重复性外周磁刺激联合上肢智能机器人对痉挛型偏瘫儿童上肢功能的效果

doi:10.3969/j.issn.1006-9771.2026.05.009

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (5): 588-596.doi: 10.3969/j.issn.1006-9771.2026.05.009

重复性外周磁刺激联合上肢智能机器人对痉挛型偏瘫儿童上肢功能的效果

李明娣, 王银, 张何威, 何妹, 霍洪亮, 顾琴, 梁冠军()

苏州大学附属儿童医院康复医学科，江苏苏州市 215004

收稿日期:2025-12-25 修回日期:2026-03-26 出版日期:2026-05-25 发布日期:2026-05-26
通讯作者: 梁冠军，E-mail：13071903@qq.com
作者简介:李明娣(1989-)，女，江苏盐城市人，副主任治疗师，主要研究方向：儿童康复评估与治疗。
梁冠军(1982-)，男，硕士，副主任治疗师，主要研究方向：儿童康复。
基金资助:
江苏省卫生健康委面上(青年)项目(MQ2024027)

Effect of repetitive peripheral magnetic stimulation combined with upper limb intelligent robot training on upper limb function in children with unilateral spastic cerebral palsy

LI Mingdi, WANG Yin, ZHANG Hewei, HE Mei, HUO Hongliang, GU Qin, LIANG Guanjun()

Department of Rehabilitation Medicine, Children's Hospital of Soochow University, Suzhou, Jiangsu 215004, China

Received:2025-12-25 Revised:2026-03-26 Published:2026-05-25 Online:2026-05-26
Contact: LIANG Guanjun, E-mail: 13071903@qq.com
Supported by:
Jiangsu Provincial Health Commission's Project (Youth)(MQ2024027)

摘要/Abstract

摘要：

目的探讨重复性外周磁刺激(rPMS)联合上肢智能机器人训练对痉挛型偏瘫儿童上肢肌张力、运动功能和运动皮质兴奋性的效果。
方法 2023年3月至2024年12月，选取苏州大学附属儿童医院90例痉挛型偏瘫患儿，随机分为对照组(n=30)、rPMS组(n=30)和联合组(n=30)。对照组行常规作业治疗，rPMS组先行rPMS，之后再行常规作业治疗，联合组先行rPMS，再进行上肢智能机器人训练，共4周。治疗前后采用改良Ashworth量表(MAS)评估肱二头肌肌张力，采用Fugl-Meyer评定量表上肢部分(FMA-UE)和上肢智能参数评估上肢功能，并采用经颅磁刺激(TMS)检测患侧运动皮质静息态运动阈值(RMT)和运动诱发电位(MEP)振幅。
结果治疗后，各组MAS分级均显著改善(|Z|>3.523, P<0.001)，联合组改善程度优于对照组(P<0.05)。FMA-UE评分、上肢智能参数和TMS参数的组内效应(F>65.21, P<0.001)、组间效应(F>17.94, P<0.001)和交互效应(F>5.36, P<0.01)均显著。事后检验显示，联合组FMA-UE评分、上肢智能参数和TMS参数改善均明显优于对照组和rPMS组(均P<0.01)，除FMA-UE评分外，rPMS组在上肢智能参数(力学反馈、运动轨迹及关节活动度)及TMS指标(RMT、MEP振幅)方面的改善均优于对照组(P<0.05)。
结论 rPMS联合上肢智能机器人训练可降低痉挛型偏瘫儿童上肢肌张力，改善运动功能，提升皮质兴奋性。

关键词: 痉挛型偏瘫, 儿童, 重复性外周磁刺激, 上肢, 智能机器人, 运动功能, 神经可塑性

Abstract:

Objective To investigate the effect of repetitive peripheral magnetic stimulation (rPMS) combined with upper limb intelligent robotic training on muscle tension, motor function and cortical excitability in children with unilateral spastic cerebral palsy (USCP).
Methods From March, 2023 to December, 2024, 90 children with USCP admitted to Children's Hospital of Soochow University were selected and randomly divided into control group (n=30), rPMS group (n=30) and combined group (n=30). The control group received conventional occupational therapy. The rPMS group received rPMS intervention followed by conventional occupational therapy. The combined group received rPMS followed by upper limb intelligent robot training, for four weeks. Before and after treatment, muscle tension of biceps brachii was assessed using the modified Ashworth Scale (MAS); upper limb motor function was evaluated using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and upper limb intelligent parameters; and cortical excitability was measured using transcranial magnetic stimulation (TMS), including resting motor threshold (RMT) and motor-evoked potential (MEP) amplitude of the affected hemisphere.
Results After treatment, MAS grades improved in all groups (|Z|>3.523, P<0.001), and the improvement in the combined group was superior to that in the control group (P<0.05). Significant intra-group (F>65.21, P<0.001), inter-group (F>17.94, P<0.001) and interaction effects (F>5.36, P<0.01) were observed in FMA-UE scores, upper limb intelligent parameters and TMS parameters. Post Hoc analysis showed that the combined group demonstrated significantly greater improvements in FMA-UE scores, upper limb intelligent parameters, and TMS parameters compared with both the control and rPMS groups (all P<0.01). Except for FMA-UE scores, the rPMS group showed significantly greater improvements than the control group in upper limb intelligent parameters (mechanical feedback, trajectory, and range of motion) and TMS parameters (RMT and MEP amplitude) (P<0.05).
Conclusion rPMS combined with upper limb intelligent robotic training can reduce upper limb muscle tension, improve motor function, and enhance cortical excitability in children with USCP.

