O'Brien Shari M, Lichtwark Glen A, Carroll Timothy J, Barber Lee A
School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.
Centre for Sensorimotor Performance, The University of Queensland, Brisbane, QLD, Australia.
Front Neurol. 2020 Nov 26;11:581892. doi: 10.3389/fneur.2020.581892. eCollection 2020.
Cerebral Palsy (CP) is a non-progressive neurological condition that results in motor impairment which increases proximally to distally along the lower extremity (i.e., greatest impairment at the ankle). Consequently, motor impairment and reduced voluntary muscle activation results in reduced neuromuscular control of the lower limb in this population. CP rehabilitation traditionally aims to improve movement proficiency for functional activities, such as walking, by using a range of active movement modalities that require volitional effort; however, the underlying neural mechanisms of improved control and function remain unknown. The primary purpose of this study was to systematically determine the efficacy of lower limb active movement interventions to improve neuromuscular control in individuals with CP. A search for studies involving an active lower limb intervention and neurophysiological outcome measures in individuals with CP was performed in five electronic databases. Studies were assessed for methodological quality using the Downs and Black assessment tool. Nine of 6,263 articles met the inclusion criteria. Methodological quality of all studies was poor, ranging from 2 to 27 out of a possible score of 32 points on the Downs and Black assessment tool. The study interventions varied extensively in modality and prescription as well as in the outcome measures used. Whether active movement improves neuromuscular control of the lower limb in CP is unclear due to high variability in intervention protocols and selected outcomes measures. Future active intervention studies must carefully consider the selection of neurophysiological outcome measures.
脑瘫（CP）是一种非进行性神经疾病，会导致运动功能障碍，且这种障碍沿着下肢从近端到远端逐渐加重（即脚踝处的障碍最为严重）。因此，运动功能障碍和自主肌肉激活减少导致该人群下肢的神经肌肉控制能力下降。传统上，脑瘫康复旨在通过一系列需要自主努力的主动运动方式来提高功能性活动（如行走）的运动熟练度；然而，改善控制和功能的潜在神经机制仍然未知。本研究的主要目的是系统地确定下肢主动运动干预对改善脑瘫患者神经肌肉控制的疗效。在五个电子数据库中检索了涉及脑瘫患者下肢主动干预和神经生理学结果测量的研究。使用唐斯和布莱克评估工具对研究的方法学质量进行评估。6263篇文章中有9篇符合纳入标准。所有研究的方法学质量都很差，在唐斯和布莱克评估工具上的得分在2到27分之间（满分32分）。研究干预在方式、处方以及所使用的结果测量方面差异很大。由于干预方案和所选结果测量的高度变异性，主动运动是否能改善脑瘫患者下肢的神经肌肉控制尚不清楚。未来的主动干预研究必须仔细考虑神经生理学结果测量的选择。
