功能性电刺激康复踏车训练对痉挛型脑性瘫痪儿童下肢运动功能的效果

doi:10.3969/j.issn.1006-9771.2021.12.013

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (12): 1464-1469.doi: 10.3969/j.issn.1006-9771.2021.12.013

功能性电刺激康复踏车训练对痉挛型脑性瘫痪儿童下肢运动功能的效果

何艳^1,²,张琦^1,²(),胡晓诗²,马婷婷^1,²,李思佳²

1. 首都医科大学康复医学院,北京市 100068
2. 中国康复研究中心北京博爱医院儿童物理疗法科,北京市 100068

收稿日期:2021-08-23 修回日期:2021-11-09 出版日期:2021-12-25 发布日期:2021-12-29
通讯作者: 张琦 E-mail:13501320729@163.com
作者简介:何艳(1985-),女,汉族,湖北天门市人,硕士,主管技师,主要研究方向：脑瘫、脊髓损伤、脑卒中的物理治疗。
基金资助:
中国康复研究中心青年基金项目(2017ZX-Q7)

Effect of Functional Electrical Stimulation Rehabilitation Cycling on Lower Limb Motor Function in Children with Spastic Cerebral Palsy

HE Yan^1,²,ZHANG Qi^1,²(),HU Xiao-shi²,MA Ting-ting^1,²,LI Si-jia²

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Department of PT, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2021-08-23 Revised:2021-11-09 Published:2021-12-25 Online:2021-12-29
Contact: ZHANG Qi E-mail:13501320729@163.com
Supported by:
Youth Fund of China Rehabilitation Research Center(2017ZX-Q7)

摘要/Abstract

摘要：

目的探讨功能性电刺激(FES)康复踏车训练对痉挛型脑瘫儿童下肢运动功能的影响。方法选取2017年11月至2020年12月北京博爱医院痉挛型偏瘫患儿36例,随机分为对照组(n = 18)和观察组(n = 18)。对照组每天进行2次常规康复训练,观察组在此基础上加1次FES康复踏车训练,共8周。治疗前后分别采用改良Ashworth量表(MAS)评价偏瘫侧腓肠肌、腘绳肌肌张力,10米步行测试评价步行速度的改变,6分钟步行测试评价步行耐力的改变,粗大运动功能测试(GMFM)的D区和E区评价步行功能,生理消耗指数(PCI)评价能量消耗。结果观察组脱落2例。训练后,两组腓肠肌MAS评分无明显变化(t < 1.145, P > 0.05);观察组腘绳肌MAS评分显著降低(t = 4.869, P < 0.001),对照组无明显变化(t = 1.458, P > 0.05)。训练后,两组10 m步行速度、6 min步行距离、GMFM评分和PCI均显著改善(|t| > 6.241, P < 0.001),且观察组优于对照组(|t| > 2.097, P < 0.05)。结论功能性电刺激康复踏车训练可改善痉挛型脑瘫儿童的下肢运动功能。

关键词: 痉挛型脑性瘫痪, 功能性电刺激, 康复踏车, 下肢, 运动功能

Abstract:

Objective To explore the effect of functional electrical stimulation (FES) rehabilitation cycling on lower limb motor function in children with spastic cerebral palsy. Methods From November, 2017 to December, 2020, 36 children with spastic hemiplegia in Beijing Bo'ai Hospital were randomly divided into control group (n = 18) and observation group (n = 18). The control group received routine rehabilitation training twice a day, and the observation group received FES rehabilitation cycling in addition, for eight weeks. Before and after treatment, the muscle tension of gastrocnemius and hamstring muscles on hemiplegic side was evaluated by modified Ashworth Scale (MAS), the change of walking speed was evaluated by 10-meter walking speed, the change of walking endurance was evaluated by 6-minute Walking Test, the walking function was evaluated by areas D and E of Gross Motor Function Measure (GMFM), and the energy consumption was evaluated by physiological cost index (PCI).Results Two cases dropped out in the observation group. After training, there was no significant difference in MAS score of gastrocnemius muscle in both groups (t < 1.145, P > 0.05), the MAS score of hamstring muscle significantly decreased in the observation group (t = 4.869, P < 0.001), and no significant change was found in the control group (t = 1.458, P > 0.05). After training, the 10-meter walking speed, 6-minute walking distance, the score of GMFM and PCI significantly improved in both groups (|t| > 6.241, P < 0.001), and were better in the observation group than in the control group (|t| > 2.097, P < 0.05).Conclusion FES rehabilitation cycling training can improve the lower limb motor function of children with spastic hemiplegia.

Key words: spastic cerebral palsy, functional electrical stimulation, rehabilitation cycling, lower limb, motor function

中图分类号:

R742.3

何艳,张琦,胡晓诗,马婷婷,李思佳. 功能性电刺激康复踏车训练对痉挛型脑性瘫痪儿童下肢运动功能的效果[J]. 《中国康复理论与实践》, 2021, 27(12): 1464-1469.

HE Yan,ZHANG Qi,HU Xiao-shi,MA Ting-ting,LI Si-jia. Effect of Functional Electrical Stimulation Rehabilitation Cycling on Lower Limb Motor Function in Children with Spastic Cerebral Palsy[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(12): 1464-1469.

图/表 7

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组别	n	性别(n)^a		年龄(岁)	偏瘫侧(n)^a
组别	n	男	女	年龄(岁)	左	右
对照组	18	11	7	8.28±1.45	8	10
观察组	18	12	6	8.33±1.37	9	9
t值				-0.118
P值		0.500		0.907	0.500

组别	n	训练前	训练后	t值	P值
对照组	18	1.89±0.76	1.83±0.71	1.000	0.331
观察组	16	2.13±0.96	1.94±0.77	1.145	0.270
t值		-0.801	-0.411
P值		0.429	0.684

组别	n	训练前	训练后	t值	P值
对照组	18	2.06±0.73	1.94±0.73	1.458	0.163
观察组	16	2.25±0.93	1.38±0.72	4.869	< 0.001
t值		-0.683	2.295
P值		0.499	0.028

组别	n	训练前	训练后	t值	P值
对照组	18	0.39±0.08	0.60±0.13	-12.212	< 0.001
观察组	16	0.41±0.09	0.86±0.16	-20.964	< 0.001
t值		-0.664	-5.102
P值		0.512	< 0.001

组别	n	训练前	训练后	t值	P值
对照组	18	91.83±12.88	133.28±19.00	-12.912	< 0.001
观察组	16	84.67±8.90	199.81±37.35	-15.356	< 0.001
t值		1.858	-6.659
P值		0.072	< 0.001

功能性电刺激康复踏车训练对痉挛型脑性瘫痪儿童下肢运动功能的效果

Effect of Functional Electrical Stimulation Rehabilitation Cycling on Lower Limb Motor Function in Children with Spastic Cerebral Palsy

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组别	n	训练前	训练后	t值	P值
对照组	18	71.11±6.51	87.56±5.34	-12.195	< 0.001
观察组	16	78.44±6.95	96.75±7.01	-67.938	< 0.001
t值		-0.575	-4.331
P值		0.569	< 0.001

组别	n	训练前	训练后	t值	P值
对照组	18	0.743±0.324	0.621±0.263	6.241	< 0.001
观察组	16	0.708±0.351	0.439±0.242	8.996	< 0.001
t值		0.298	2.097
P值		0.768	0.043

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