节律性听觉刺激对脑性瘫痪患者步态改善的系统综述

doi:10.3969/j.issn.1006-9771.2023.12.003

摘要/Abstract

摘要：

目的分析节律性听觉刺激对脑瘫患者步态改善的效果。

方法采取主题词检索方式，在Web of Science、PubMed、EBSCO、中国知网、万方数据库中检索节律性听觉刺激对脑瘫患者步态改善的相关文献，自建库至2022年12月。采用物理治疗证据数据库(PEDro)量表对纳入文献进行方法学质量评估，提取相关数据进行系统综述。

结果共检索出文献1 339篇，最终纳入10篇，研究对象主要来源于美国、埃及、以色列、韩国和希腊，干预地点主要在医院和社区，部分患者居家干预，发表时间主要在2010年后。在常规物理治疗训练的基础上加入节律性听觉刺激，可以增加脑瘫患者的关节活动度，提高步速、步长和步幅，改善运动模式，增强步态训练的干预效果。

结论节律性听觉刺激可以增加脑瘫患者关节活动度，提高步速、步频和步长，改善步态。

关键词: 脑性瘫痪, 节律性听觉刺激, 步态, 系统综述

Abstract:

Objective To systematically review the effect of rhythmic auditory stimulation on gait of patients with cerebral palsy.

Methods Relevant literature on gait improvement of patient with cerebral palsy by rhythmic auditory stimulation were retrieved from Web of Science, PubMed, EBSCO, CNKI and Wanfang database from establishment to December, 2022. Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the articles, and the relevant data was extracted. A systematic review was conducted.

Results A total of 1 339 literatures were retrieved, and ten were finally included. The patients mainly came from America, Egypt, Israel, South Korea and Greece. The intervention sites were mainly in hospitals and communities, and some patients received home-based intervention. The publication date was mainly after 2010. Adding rhythmic auditory stimulation on the basis of conventional rehabilitation training increased the range of motion of the joints of patients with cerebral palsy; improved the walking speed, step length and stride length; improved the movement mode, and enhanced the intervention effect of gait training.

Conclusion Rhythmic auditory stimulation is effective on the range of motion, walking speed, step length and stride length of patient with spastic cerebral palsy, which can improve gait.

Key words: cerebral palsy, rhythmic auditory stimulation, gait, systematic review

中图分类号:

R742.3

马红颖, 刘建军, 何学金, 王宇翔. 节律性听觉刺激对脑性瘫痪患者步态改善的系统综述[J]. 《中国康复理论与实践》, 2023, 29(12): 1386-1394.

MA Hongying, LIU Jianjun, HE Xuejin, WANG Yuxiang. Effect of rhythmic auditory stimulation on gait of patients with cerebral palsy: a systematic review[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(12): 1386-1394.

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纳入文献基本特征"

