基于镜像神经元的动作观察训练对脑瘫儿童平衡和步行能力的影响

目的 观察基于镜像神经元的动作观察训练(AOT)对脑瘫(CP)儿童平衡和步行能力的影响,以期为改善CP儿童下肢运动功能提供临床依据。方法 选取湘雅博爱康复医院2021年10月-2022年2月收治的99例CP儿童按数字表法随机分为AOT组(50例)和对照组(49例)。AOT组和对照组儿童均进行常规康复治疗,AOT组每日行40 min的AOT,先观察有运动内容的视频,后执行观察到的动作;对照组先观察与运动内容无关的动画视频,后执行AOT组相同的功能性动作,训练时间为40 min。两组儿童1次/d,5次/周,共12周。于治疗前、治疗12周后采用儿童平衡量表(PBS)、10 m步行速度(10 m MWS)和粗大运动功能测试量表(GMFM)分别评估两组CP儿童平衡功能、步行能力和粗大运动功能。结果 治疗12周后,两组儿童PBS、10 m MWS、GMFM-D区和E区评分均较治疗前明显改善(AOT组t=34.156、40.379、18.569、28.856,对照组t=14.342、31.533、11.058、16.479,P＜0.001);且AOT组治疗12周后PBS、10 m MWS、GMFM-D区和E区评分分别为(40.76±6.38)、(20.30±3.06)、(33.52±5.88)和(46.44±13.37),均显著高于治疗12周后对照组(t=2.245、2.573、2.345、2.101,P＜0.05)。结论 基于镜像神经元的AOT能有效改善CP儿童平衡功能、步行能力和粗大运动功能,值得在CP儿童康复的临床实践中推广使用。

Effects of action observation therapy based on mirror neuron theory on the balance and walking ability of children with cerebral palsy

Objective To investigate the effects of action observation therapy(AOT) based on mirror neuron theory on the balance and walking ability of children with cerebral palsy(CP), so as to provide clinical basis for improving the motor function of the lower extremities in CP children. Methods A total of 99 CP children who were treated in Xiangya Boai Rehabilitation Hospital from October 2021 to February 2022 were randomly divided into AOT group (n=50) and control group (n=49) according to the digital table method. Both groups of CP children received routine rehabilitation therapy. Additionally, children in AOT group received AOT for 40 minutes a day, where they watched the video with sports content first, and then performed the action. Children in the control group received therapy 40 minutes a day, watched the animated videos irrelevant to the content of the movement first, and then performed the same functional actions with the AOT group. Both groups received treatment for 12 weeks, once a day, 5 times per week. The balance function, walking ability and gross motor function were assessed before treatment and after 12 weeks of treatment using the Pediatric Balance Scale (PBS), 10-meter Maximum Walking Speed (10 m MWS) and Gross Motor Function Methods (GMFM). Results After 12 weeks of treatment, the scores of PBS, 10 m MWS, GMFM-D area and E area in the two groups were significantly higher than those before treatment (AOT group:t=34.156, 40.379, 18.569, 28.856; control group:t=14.342, 31.533, 11.058, 16.479, P<0.001). The scores of PBS (40.76±6.38), 10 m MWS(20.30±3.06), GMFM-D area (33.52±5.88) and GMFM-E area (46.44±13.37) in the AOT group were significantly higher than those in the control group after 12 weeks of treatment (t=2.245, 2.573, 2.345, 2.101, P<0.05). Conclusions Action observation therapy based on mirror neuron theory can effectively improve the balance function and walking ability of children with cerebral palsy,which is worthy of application in clinic practice.