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

Abstract

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

CLC Number:

R742.3

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.

Figures/Tables 7

References 28

[1]	BRANDENBURG J E, FOGARTY M J, SIECK G C. A critical evaluation of current concepts in cerebral palsy[J]. Physiology (Bethesda), 2019, 34(3):216-229.
[2]	VITRIKAS K, DALTON H, BREISH D. Cerebral palsy: an overview[J]. Am Fam Physician, 2020, 101(4):213-220.
[3]	MOREAU N G, BODKIN A W, BJORNSON K, et al. Effectiveness of rehabilitation interventions to improve gait speed in children with cerebral palsy: systematic review and meta-analysis[J]. Phys Ther, 2016, 96(12):1938-1954. doi: 10.2522/ptj.20150401
[4]	NOVAK I, MORGAN C, FAHEY M. State of the Evidence Traffic Lights 2019: systematic review of interventions for preventing and treating children with cerebral palsy[J]. Curr Neurol Neurosci Rep, 2020, 20(2):3.
[5]	汪乐, 徐林, 胡传宇, 等. 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.
	WANG L, XU L, HU C Y, et al. Effects of functional electrical stimulation on lower-limb and trunk function in children with cerebral palsy: a meta-analysis[J]. Chin J Rehabil Theory Pract, 2021, 27(4):420-428.
[6]	糜迅, 杨裕梅. 功能性电刺激联合踏车运动在临床康复中的应用及研究现状[J]. 系统医学, 2017, 2(2):165-168.
	MI X, YANG Y M. The present situation of research and application of electrical stimulation combined with treadmill exercise in clinical rehabilitation function[J]. Sys Med, 2017, 2(2):165-168.
[7]	MARQUEZ-CHIN C, POPOVIC M R. Functional electrical stimulation therapy for restoration of motor function after spinal cord injury and stroke: a review[J]. Biomed Eng Online, 2020, 19(1):34. doi: 10.1186/s12938-020-00773-4
[8]	MESEGUER-HENAREJOS A B, SÁNCHEZ-MECA J, LÓPEZ-PINA J A, et al. Inter- and intra-rater reliability of the modified Ashworth Scale: a systematic review and meta-analysis[J]. Eur J Phys Rehabil Med, 2018, 54(4):576-590.
[9]	CHO C, HWANG W, HWANG S, et al. Treadmill training with virtual reality improves gait, balance, and muscle strength in children with cerebral palsy[J]. Tohoku J Exp Med, 2016, 238(3):213-218. doi: 10.1620/tjem.238.213
[10]	MYLIUS C F, PAAP D, TAKKEN T. Reference value for the 6-minute walk test in children and adolescents: a systematic review[J]. Expert Rev Respir Med, 2016, 10(12):1335-1352. doi: 10.1080/17476348.2016.1258305
[11]	ALOTAIBI M, LONG T, KENNEDY E, et al. The efficacy of GMFM-88 and GMFM-66 to detect changes in gross motor function in children with cerebral palsy (CP): a literature review[J]. Disabil Rehabil, 2014, 36(8):617-627. doi: 10.3109/09638288.2013.805820
[12]	李品香. 生理消耗指数的信度[J]. 国外医学(物理医学与康复学分册), 1997(1):25-26.
	LI P X. Reliability of physiological consumption index[J]. Neural Inj Funct Reconstr, 1997(1):25-26.
[13]	STACKHOUSE S K, BINDER-MACLEOD S A, LEE S C. Voluntary muscle activation, contractile properties, and fatigability in children with and without cerebral palsy[J]. Muscle Nerve, 2005, 31(5):594-601. doi: 10.1002/(ISSN)1097-4598
[14]	BENNETT B C, ABEL M F, WOLOVICK A, et al. Center of mass movement and energy transfer during walking in children with cerebral palsy[J]. Arch Phys Med Rehabil, 2005, 86(11):2189-2194. doi: 10.1016/j.apmr.2005.05.012