Key words: unilateral spastic cerebral palsy, children, repetitive peripheral magnetic stimulation, upper limb, intelligent robot, motor function, neuroplasticity

中图分类号:

R742.3

李明娣, 王银, 张何威, 何妹, 霍洪亮, 顾琴, 梁冠军. 重复性外周磁刺激联合上肢智能机器人对痉挛型偏瘫儿童上肢功能的效果[J]. 《中国康复理论与实践》, 2026, 32(5): 588-596.

LI Mingdi, WANG Yin, ZHANG Hewei, HE Mei, HUO Hongliang, GU Qin, LIANG Guanjun. Effect of repetitive peripheral magnetic stimulation combined with upper limb intelligent robot training on upper limb function in children with unilateral spastic cerebral palsy[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(5): 588-596.

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组别	n	性别(男/女)/n	平均年龄/月	智商	偏瘫侧(左/右)/n
对照组	30	15/15	42.57±9.71	85.56±8.18	15/15
rPMS组	30	14/16	43.35±10.94	87.31±9.43	13/17
联合组	30	16/14	43.22±10.61	86.40±8.59	12/18
χ²/F值		0.267	0.049	0.230	0.630
P值		0.874	0.951	0.796	0.730

组别		U值	Z值	P值	Bonferroni校正P值
对照组	rPMS组	372.500	-2.150	0.032	0.096
对照组	联合组	312.000	-3.182	0.015	0.045
rPMS组	联合组	395.500	-1.567	0.119	0.357

项目	组别	治疗前		治疗后
项目	组别	均值	标准差	均值	标准差
FMA-UE	对照组	44.81	5.94	55.27	6.25
	rPMS组	45.14	6.10	56.67	6.77
	联合组	45.22	6.38	62.50	7.01
力学反馈	对照组	40.06	8.28	45.31	8.91
	rPMS组	41.15	9.33	50.92	9.49
	联合组	42.24	9.19	56.95	10.03
运动轨迹	对照组	35.24	6.64	39.21	6.31
	rPMS组	36.19	6.32	43.48	7.26
	联合组	38.22	6.76	48.72	8.73
关节活动度	对照组	26.20	5.18	29.79	6.34
	rPMS组	27.07	6.34	32.16	7.85
	联合组	27.10	6.82	37.39	7.74

变量		平方和	自由度	均方	F值	P值
FMA-UE	组内	5689.313	1	5689.313	189.347	<0.001
	组间	1289.764	2	644.882	20.983	<0.001
	组内×组间	328.578	2	164.284	5.358	0.006
力学反馈	组内	4287.694	1	4287.694	65.212	<0.001
	组间	2986.457	2	1493.223	22.746	<0.001
	组内×组间	897.825	2	448.912	6.835	0.002
运动轨迹	组内	2896.433	1	2896.433	82.154	<0.001
	组间	1875.687	2	937.843	26.636	<0.001
	组内×组间	412.982	2	206.491	5.862	0.004
关节活动度	组内	4512.786	1	4512.786	102.877	<0.001
	组间	1568.921	2	784.460	17.943	<0.001
	组内×组间	628.456	2	314.228	7.196	0.001

变量	组别		平均值差	P 值	95% CI
变量	组别		平均值差	P 值	下限	上限
FMA-UE	对照组	rPMS组	-1.404	0.183	-2.658	0.483
	对照组	联合组	-7.232	<0.001	-8.578	-5.114
	rPMS组	联合组	-5.833	<0.001	-7.523	-3.876
力学反馈	对照组	rPMS 组	-5.614	<0.001	-6.517	-2.522
	对照组	联合组	-11.644	<0.001	-12.936	-7.523
	rPMS组	联合组	-6.034	<0.001	-6.979	-2.903
运动轨迹	对照组	rPMS组	-4.278	<0.001	-5.058	-1.581
	对照组	联合组	-9.515	<0.001	-10.211	-4.848
	rPMS组	联合组	-5.243	0.001	-6.014	-1.405
关节活动度	对照组	rPMS组	-2.374	0.041	-2.975	-0.020
	对照组	联合组	-7.605	<0.001	-8.581	-4.818
	rPMS组	联合组	-5.230	<0.001	-7.224	-3.537

重复性外周磁刺激联合上肢智能机器人对痉挛型偏瘫儿童上肢功能的效果

Effect of repetitive peripheral magnetic stimulation combined with upper limb intelligent robot training on upper limb function in children with unilateral spastic cerebral palsy

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组别	n	治疗前/n						治疗后/n						Z值	P值
组别	n	0	1	1⁺	2	3	4	0	1	1⁺	2	3	4	Z值	P值
对照组	30	0	8	10	12	0	0	0	10	12	8	0	0	-3.681	<0.001
rPMS组	30	0	9	9	12	0	0	0	12	11	7	0	0	-3.523	<0.001
联合组	30	0	9	10	11	0	0	0	15	10	5	0	0	-4.129	<0.001
H值		1.980						10.215
P值		0.372						0.006

变量		平方和	自由度	均方	F值	P值
RMT	组内	4268.513	1	4268.513	198.523	<0.001
	组间	2896.290	2	1448.150	68.749	<0.001
	组内×组间	528.424	2	264.212	13.020	<0.001
MEP振幅	组内	12.550	1	12.550	214.856	<0.001
	组间	3.761	2	1.880	31.711	<0.001
	组内×组间	0.874	2	0.437	7.270	0.001

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项目	组别	治疗前		治疗后
项目	组别	均值	标准差	均值	标准差
RMT/%MSO	对照组	52.32	5.08	46.37	5.24
	rPMS组	51.49	5.36	44.37	4.69
	联合组	52.19	5.57	40.36	4.58
MEP振幅/mV	对照组	0.48	0.12	0.65	0.15
	rPMS组	0.49	0.11	0.72	0.16
	联合组	0.50	0.13	0.85	0.18