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

Abstract

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

CLC Number:

R742.3

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.

Figures/Tables 9

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References 34

[1]	NOVAK I, JACKMAN M, FINCH-EDMONDSON M, et al. Cerebral palsy[J]. Lancet, 2025, 406(10499): 174-188. doi: 10.1016/S0140-6736(25)00686-5
[2]	OSKOUI M, COUTINHO F, DYKEMAN J, et al. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis[J]. Dev Med Child Neurol, 2013, 55(6): 509-519. doi: 10.1111/dmcn.12080 pmid: 23346889
[3]	李晓捷, 邱洪斌, 姜志梅, 等. 中国十二省市小儿脑性瘫痪流行病学特征[J]. 中华实用儿科临床杂志, 2018, 33(5): 378-383.
	LI X J, QIU H B, JIANG Z M, et al. Epidemiological characteristics of cerebral palsy in children from twelve provinces and cities in China[J]. Chin J Appl Clin Pediat, 2018, 33(5): 378-383.
[4]	中国残疾人联合会. 2024年残疾人事业发展统计公报[EB/OL]. (2025-05-08)[2025-10-06]. https://www.cdpf.org.cn/zwgk/zccx/tjgb/1706f34657364af9a52b67f77d8c9f2b.htm.
[5]	BINGÖL H, GÜNEL M K. Comparing the effects of modified constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy mainstreamed in regular school: a randomized controlled study[J]. Arch Pediatr, 2022, 29(2): 105-115. doi: 10.1016/j.arcped.2021.11.017
[6]	PATEL D R, BOVID K M, RAUSCH R, et al. Cerebral palsy in children: a clinical practice review[J]. Curr Probl Pediatr Adolesc Health Care, 2024, 54(11): 101673.
[7]	REEDMAN S E, KILGOUR G M, GOMERSALL S, et al. Active start active future: feasibility of a behaviour-change intervention to reduce sedentary behaviour and promote physical activity in young children with cerebral palsy[J]. Phys Occup Ther Pediatr, 2025, 45(5): 745-768. doi: 10.1080/01942638.2025.2506061 pmid: 40415733
[8]	ZSCHORLICH V, YAMAGUCHI T, SCHNEIDER C. Editorial: the use of repetitive peripheral magnetic stimulation (rPMS) in neurological disorders and neurorehabilitation[J]. Front Neurol, 2023, 14: 41324882.
[9]	STARKOVA E Y, VLADIMIROVA N N, TSVETKOVA E M, et al. Elektromagnitnaya stimulyatsiya pri disfunktsii diafragmy: ritmicheskaya perifericheskaya magnitnaya stimulyatsiya kak metod vybora v vosstanovitel'nom periode insul'ta[J]. Vopr Kurortol Fizioter Lech Fiz Kult, 2024, 101(5): 57-65.
[10]	CARDONE D, PERPETUINI D, DI NICOLA M, et al. Robot-assisted upper limb therapy for personalized rehabilitation in children with cerebral palsy: a systematic review[J]. Front Neurol, 2025, 15: 151499249.
[11]	王潇珺, 王哈妮, 俞红, 等. 高精度经颅直流电刺激联合上肢机器人对缺血性脑卒中上肢功能的效果[J]. 中国康复理论与实践, 2025, 31(2): 218-224. doi: 10.3969/j.issn.1006-9771.2025.02.011
	WANG X J, WANG H N, YU H, et al. Effect of high-definition transcranial direct current stimulation combined with upper limb robot on upper limb dysfunction after ischemic stroke[J]. Chin J Rehabil Theory Pract, 2025, 31(2): 218-224.
[12]	华裕, 朱敏, 张跃. 儿童康复机器人应用现状及发展趋势[J]. 中国康复理论与实践, 2018, 24(6): 667-670. doi: 10.3969/j.issn.1006-9771.2018.06.009
	HUA Y, ZHU M, ZHANG Y. Application and development of pediatric rehabilitation robot (review)[J]. Chin J Rehabil Theory Pract, 2018, 24(6): 667-670.
[13]	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, 中国医师协会康复医师分会儿童康复专业委员会, 等. 中国脑性瘫痪康复指南(2022)第一章:概论[J]. 中华实用儿科临床杂志, 2022, 37(12): 887-892.
	Chinese Association of Rehabilitation Medicine Pediatric Rehabilitation Committee, Chinese Association of Rehabilitation of Disabled Persons Rehabilitation Committee for Cerebral Palsy, Chinese Medical Doctor Association Pediatric Rehabilitation Committee, et al. Chinese rehabilitation guidelines for cerebral palsy (2022) part 1: overview[J]. Chin J Appl Clin Pediatr, 2022, 37(12): 887-892.
[14]	BOHANNON R W, SMITH M B. Interrater reliability of a modified Ashworth Scale of muscle spasticity[J]. Phys Ther, 1987, 67(2): 206-207. doi: 10.1093/ptj/67.2.206 pmid: 3809245
[15]	RECH K D, SALAZAR A P, MARCHESE R R, et al. Fugl-Meyer Assessment scores are related with kinematic measures in people with chronic hemiparesis after stroke[J]. J Stroke Cerebrovasc Dis, 2020, 29(1): 104463. doi: 10.1016/j.jstrokecerebrovasdis.2019.104463
[16]	LUM P S, BURGAR C G, SHOR P C, et al. Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke[J]. Arch Phys Med Rehabil, 2002, 83(7): 952-959. doi: 10.1053/apmr.2001.33101
[17]	GRASER J V, PROSPERO L, LIESCH M, et al. Test-retest reliability of upper limb robotic exoskeleton assessments in children and youths with brain lesions[J]. Sci Rep, 2022, 12(1): 16685. doi: 10.1038/s41598-022-20588-8 pmid: 36202825
[18]	NARDONE R, SEBASTIANELLI L, FERRAZZOLI D, et al. Brain functional reorganization in children with hemiplegic cerebral palsy: assessment with TMS and therapeutic perspectives[J]. Neurophysiol Clin, 2021, 51(5): 391-408. doi: 10.1016/j.neucli.2021.09.002 pmid: 34615605
