Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt -
Eur J Phys Rehabil Med. 2019 Apr;55(2):241-249. doi: 10.23736/S1973-9087.18.05196-1. Epub 2018 Jun 14.
Combination of medical and physical therapy protocols are increasingly recommended for cerebral palsied children. However, the clinicians frequently choose between independent or integrated treatment delivery based on little empirical evidence.
The aim of this study was to analyze the independent versus the integrated effects of reciprocal electrical stimulation (RES) and botulinum toxin-A (BoNT-A) in terms of dynamic limits of postural stability and ankle kinematics in spastic diplegia.
A single-blinded randomized trial.
Physical therapy laboratories and out-patient clinic and a tertiary local hospital.
Sixty children with spastic diplegia were allocated to RES, BoNT, or Integrated RES and BoNT interventions (20 children for each group).
All children participated in a 60-minutes exercise program, three times/week for 12 successive weeks. Additionally, The RES group received reciprocal electrical stimulation of ankle dorsi and plantar flexors for 30 minutes before each exercise session, the BoNT group were injected by botulinum toxin-A to calf muscles one-week prior to commencing the exercise program, and the Integrated RES and BoNT group received both interventions. Ankle joint kinematics (displacement angle at initial contact, maximum dorsiflexion-stance, and peak dorsiflexion-swing) and dynamic limits of postural stability (anterior/posterior [AP-LOS], medial/lateral [ML-LOS], and overall [O-LOS]) were assessed at entry and after intervention.
Study groups were comparable with respect to all outcome measures at entry (P>0.05). Compared to the independent effect of either RES or BoNT-A, the integrated RES and BoNT-A produced a preferable improvement of O-LOS, maximum dorsiflexion-stance, and peak dorsiflexion-swing subsequently after intervention (P<0.05). Further, significant differences between BoNT-A and RES regarding the AP-LOS and ML-LOS were observed in favor of BoNT-A (P<0.05).
Integration of RES and BoNT-A has the capability to restore postural stability and ankle kinematics in diplegic children.
Integration of RES and BoNT-A has a considerable effect on some of the essential elements that contribute toward the improvement of ankle biomechanics and postural stability. The demonstrated effect provides the basis for its application in the treatment of spastic diplegia.
医学和物理治疗方案的联合应用越来越多地被推荐用于脑瘫患儿。然而，临床医生通常根据经验证据不足来选择独立或综合的治疗方式。
本研究旨在分析经皮神经电刺激（RES）和肉毒毒素 A（BoNT-A）的独立和综合作用，以评估痉挛性双瘫患儿的姿势稳定动态极限和踝关节运动学。
单盲随机试验。
物理治疗实验室和门诊以及当地一家三级医院。
60 名痉挛性双瘫患儿被分配到 RES、BoNT 或 RES 和 BoNT 综合干预组（每组 20 名患儿）。
所有患儿均参加了 60 分钟的运动方案，每周 3 次，持续 12 周。此外，RES 组在每次运动前 30 分钟接受踝关节背屈和跖屈肌的经皮神经电刺激，BoNT 组在开始运动方案前一周接受小腿肌肉注射肉毒毒素 A，而 RES 和 BoNT 综合干预组则同时接受两种干预措施。在入组时和干预后评估踝关节运动学（初始接触时的位移角度、最大背屈站立位和最大背屈摆动位）和姿势稳定的动态极限（前/后向 [AP-LOS]、内/外 [ML-LOS] 和整体 [O-LOS]）。
研究组在入组时在所有结局指标上均具有可比性（P＞0.05）。与 RES 或 BoNT-A 的单独作用相比，RES 和 BoNT-A 的综合作用在干预后更能改善 O-LOS、最大背屈站立位和最大背屈摆动位（P＜0.05）。此外，BoNT-A 和 RES 组在 AP-LOS 和 ML-LOS 方面也存在显著差异，BoNT-A 组的结果更优（P＜0.05）。
RES 和 BoNT-A 的联合应用能够恢复双瘫患儿的姿势稳定性和踝关节运动学。
RES 和 BoNT-A 的联合应用对改善踝关节生物力学和姿势稳定性的一些重要因素有显著影响。所证明的效果为其在痉挛性双瘫治疗中的应用提供了依据。
