脑性瘫痪患者上肢的神经肌肉电刺激：随机对照试验的系统评价和荟萃分析。
Neuromuscular Electrical Stimulation of Upper Limbs in Patients With Cerebral Palsy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
机构信息
From the Division of Physical Therapy, Department of Rehabilitation, En Chu Kong Hospital, New Taipei City, Taiwan (C-HO); Department of Rehabilitation, En Chu Kong Hospital, New Taipei City, Taiwan (C-CS); Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (Y-CK); Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (Y-CK); Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (Y-CK, H-CC); Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan (Y-CK, T-HL, H-CC, T-JK); Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan (T-HL, H-CC, T-JK); and Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (T-HL, H-CC).
出版信息
Am J Phys Med Rehabil. 2023 Feb 1;102(2):151-158. doi: 10.1097/PHM.0000000000002058. Epub 2022 Jun 9.
OBJECTIVE
The aim of the study is to assess the effects of neuromuscular electrical stimulation on the upper limbs of patients with cerebral palsy.
DESIGN
We searched PubMed, Cochrane, Embase, and Scopus databases for randomized controlled trials examining the effects of neuromuscular electrical stimulation on the upper limbs of children with cerebral palsy.
RESULTS
Eight randomized controlled trials ( N = 294) were included in the meta-analysis. Compared with traditional physical therapy, sensorimotor training and task-oriented training, constraint-induced movement therapy, dynamic bracing, and conventional robot-assisted therapy, neuromuscular electrical stimulation in combination with these therapies resulted in significantly greater functional scale scores (standardized mean difference = 0.80; 95% confidence interval = 0.54 to 1.06), muscle strength of upper limbs (standardized mean difference = 0.57; 95% confidence interval = 0.25 to 0.88), and spasticity of upper limbs (relative risk = 2.53; 95% confidence interval = 1.46 to 4.39; standardized mean difference = -0.18; 95% confidence interval = -0.29 to -0.06) but did not improve the wrist range of motion (standardized mean difference = 0.43; 95% confidence interval = -0.04 to 0.91). In addition, the effect of neuromuscular electrical stimulation on functional scale scores remained after 3-mo follow-up (standardized mean difference = 0.68; 95% confidence interval = 0.16 to 1.2).
CONCLUSIONS
Neuromuscular electrical stimulation effectively improved hand function, muscle strength, and spasticity in patients with cerebral palsy.
目的
本研究旨在评估神经肌肉电刺激对上运动神经元损伤患儿上肢的影响。
设计
我们检索了 PubMed、Cochrane、Embase 和 Scopus 数据库，以寻找评估神经肌肉电刺激对上运动神经元损伤患儿上肢影响的随机对照试验。
结果
共有 8 项随机对照试验（N=294）纳入荟萃分析。与传统物理疗法、感觉运动训练和任务导向训练、强制性运动疗法、动态矫形器治疗以及常规机器人辅助治疗相比，神经肌肉电刺激联合这些疗法可显著提高上肢功能量表评分（标准化均数差=0.80；95%置信区间=0.54 至 1.06）、上肢肌肉力量（标准化均数差=0.57；95%置信区间=0.25 至 0.88）和上肢痉挛程度（相对危险比=2.53；95%置信区间=1.46 至 4.39；标准化均数差=-0.18；95%置信区间=-0.29 至 -0.06），但并未改善腕关节活动度（标准化均数差=0.43；95%置信区间=-0.04 至 0.91）。此外，神经肌肉电刺激对上肢功能量表评分的影响在 3 个月随访时仍存在（标准化均数差=0.68；95%置信区间=0.16 至 1.2）。
结论
神经肌肉电刺激可有效改善脑瘫患儿手部功能、肌肉力量和痉挛程度。
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