Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia.
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
Restor Neurol Neurosci. 2020;38(6):431-441. doi: 10.3233/RNN-201088.
The integration of therapeutic approaches is increasingly recommended for children with cerebral palsy, to enhance outcomes. Nevertheless, clinicians still opt for separate or combined therapies based on little credible knowledge.
This study endeavored to evaluate the effect of botulinum neurotoxin-A (BoNT-A) injection and reciprocal neuromuscular electrical stimulation (rNMES) and their combination on the upper extremity function in children with spastic hemiplegia.
Sixty-four children with spastic hemiplegia (aged 6- 10 years) were randomly assigned to four treatment-based groups [group I (BoNT-A), group II (rNMES), group III (combined BoNT-A and rNMES), and group IV (Control)]. All children received a physical rehabilitation program, thrice/week over three months. Unilateral upper-limb function, bimanual hand function, and real-time arm-hand function were assessed using Melbourne Assessment (MA), Assisting Hand Assessment (AHA), and Pediatric Motor Activity Log (PMAL) scales respectively pre-treatment, post-treatment, and at 6 months follow-up.
Post-treatment, group III achieved greater improvement in MA, AHA, and PMAL compared to other groups (all P < 0.05), and the difference remained in favor of group III at the follow-up (all P < 0.05).
This study suggests that BoNT-A and rNMES combined are more effective than either of them alone to enhance upper-extremity function in children with spastic hemiplegia.
为了提高疗效，越来越多的建议将治疗方法整合应用于脑瘫患儿。然而，临床医生仍根据有限的可靠知识选择单独或联合治疗。
本研究旨在评估肉毒毒素 A（BoNT-A）注射与交互神经肌肉电刺激（rNMES）及其联合应用对痉挛性偏瘫儿童上肢功能的影响。
64 例痉挛性偏瘫儿童（6-10 岁）随机分为 4 个治疗组[组 I（BoNT-A）、组 II（rNMES）、组 III（BoNT-A 和 rNMES 联合）和组 IV（对照组）]。所有儿童均接受为期 3 个月、每周 3 次的物理康复方案。采用墨尔本评估（MA）、辅助手评估（AHA）和小儿运动活动日志（PMAL）量表分别于治疗前、治疗后和 6 个月随访时评估单侧上肢功能、双手协作手功能和实时手臂-手功能。
治疗后，组 III 在 MA、AHA 和 PMAL 方面的改善均优于其他组（均 P<0.05），且在随访时仍有利于组 III（均 P<0.05）。
本研究表明，BoNT-A 和 rNMES 联合应用比单独应用更能有效增强痉挛性偏瘫儿童的上肢功能。
