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全身冷刺激对调节成人脑瘫患者的痉挛是否有效?一项案例研究。

Is Whole-Body Cryostimulation Useful in Modulating Spasticity in Adults with Cerebral Palsy? A Case Study.

作者信息

Piterà Paolo, Bigoni Matteo, Prina Elisa, Barrera Boris, Yavuz Duru Ceren, Verme Federica, Fontana Jacopo Maria, Priano Lorenzo, Mauro Alessandro, Capodaglio Paolo

机构信息

Department of Neurosciences "Rita Levi Montalcini", University of Turin, 10126 Turin, Italy.

Laboratory of Clinical Neurobiology, IRCCS Istituto Auxologico Italiano, San Giuseppe Hospital, 28824 Verbania, Italy.

出版信息

J Clin Med. 2024 Dec 16;13(24):7674. doi: 10.3390/jcm13247674.

DOI:10.3390/jcm13247674
PMID:39768597
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11677623/
Abstract

: This case study investigates the effect of a five-session whole-body cryostimulation (WBC) cycle on a 55-year-old female patient with cerebral palsy (CP) and lower limb spasticity (LLS) with a typical diplegic gait pattern. CP is a common physical disability characterized by motor impairments, including spasticity, which significantly impacts mobility and quality of life. The current treatments for spasticity often have limited efficacy and considerable side effects, making alternative therapies like WBC an area of interest. : The patient underwent a 10-day inpatient rehabilitation program integrated with five WBC sessions at -110 °C for 2 min. The treatment effects were assessed immediately before and after the five WBC sessions using the Ashworth Scale, Fugl-Meyer Assessment, H-reflex test, and gait analysis. Psychosocial outcomes were measured with the SF-36, WHO-5, PSQI, ESS, and BDI questionnaires. Immediately after the WBC cycle, gait analysis showed increased walking speed (0.48 to 0.61 m/s left; 0.49 to 0.57 m/s right) and step length (0.30 to 0.38 m left; 0.30 to 0.35 m right). The H/M ratio in the H-reflex test improved, indicating a better neuromuscular efficiency. Psychosocial assessments revealed a 42.5% reduction in pain and a 24% improvement in overall quality of life and well-being. : The objective improvements in gait parameters and neuromuscular modulation, along with the subjectively reported enhancements in functional abilities, highlight the potential of WBC as a valuable addition to rehabilitation strategies for this population. Further research is needed to confirm these findings and assess long-term outcomes.

摘要

本案例研究调查了为期五节的全身冷冻刺激(WBC)疗程对一名55岁患有脑瘫(CP)和下肢痉挛(LLS)且具有典型双侧瘫步态模式的女性患者的影响。脑瘫是一种常见的身体残疾,其特征为运动障碍,包括痉挛,这对行动能力和生活质量有显著影响。目前针对痉挛的治疗方法往往疗效有限且副作用较大,使得像全身冷冻刺激这样的替代疗法成为一个受关注的领域。

该患者接受了一个为期10天的住院康复计划,其中包括在-110°C下进行五节每次2分钟的全身冷冻刺激疗程。在五节全身冷冻刺激疗程前后,使用Ashworth量表、Fugl-Meyer评估、H反射测试和步态分析对治疗效果进行了评估。使用SF-36、WHO-5、PSQI、ESS和BDI问卷对心理社会结果进行了测量。在全身冷冻刺激疗程结束后,步态分析显示步行速度增加(左侧从0.48米/秒增至0.61米/秒;右侧从0.49米/秒增至0.57米/秒),步长增加(左侧从0.30米增至0.38米;右侧从0.30米增至0.35米)。H反射测试中的H/M比值有所改善,表明神经肌肉效率提高。心理社会评估显示疼痛减轻了42.5%,整体生活质量和幸福感提高了24%。

步态参数和神经肌肉调节方面的客观改善,以及主观报告的功能能力增强,凸显了全身冷冻刺激作为该人群康复策略中一项有价值补充的潜力。需要进一步的研究来证实这些发现并评估长期结果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/962c/11677623/daf716d84fbd/jcm-13-07674-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/962c/11677623/32abcd7f5798/jcm-13-07674-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/962c/11677623/35c57ab12bba/jcm-13-07674-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/962c/11677623/daf716d84fbd/jcm-13-07674-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/962c/11677623/32abcd7f5798/jcm-13-07674-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/962c/11677623/35c57ab12bba/jcm-13-07674-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/962c/11677623/daf716d84fbd/jcm-13-07674-g003.jpg

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本文引用的文献

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Multimodal therapy and use of adjunctive therapies to BoNT-A in spasticity management: defining terminology to help enhance spasticity treatment.多模式疗法及肉毒毒素A辅助疗法在痉挛管理中的应用:定义术语以助力改善痉挛治疗。
Front Neurol. 2024 Aug 30;15:1432330. doi: 10.3389/fneur.2024.1432330. eCollection 2024.
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Whole-Body Cryostimulation in Multiple Sclerosis: A Scoping Review.多发性硬化症中的全身冷冻刺激:一项范围综述。
J Clin Med. 2024 Mar 29;13(7):2003. doi: 10.3390/jcm13072003.
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Whole-Body Cryostimulation as an Adjunctive Treatment for Neurophysiologic Tinnitus and Associated Disorders: Preliminary Evidence from a Case Study.
全身冷冻刺激作为神经生理性耳鸣及相关疾病的辅助治疗:一项病例研究的初步证据
J Clin Med. 2024 Feb 8;13(4):993. doi: 10.3390/jcm13040993.
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Whole-Body Cryostimulation in Post-COVID Rehabilitation for Patients with Obesity: A Multidisciplinary Feasibility Study.肥胖 COVID-19 康复患者的全身冷冻刺激:一项多学科可行性研究。
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Eur J Med Res. 2023 Sep 28;28(1):387. doi: 10.1186/s40001-023-01385-z.
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