Kamper Derek G, Yasukawa Audrey M, Barrett Kenley M, Gaebler-Spira Deborah J
Sensory Motor Performance Program, Northwestern University, Chicago, IL 606011, USA.
Pediatr Phys Ther. 2006 Spring;18(1):31-8. doi: 10.1097/01.pep.0000202102.07477.7a.
This pilot study examined the effects of neuromuscular electrical stimulation (NMES) therapy on upper limb impairment in children with cerebral palsy, specifically addressing spasticity, heightened passive resistance to wrist rotation, coactivation, and weakness.
Eight subjects, aged five to 15 years, with spastic hemiparesis subsequent to brain injury, participated in three months of NMES therapy, targeting the wrist flexor and extensor muscles. Maximum voluntary wrist extension range of motion against gravity, spasticity, passive torque, maximum voluntary isometric torque, and coactivation were recorded prior to, during, and at the conclusion of the therapy.
Seven of the eight subjects demonstrated a significant (>15 degrees) improvement in wrist extension range of motion against gravity following the NMES treatment, with an average gain of 38 degrees. Differences in spasticity (0.01 +/- 0.14 N-m, p = 0.80) and passive torque (0.03 +/- 0.11 N-m, p = 0.52) were not significant for these subjects. Isometric wrist extension torque, however, did increase significantly (p < 0.01), accompanied by a reduction in flexor coactivation (p < 0.01).
Evidence suggests that the NMES treatment protocol affected wrist extension by improving the strength of the wrist extensor muscles, possibly through decreased flexor coactivation. Further studies are required, however, to determine whether electrical stimulation itself or other facets of the therapy paradigm played the key role in improvement.
本初步研究探讨了神经肌肉电刺激（NMES）疗法对脑瘫患儿上肢功能障碍的影响，具体涉及痉挛、腕关节旋转时被动阻力增加、共同激活和肌无力等方面。
8名年龄在5至15岁之间、因脑损伤导致痉挛性偏瘫的受试者参加了为期三个月的NMES疗法，治疗目标为腕屈肌和伸肌。在治疗前、治疗期间和治疗结束时记录了抗重力下最大自主腕关节伸展活动范围、痉挛程度、被动扭矩、最大自主等长扭矩和共同激活情况。
8名受试者中有7名在接受NMES治疗后，抗重力下腕关节伸展活动范围有显著（>15度）改善，平均增加了38度。这些受试者的痉挛程度（0.01±0.14牛米，p = 0.80）和被动扭矩（0.03±0.11牛米，p = 0.52）差异不显著。然而，等长腕关节伸展扭矩确实显著增加（p < 0.01），同时屈肌共同激活减少（p < 0.01）。
有证据表明，NMES治疗方案通过改善腕伸肌力量影响腕关节伸展，可能是通过减少屈肌共同激活实现的。然而，需要进一步研究以确定是电刺激本身还是治疗模式的其他方面在改善过程中起关键作用。
