3~6岁孤独症谱系障碍儿童医教结合康复的疗效初探

探索经颅重复磁刺激疗法(repetitive transcranial magnetic stimulation,rTMS)和注射用鼠神经生长因子(mNGF),结合结构化教育(treatment and education of autistic and related communication handicapped children,TEACCH)的综合干预方案对孤独症谱系障碍(autism spectrum disorder,ASD)儿童的疗效,为治疗方案的选取提供循证依据.方法 采用临床对照试验,从广东省深圳市罗湖区妇幼保健院儿童神经康复病区选取20例3~6岁ASD儿童为综合康复组(rTMS+mNGF +TEACCH).从深圳市罗湖区雅博儿童康复服务中心招募与综合康复组性别、年龄匹配的ASD儿童20例为对照组(TEACCH).各组儿童的康复周期均持续6个月.2组在干预前和干预后分别进行ASD儿童行为检查表(autism behaviorcheeklist,ABC)、儿童孤独症评定量表(childhood autism rating scale,CAW)评估.结果 干预后与干预前比较,2组的ABC量表在感觉、交往、躯体运动、语言、生活自理5个维度得分和总分及CARS量表评分均下降(P值均<0.05).干预后综合康复组的ABC量表在感觉、交往、躯体运动、语言、生活自理5个维度得分和总分及CARS量表评分均低于对照组(p值均<0.05).结论 ASD儿童经过持续6个月的医教结合康复或TEACCH课程,临床表现均有改善;rTMS+mNGF+TEACCH的综合干预方案康复效果尤为明显.

Comprehensive rehabilitation intervention with medical treatment and education among autism children aged 3-6 years old

Objective To explore the effect of combined intervention with deep repetitive transcranial magnetic stimulation (rTMS),injectable mouse nerve growth factor (mNGF) with treatment and education of autistic and related communication handicapped children (TEACCH) among autism spectrum disorder (ASD) children.Methods Twennty ASD children aged 3-6 years old were selected from a controlled clinical trial as the intervention group receiving TMS,mNGF and TEACCH;another 20 gender and age-matched ASD children from one public welfare institution was recruited as control group receiving only TEACCH.All of the participants were followed up for 6 months,ABC and CARS scales were assessed before and after intervention.Results After intervention,significant improvements were found in both groups in communication,body movement,language,daily self-care and total score of the ABC scale,as well as in total score of CARS scale(P<0.05).The communication,body movement,language,daily self-care and total score of ABC scale,as well as the total score of CARS scale were lower in the intervention group than control group(P<0.05).Conclusion Comprehensive rehabilitation intervention with deep repetitive transcranial magnetic stimulation(rT-MS),injectable mNGF with TEACCH could significantly improve developmental outcomes among autism child.