[15]	ZAHRADKA N, BEHBOODI A, SANSARE A, et al. Evaluation of individualized functional electrical stimulation-induced acute changes during walking: a case series in children with cerebral palsy[J]. Sensors (Basel), 2021, 21(13):4452. doi: 10.3390/s21134452
[16]	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. doi: 10.1111/dmcn.12955
[17]	SHARIF F, GHULAM S, MALIK A N, et al. Effectiveness of functional electrical stimulation (FES) versus conventional electrical stimulation in gait rehabilitation of patients with stroke[J]. J Coll Physicians Surg Pak, 2017, 27(11):703-706.
[18]	LEE D, LEE G. Effect of afferent electrical stimulation with mirror therapy on motor function, balance, and gait in chronic stroke survivors: a randomized controlled trial[J]. Eur J Phys Rehabil Med, 2019, 55(4):442-449.
[19]	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. doi: 10.1111/dmcn.13501
[20]	姜艳, 刘月芬, 王艳波, 等. 多通道功能性电刺激对脑性瘫痪青少年下肢运动和平衡功能的影响[J]. 中国康复理论与实践, 2016, 22(9):1056-1058.
	JIANG Y, LIU Y F, WANG Y B, et al. Effect of multichannel function electrical stimulation on motor and balance function of lower extremity in adolescent with cerebral palsy[J]. Chin J Rehabil Theory Pract, 2016, 22(9):1056-1058.
[21]	刘加鹏, 王卫宁, 梁思捷, 等. 多通道功能性电刺激踏车训练对脑卒中患者步行功能的影响[J]. 中国康复医学杂志, 2021, 36(2):182-185.
	LIU J P, WANG W N, LIANG S J, et al. Effect of multichannel functional electrical stimulation cycling on walking function of stroke patients[J]. Chin J Rehabil Med, 2021, 36(2):182-185.
[22]	陈薇, 陈立峰, 黄凌锋, 等. 功能性电刺激训练对痉挛型脑瘫儿童运动功能的影响[J]. 中国医学物理学杂志, 2021, 38(6):788-792.
	CHEN W, CHEN L F, HUANG L F, et al. Efficacy of functional electrical stimulation training on motor function in pediatric patients with spastic cerebral palsy[J]. Chin J Med Phys, 2021, 38(6):788-792.
[23]	李娟, 罗伦, 张禄菊, 等. FES康复踏车联合太极运动想象疗法对脑卒中患者下肢运动功能、本体感觉以及ADL的影响[J]. 神经损伤与功能重建, 2021, 16(3):180-182, 186.
	LI J, LUO L, ZHANG L J, et al. Effects of FES rehabilitation cycling combined with Taiji exercise imagination therapy on lower limb motor function, proprioception and ADL in stroke patients[J]. Neural Inj Funct Reconstr, 2021, 16(3):180-182, 186.
[24]	徐泉, 马迪, 潘钰, 等. 功能性电刺激下踏车训练对亚急性期脑卒中患者运动功能和心肺适能的效果[J]. 中国康复理论与实践, 2020, 26(9):1005-1009.
	XU Q, MA D, PAN Y, et al. Effects of functional electrical stimulation-assisted cycling on motor function and cardiopulmonary fitness in subacute stroke patients[J]. Chin J Rehabil Theory Pract, 2020, 26(9):1005-1009.
[25]	AARON S E, VANDERWERKER C J, EMBRY A E, et al. FES-assisted cycling improves aerobic capacity and locomotor function post-cerebrovascular accident[J]. Med Sci Sports Exerc, 2018, 50(3):400-406.
[26]	ARMAND S, DECOULON G, BONNEFOY-MAZURE A. Gait analysis in children with cerebral palsy[J]. EFORT Open Rev, 2016, 1(12):448-460. doi: 10.1302/2058-5241.1.000052
[27]	HUANG H P, KUO C C, LU T W, et al. Bilateral symmetry in leg and joint stiffness in children with spastic hemiplegic cerebral palsy during gait[J]. J Orthop Res, 2020, 38(9):2006-2014. doi: 10.1002/jor.v38.9
[28]	KAMP F A, LENNON N, HOLMES L, et al. Energy cost of walking in children with spastic cerebral palsy: relationship with age, body composition and mobility capacity[J]. Gait Posture, 2014, 40(1):209-214. doi: 10.1016/j.gaitpost.2014.03.187

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

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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