Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy

Summary

Children with spastic cerebral palsy (SCP) have limb spasticity, movement disorders, and abnormal posture due to injury to the cerebral cortex motor area, resulting in inability to stand and walk normally. Therefore, alleviating limb spasticity and enhancing gross motor function in children with SCP have become important therapeutic goals.

Abstract

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.

Introduction

Cerebral palsy¹ (CP) is one of the most common disabling disorders in children and is a group of persistent syndromes caused by non-progressive brain damage in developing fetuses and infants, including central dyskinesia, abnormal posture, and limited mobility. Currently, there are approximately 17 million children worldwide affected by cerebral palsy², with over 5 million cases in China. Among various forms of cerebral palsy, spastic cerebral palsy (SCP) accounts for roughly 80%³. Children with SCP suffer from brain damage resulting in muscle spasms, diminished sensory function, impaired muscle c....

Protocol

This study was carried out in strict accordance with the national standards for human experimentation, and the clinical study was approved by the Ethics Association of Xiangya Boai Rehabilitation Hospital (ethics approval number: 20211223). The children's guardians agreed to participate in this training program and signed informed consent forms. Children with SCP were recruited in the Xiangya Boai Rehabilitation Hospital and Xiangya Hospital of Central South University from February 2022 to December 2022.

Discussion

For children with SCP, increased activity of γ and α neurons leads toinhibition of corticospinal tract input, which results in increased muscle tension known as spasm. As limb spasms significantly affect the development of lower limb motor function of children with SCP, one of the crucial training goals is to reduce spasticity. Currently, stepwise treatment strategies are employed to alleviate spasticity, including rehabilitation nursing, physical therapy, orthopedic brace application, botulinum toxin injection.......

Materials

Name	Company	Catalog Number	Comments
K6 multimedia scene interactive training system	Hunan Le Jiekang technology Co., LTD		Program implementation
KLW-SLL type spa machine for children	Nanjing Kanglongwei Technology Industrial Co., LTD		Conventional therapy
Pulse magnetic field stimulator model YRD CCY-II	Shenzhen Yingzhi technology Co., LTD		Program implementation
SPSS26 software	IBM		Statistic analysis