步态诱发功能性电刺激改善痉挛型双瘫型脑瘫患儿下肢运动功能的疗效观察

摘要目的：探讨功能性电刺激（FES）对痉挛型双瘫型脑瘫患儿下肢功能的影响。方法：25例痉挛型双瘫型脑瘫患儿随机分为FES组（n=14）及对照组（n=11），两组均进行运动训练、物理疗法等。对照组在此基础上进行步行训练30min，每天1次，每周5d，共12周。前6周FES组在此基础上应用FES对双侧腓总神经进行神经肌肉电刺激（NMES）治疗，同时进行步行训练30min，每天1次，每周5d。后6周FES组在此基础上进行步行训练30min，每天1次，每周5d。在治疗前、治疗6周和治疗12周后，分别进行腓肠肌痉挛评分（改良Ashworth 分值，MAS）、踝关节主动背屈活动度（ROM）和粗大运动功能量表（GMFM-88）之D区（站立）、E区（走跑跳）评定。结果：两组患儿治疗6周和12周后，踝关节ROM增加，GMFM之D区（站立）评分提高，与各自治疗前相比，差异均有显著性意义(P<0.05或0.01)；FES组患儿治疗6周和12周后，对照组患儿治疗12周后，MAS评分及GMFM-88之E区分值均优于治疗前(P<0.05或0.01)。治疗6周和12周后，FES组MAS、踝关节ROM及GMFM-88之D区（站立）、E区（走跑跳）等指标均优于对照组，差异有显著性意义（P<0.05或0.01）。结论：FES配合康复功能训练能降低痉挛型双瘫型脑瘫患儿的下肢肌张力，增加踝关节活动度，提高下肢运动功能。

Effects of gait triggered functional electrical stimulation on motor function of lower extremities in children with spastic diplegia cerebral palsy

AbstractObjective: To observe the effect of gait triggered functional electrical stimulation (FES) on motor function of lower extremities in children with spastic diplegia cerebral palsy (CP).Method: Twenty-five spastic diplegia CP children were randomly divided into FES group (n=14) and control group (n=11). All children were treated with motor training and physical therapy. In addition, control group received walking training for 30 min once a day, 5d per week, 12 weeks in total. In the first 6 weeks, FES group received neuromuscular electrical stimulation (NMES) on bilateral common peroneal nerve and 30 min walking training were proceeded once a day, 5d per week. In the next 6 weeks, FES group received walking training for 30 min once a day, 5d per week. Modified Ashworth scale (MAS), range of motion (ROM) of ankle active dorsiflexion motion and D and E domains of gross motor function measure (GMFM-88) were evaluated at the beginning and at the end of the 6th and 12th week of treatment course respectively. Result: ROM of ankle and D domain of GMFM-88 score increased in both groups at the end of 6th and 12th week of treatment (P<0.05 or 0.01); In FES group MAS and E domain of GMFM-88 score significantly increased at the end of the 6th and 12th week of treatment, while in control group increased only after 12 weeks of treatment (P<0.05 or 0.01). Compared with control group, MAS and ROM of ankle as well as D and E domains of GMFM-88 scores in FES group children significantly improved at the end of the 6th and 12th week of treatment (P<0.05 or 0.01). Conclusion: FES in combination with rehabilitation functional training in the treatment for children with spastic diplegia CP can decrease the muscle tone of lower extremities and improve the range of ankle active motion, as well as the motor function of lower extremities.