	3.31/3.29	FES+康复训练	康复训练	每次20 min，每周5次	6	6	①②③

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