纳入文献	国家	设计	n	年龄/岁	患病类型	干预方式	干预时间	干预地点	比较	结局
Kwak^[19](2007)	美国	随机对照研究	对照组：10 观察组1：10 观察组2：10	6~20	痉挛性脑瘫	对照组：常规物理治疗观察组1：常规物理治疗+指导下RAS训练观察组2：常规物理治疗+RAS自我引导训练	每天30 min，每周5 d，共3周	学校	步频、步幅、步速、步态参数、步态对称性和脚接触模式	观察组1、观察组2较对照组步幅、步长、步速均有提高；观察组1步长、步速改善更显著
Nagy等^[20](2020)	埃及	随机对照研究	对照组：15 观察组：15	6~10	痉挛性偏瘫	对照组：常规物理治疗观察组：常规物理治疗+RAS训练	每周3次，共4个月	医院	二维步态分析、步态对称指数	两组步长、步幅、站立时间和摆动时间均有改善；观察组比对照组改善更明显
Baram等^[21](2012)	以色列	前后测设计	对照组1：7 观察组1：10 对照组2：8 观察组2：10	4~20	脑瘫	实验1：随机选取10例脑瘫步态障碍患者和7例年龄匹配的健康个体，使用视觉反馈线索训练实验2：10例患者和8例年龄匹配的健康个体，使用听觉反馈线索训练	40 min	医院	测试前后步态分析，在视觉或听觉提示的测试之间进行的行走测试	采用视觉和听觉反馈训练的患者，步行速度和步幅显著提高，步态参数改善；与年龄匹配的健康个体没有改善
Kim等^[22](2020)	韩国	前后测设计	对照组：6 观察组：7	14~23	脑瘫	对照组：在简单和弦的RAS干预下进行步态训练观察组：在复杂和弦的RAS干预下进行步态训练	每次30 min，每周3次，共4周	康复门诊	时空参数(步频、步速、步幅、步宽、单腿和双腿支撑)和运动学参数(矢状面、冠状面、横面3个维度测量每个关节运动活动范围)	RAS干预后步频、步速和步幅显著增加，足底屈曲角度和踝关节活动度在时间和组间存在显著交互作用；观察组在预旋前阶段显示最大踝关节跖屈增加；结果表明，步态控制的主要因素是节奏，音乐元素的不同，对音乐的感知有助于患者参与行走
Varsami等^[23](2012)	希腊	前后测设计	对照组：9 观察组：9	14~24	痉挛性四肢瘫和精神发育迟缓	对照组：治疗师用熟悉的方式训练患儿，然后运用患儿目标设定和自我对比的方式进行对比观察组：在有氧运动的正常脉搏范围内尽可能地长时间运动，跟随节律性音乐的节奏进行训练	6周	医院	步态持续时间、总步数、心率指标、每分钟步数、每分钟脉搏	观察组运动时间变长，步频下降，每分钟心率也有所下降；基于实际心率做出节奏变化会更加有效；步速降低，对运动的控制能力提高
Shin等^[24](2015)	韩国	前后测设计	对照组：9 观察组：9	6~20	痉挛性偏瘫	所有受试者均接受步态训练对照组：进行常规物理治疗观察组：常规物理治疗+RAS(键盘上的和弦提供有节奏的节拍)干预下进行步态训练	每次30 min，每周3次，连续4周	社区	步频、步行速度、步幅、步行周期、单双支撑时间、站姿/摆动阶段(时间空间偏差和左右比较) 骨盆、髋关节、膝关节、踝关节足部运动学模式，GDI	RAS步态训练显著改善髋内收、膝关节屈曲和踝-足底屈曲的近端和远端关节运动学模式，提高GDI；站立和摆动阶段的时间不对称性改善
Kim等^[25](2012)	韩国	随机对照研究	对照组：13 观察组：15	20~33	痉挛性脑瘫	对照组：神经发育疗法观察组：RAS(节拍器节拍与个人的节奏和现场键盘演奏的节奏)提示相结合	每周3次，共3周	康复医院	步态周期的每个关节的时空和运动参数、运动范围	与对照组相比，观察组节奏、步态速度、步幅、步长、摆动期、GDI显著提高；与对照组相比，观察组步幅时间、步态时间、站立期显著减少；与对照组相比，骨盆前倾显著减少，矢状面(前倾初始接触，前倾最大角度)髋关节运动范围增加，步态明显改善
Kim等^[26](2011)	韩国	前后测设计	对照组：30 观察组：14	25~30	痉挛性双瘫	有/无RAS的情况下对步态进行重复测量分析	有无节拍器提示的步态计时表现	医院、社区和家庭	步态分析和GDI等运动学数据，颞空间数据的不对称	在有节奏的听觉刺激后，步态周期中骨盆前倾和髋关节屈曲明显减少； GDI以及步长左右不对称显著改善
Hamed等^[27](2011)	埃及	随机对照研究	对照组：15 观察组：15	6~8	痉挛性偏瘫	对照组：常规步态训练观察组：常规步态训练+计步器的步态训练	每周3次，共3个月	医院	测试前后的时空步态参数，主要测量标准是步行速度，其次是步频、步幅和周期持续时间	基于计步器的步态训练，所有步态参数(主要和次要结果测量指标)都有很大改善，可用于改善痉挛性偏瘫脑瘫患者的步态参数
Efraimidou等^[28](2016)	希腊	随机对照研究	对照组：5 观察组：5	22~48	痉挛性偏瘫	对照组：仅参加常规的物理治疗训练观察组：根据RAS进行运动干预计划下训练	每次50 min，每周2次，共8周	俱乐部	计时起立-行走测试、10米步行测试、EPS压力平台测试、Berg平衡量表、自尊量表、情绪状态情况	RAS可以增加脑瘫运动员的步态、平衡和心理参数，改善下肢的功能，减少步行差异；减少参与者的抑郁、疲劳和困惑，增强自信，对心理结果有积极影响

表3

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人群 (Population)		干预 (Intervention)	比较 (Comparison)	结局 (Outcome)
脑瘫患者	ICD-11编码	干预 (Intervention)	比较 (Comparison)	结局 (Outcome)
样本量性别年龄	08神经系统疾病 L1-8D2脑瘫 8D20痉挛性脑瘫 8D20.0痉挛性单侧脑瘫 8D20.1痉挛性双侧脑瘫 8D20.10痉挛性四肢瘫脑瘫	干预方式常规物理治疗常规物理治疗+RAS 干预时间干预场所	是否在常规物理治疗中加入RAS；关节活动度；步频；步长；步速；步态分析；步态偏差指数(gait deviation index, GDI)	身体功能 b710关节活动功能 b730肌肉力量功能 b760随意运动控制功能 b770患儿步态功能身体结构 s770与运动有关的附属肌肉骨骼的结构活动和参与 d450步行 d455到处移动

纳入文献	资格标准	随机分配	分配隐藏	基线相似	被试者施盲	治疗者施盲	评估者施盲	被试流失率≤ 15%	意向性分析	组间统计比较	变异性测量	总分
Kwak^[19](2007)	√	√		√	√	√		√	√	√	√	8
Nagy等^[20](2020)	√	√		√	√			√	√	√	√	7
Baram等^[21](2012)	√	√			√			√	√	√	√	6
Kim 等^[22](2020)	√		√	√	√			√	√	√	√	7
Varsamis 等^[23](2012)	√	√			√		√	√	√	√	√	7
Shin等^[24](2015)	√			√	√			√	√	√	√	6
Kim等^[25](2012)	√	√	√	√	√	√		√	√	√	√	9
Kim等^[26](2011)	√				√			√	√	√	√	5
Hamed等^[27](2011)	√	√		√	√		√	√	√	√	√	8
Efraimidou等^[28](2016)	√	√		√	√	√		√	√	√	√	8