Department of Pediatric Rehabilitation, Nanhai Maternity and Children's Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Foshan, Guangdong Province, China.
Department of Pediatric Rehabilitation, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong Province, China.
BMC Pediatr. 2021 Mar 24;21(1):141. doi: 10.1186/s12887-021-02615-1.
In the current study, we applied a combination of non-invasive neuromodulation modalities concurrently with multiple stimulating electrodes. Specifically, we used transcranial pulsed current stimulation (tPCS) and transcutaneous electrical nerve stimulation (TENS) as a novel strategy for improving lower limb spasticity in children with spastic cerebral palsy (SCP) categorized on levels III-V of the Gross Motor Function Classification System (GMFCS) with minimal side effects.
Sixty-three SCP children aged 2-12 years, who were classified on levels III-V of the GMFCS were randomly assigned to one of two groups, resulting in 32 children in the experimental group and 31 children in the control group. The experimental group underwent a combination therapy of tPCS (400 Hz, 1 mA cerebello-cerebral stimulation) and TENS (400 Hz, max 10 mA) for 30 min, followed by 30 min of physiotherapy five times per week for 12 weeks. The control group underwent physiotherapy only 30 mins per day five times per week for 12 weeks. In total, all groups underwent 60 treatment sessions. The primary outcome measures were the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). Evaluations were performed 3 days before and after treatment.
We found a significant improvement in MAS and MTS scores of the lower limbs in the experimental group compared to the control group in the hip adductors (Left: p = 0.002; Right: p = 0.002), hamstrings (Left: p = 0.001; Right: p < 0.001, and gastrocnemius (Left: p = 0.001; Right: p = 0.000). Moreover, MTS scores of R1, R2 and R2-R1 in left and right hip adduction, knee joint, and ankle joint all showed significant improvements (p ≤ 0.05). Analysis of MAS and MTS scores compared to baseline scores showed significant improvements in the experimental group but declines in the control group.
These results are among the first to demonstrate that a combination of tPCS and TENS can significantly improve lower limb spasticity in SCP children classified on GMFCS levels III-V with minimal side effects, presenting a novel strategy for addressing spasticity challenges in children with severe SCP.
ChiCTR.org, ChiCTR1800020283, Registration: 22 December 2018 (URL: http://www.chictr.org.cn/showproj.aspx?proj=33953 ).
在目前的研究中，我们应用了无创神经调节模式的组合，并同时使用多个刺激电极。具体来说，我们使用经颅脉冲电流刺激（tPCS）和经皮神经电刺激（TENS）作为一种新策略，以改善脑瘫（CP）儿童的下肢痉挛，这些儿童被分类为 GMFCS 水平 III-V 级，具有最小的副作用。
63 名年龄在 2-12 岁之间的 CP 儿童，被 GMFCS 分类为 III-V 级，被随机分配到两组中的一组，导致实验组有 32 名儿童，对照组有 31 名儿童。实验组接受 tPCS（400Hz，1mA 小脑-大脑刺激）和 TENS（400Hz，最大 10mA）联合治疗 30 分钟，然后每周 5 次进行 30 分钟的物理治疗，共 12 周。对照组仅在每天进行 30 分钟的物理治疗，每周 5 次，共 12 周。总共，所有组都接受了 60 次治疗。主要结局测量是改良 Ashworth 量表（MAS）和改良 Tardieu 量表（MTS）。在治疗前和治疗后 3 天进行评估。
我们发现实验组的髋关节内收肌（左侧：p=0.002；右侧：p=0.002）、半腱肌（左侧：p=0.001；右侧：p<0.001）和腓肠肌（左侧：p=0.001；右侧：p=0.000）的 MAS 和 MTS 评分与对照组相比均有显著改善。此外，左、右侧髋关节内收、膝关节和踝关节的 R1、R2 和 R2-R1 的 MTS 评分均有显著改善（p≤0.05）。与基线评分相比，MAS 和 MTS 评分的分析显示实验组有显著改善，但对照组有下降。
这些结果是第一批表明 tPCS 和 TENS 的联合应用可以显著改善 GMFCS 水平 III-V 级 CP 儿童的下肢痉挛，且副作用最小，为严重 CP 儿童的痉挛挑战提供了一种新的策略。
ChiCTR.org，ChiCTR1800020283，注册日期：2018 年 12 月 22 日（网址：http://www.chictr.org.cn/showproj.aspx?proj=33953）。
