Department of Children's Rehabilitation Treatment, Xiangya Boai Rehabilitation Hospital.
Department of Rehabilitation, Xiangya Hospital, Central South University;
J Vis Exp. 2024 Aug 9(210). doi: 10.3791/66013.
This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial magnetic stimulation (rTMS) and action observation training (AOT) intervention methods on spasticity, balance function, and motor function in children with spastic cerebral palsy (SCP). The study aimed to investigate whether the combination of the two interventions produces greater improvement than either treatment alone or conventional treatment. Subject children in this study, in accordance with the random number table, were randomly divided into four groups: conventional group, rTMS group, AOT group, and combined intervention group. All the children in the four groups received conventional rehabilitation treatment, on the basis of which they were given different therapeutic programs of rehabilitation measures. The conventional group had no other treatment while the rTMS group received rTMS, the AOT group received AOT and the combined intervention group was given a combined intervention of rTMS and AOT. They were trained five days per week for 12 weeks. Changes in scores of spasticity, balance function, walking ability, and gross motor function were assessed at the onset of the training program and upon completion of 12 weeks of treatment. A total of 64 Children with SCP completed the study, and their results were analyzed. The total gross motor function efficiency of 87.50% in the experimental group was significantly higher than that of 25.00% in the conventional group, 62.50% in the rTMS group, and 68.75% in the AOT group. The preliminary results showed that combined intervention of rTMS and AOT could effectively improve the balance function and motor function of children, and the therapeutic effect of the combined intervention was better than that of conventional treatment, rTMS or AOT alone. Finally, clinical efficacy and optimal treatment parameters of the combined intervention were clarified to provide a clinical basis for therapists to conduct lower limb function rehabilitation for children with SCP.
本研究采用 2×2 析因设计的随机对照试验，比较了重复经颅磁刺激（rTMS）和动作观察训练（AOT）干预方法对痉挛型脑瘫（SCP）儿童的痉挛、平衡功能和运动功能的影响。本研究旨在探讨两种干预措施的联合应用是否比单一治疗或常规治疗产生更大的改善。本研究的受试儿童按照随机数字表法分为四组：常规组、rTMS 组、AOT 组和联合干预组。四组儿童均接受常规康复治疗，在此基础上给予不同的康复措施治疗方案。常规组不接受其他治疗，rTMS 组接受 rTMS，AOT 组接受 AOT，联合干预组给予 rTMS 和 AOT 联合干预。每周训练 5 天，共 12 周。在训练方案开始时和治疗 12 周后评估痉挛、平衡功能、步行能力和粗大运动功能评分的变化。共有 64 例 SCP 患儿完成了研究，并对其结果进行了分析。实验组总运动功能效率为 87.50%，明显高于常规组的 25.00%、rTMS 组的 62.50%和 AOT 组的 68.75%。初步结果表明，rTMS 和 AOT 的联合干预能有效改善儿童的平衡功能和运动功能，且联合干预的疗效优于常规治疗、rTMS 或 AOT 单一治疗。最后，明确了联合干预的临床疗效和最佳治疗参数，为治疗师对 SCP 儿童进行下肢功能康复提供了临床依据。
