神经调节：脑瘫儿童言语康复的联合治疗方案。
Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy.
机构信息
Department of Hearing and Speech Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; Teaching Center, Assistance and Research in Reading and Writing (NEAPEL) - Department of Hearing and Speech Pathology, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Brazil; Center for Technological Innovation in Rehabilitation, Federal University of Bahia, Brazil; Specialized Support Network Coordination, State of Bahia Health Department, Brazil.
出版信息
J Bodyw Mov Ther. 2022 Jan;29:10-15. doi: 10.1016/j.jbmt.2021.09.002. Epub 2021 Sep 25.
INTRODUCTION
Transcranial direct current stimulation (tDCS) modulates cortical activity and potentiates functional gains achieved during therapeutic protocols. The aim of Integrative Speech Therapy Protocol is to rehabilitate speech in patients with impairments regarding neuropyschomotor development by combining oral motor stimuli, specific articulatory production, and the stimulation of phonological aspects of language.
OBJECTIVE
Investigate the effect of transcranial direct current stimulation combined to integrative speech therapy in a child with cerebral palsy.
METHODS
We performed a case study with tDCS and speech therapy in a patient with cerebral palsy and apraxia of speech. To assess the patient's speech, we used a parameterized test for the Brazilian Portuguese speech - ABFW. The CFCS and Vicking Speech Scales presented level IV and III, respectively. The patient underwent two periods with ten stimulation sessions each: first with anodal stimulation over Broca's area; and second over the left dorsolateral prefrontal cortex. Two indices were calculated: the percentage of consonants correct; and percentage of consonants correct-revised. Descriptive statistics were employed for the clinical data. For the outcomes, changes in each score were calculated as the difference in pre-intervention and post-intervention using Wilcoxon-Mann-Whitney test.
RESULTS
Increases were found in percentage of correct consonants indices as well as to produce two-syllable and three-syllable words after both types of stimulation, characterized mainly by correct vowels that marked the presence of the syllable. Number of phonemes increased 0 to 4 at first the stimulation and 4 to 10 at the second.
CONCLUSION
The combined-therapy program contributed to improve the speech rehabilitation results in a patient with cerebral palsy.
简介
经颅直流电刺激（tDCS）调节皮质活动并增强治疗方案期间获得的功能增益。综合言语治疗方案的目的是通过结合口腔运动刺激、特定的发音产生以及语言的语音方面的刺激，来恢复神经运动发育障碍患者的言语能力。
目的
研究经颅直流电刺激联合综合言语治疗对脑瘫儿童的影响。
方法
我们对一名患有脑瘫和言语失用症的患者进行了 tDCS 和言语治疗的病例研究。为了评估患者的言语，我们使用了巴西葡萄牙语言语参数测试 - ABFW。CFCS 和 Vicking 语音量表分别显示为 IV 级和 III 级。患者接受了两个为期 10 次刺激的治疗期：第一期是在布罗卡区进行阳极刺激；第二期是在左背外侧前额叶皮层进行刺激。计算了两个指数：辅音正确百分比；和辅音正确修订百分比。对临床数据进行了描述性统计。对于结果，使用 Wilcoxon-Mann-Whitney 检验计算了每个评分在干预前和干预后的差异，以计算变化。
结果
在两种刺激类型后，正确辅音百分比指数以及产生两个和三个音节词的能力均有所提高，主要表现为正确的元音，这标志着音节的存在。在第一次刺激时，音位数从 0 增加到 4，在第二次刺激时，从 4 增加到 10。
结论
联合治疗方案有助于改善脑瘫患者的言语康复结果。
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