[19]	邹聪聪, 王潇珺, 马锦蓉, 等. 耳迷走神经电刺激联合双任务训练对缺血性脑卒中患者上肢功能的效果[J]. 中国康复理论与实践, 2025, 31(5): 513-519. doi: 10.3969/j.issn.1006-9771.2025.05.003
	ZOU C C, WANG X J, MA J R, et al. Effect of transcutaneous auricular vagus nerve stimulation combined with dual-task training on upper limb function in patients with ischemic stroke[J]. Chin J Rehabil Theory Pract, 2025, 31(5): 513-519.
[20]	DEMECO A, MOLINARO A, AMBROGGI M, et al. Cognitive approaches in the rehabilitation of upper limb function in children with cerebral palsy: a systematic review and meta-analysis[J]. Eur J Phys Rehabil Med, 2024, 60(3): 445-457.
[21]	XU L, LUO H, HUANG L, et al. Effects of different magnetic stimulation paradigms on post-stroke upper limb function: a randomized controlled trial[J]. Front Neurol, 2025, 16: 161683552.
[22]	ZHAO X, WANG Y, GAO L, et al. Efficacy of repetitive peripheral magnetic stimulation in managing spasticity of the triceps surae muscle in children with cerebral palsy: a retrospective analysis of influencing factors[J]. BMC Pediatr, 2025, 25(1): 912-915. doi: 10.1186/s12887-025-06174-7
[23]	程期琳. rTMS联合rPMS对脑卒中患者上肢运动功能和皮层兴奋性的影响[D]. 上海: 上海体育大学, 2023.
	CHENG Q L. Effect of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper limb motor function and cortical excitability in stroke patients[D]. Shanghai: Shanghai University of Sport, 2023.
[24]	KLAROD K, SUKKHO O, KIATKULANUSORN S, et al. The effect of peripheral magnetic stimulation on functional mobility and morphology in cerebral palsy with spastic diplegia: a randomized controlled trial[J]. Life (Basel), 2025, 15(3): 416.
[25]	罗红, 徐丽. 重复经颅磁刺激联合重复外周磁刺激对脑出血患者上肢运动功能的效果:基于静息态功能磁共振成像的随机对照试验[J]. 中国康复理论与实践, 2024, 30(9): 1060-1068. doi: 10.3969/j.issn.1006-9771.2024.09.009
	LUO H, XU L. Effect of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper extremities motor function in patients with cerebral hemorrhage: a randomized controlled trial based on resting state-functional magnetic resonance imaging[J]. Chin J Rehabil Theory Pract, 2024, 30(9): 1060-1068.
[26]	LUO S, WEN Z, LIU Y, et al. Effects of repetitive transcranial magnetic stimulation combined with repetitive peripheral magnetic stimulation on upper limb motor function after stroke: a systematic review and meta-analysis[J]. Front Neurol, 2024, 15: 151472837.
[27]	崔甜甜, 杨钰琳, 崔腾腾, 等. 不同强化训练对脑性瘫痪儿童上肢运动功能效果的网状Meta分析[J]. 中国康复理论与实践, 2024, 30(4): 437-448. doi: 10.3969/j.issn.1006-9771.2024.04.009
	CUI T T, YANG Y L, CUI T T, et al. Effect of different intensive training on upper limb motor function in children with cerebral palsy: a network meta-analysis[J]. Chin J Rehabil Theory Pract, 2024, 30(4): 437-448.
[28]	POHL K L, MÜLLER J, WITTIG-BÖTTGER K, et al. A randomized controlled trial to test the effects of repetitive peripheral magnetic stimulation versus neuromuscular electrical stimulation in patients with spastic hemiparesis after stroke (Repmast): study protocol[J]. Brain Sci, 2024, 14(12): 1249. doi: 10.3390/brainsci14121249
[29]	FADLI R A, YAMANOUCHI Y, JOVANOVIC L I, et al. Effectiveness of motor and prefrontal cortical areas for brain-controlled functional electrical stimulation neuromodulation[J]. J Neural Eng, 2023, 20(5): 1741-1750.
[30]	KAMO T, WADA Y, OKAMURA M, et al. Repetitive peripheral magnetic stimulation for impairment and disability in people after stroke[J]. Cochrane Database Syst Rev, 2022, 9(9): CD011968.
[31]	SAWAI S, FUJIKAWA S, USHIO R, et al. Repetitive peripheral magnetic stimulation combined with motor imagery changes resting-state EEG activity: a randomized controlled trial[J]. Brain Sci, 2022, 12(11): 1548-1555. doi: 10.3390/brainsci12111548
[32]	SAKAI K, YASUFUKU Y, KAMO T, et al. Repetitive peripheral magnetic stimulation for patients after stroke[J]. Stroke, 2020, 51(6): e105-e106.
[33]	HU S, WU G, WU B, et al. Rehabilitative training paired with peripheral stimulation promotes motor recovery after ischemic cerebral stroke[J]. Exp Neurol, 2022, 349: 1-10.
[34]	KIM M G, LIM H, LEE H S, et al. Brain-computer interface-based action observation combined with peripheral electrical stimulation enhances corticospinal excitability in healthy subjects and stroke patients[J]. J Neural Eng, 2022, 19(3): 35675795.

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	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

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

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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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

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