Name: 作者聚焦： 重复经颅磁刺激结合脑瘫的运动观察
Uploaded: 2024-08-09T12:40:00
Description: This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial ...

这项研究得到了湘雅博爱康复医院的资助。

本研究严格按照国家人体实验标准进行，临床研究经湘雅博爱康复医院伦理协会批准（伦理批准文号：20211223）。儿童的监护人同意参加该培训项目，并签署了知情同意书。2022年2月至2022年12月，在中南大学湘雅博爱康复医院和湘雅医院招募了患有SCP的儿童。
1.实验前的准备工作
<ol><li>为确保学习结果的准确性，应为康复治疗师提供相关培训，并提前评估他们的?...

痉挛性脑瘫儿童联合干预训练 

对于患有SCP的儿童，γ和α神经元的活动增加会导致皮质脊髓束输入受到抑制，从而导致肌肉紧张增加，称为痉挛。由于肢体痉挛会显著影响SCP患儿下肢运动功能的发展，因此减少痉挛是重要的训练目标之一。目前，采用逐步治疗策略来缓解痉挛状态，包括康复护理、物理治疗、骨科支具应用、肉毒杆菌毒素注射27、药物治疗和手术干预28。在这项研究中，使用?...

脑性瘫痪1 型 （CP） 是儿童中最常见的致残性疾病之一，是一组由发育中的胎儿和婴儿非进行性脑损伤引起的持续性综合征，包括中枢性运动障碍、姿势异常和行动不便。目前，全球约有1700万儿童患有脑瘫2，其中中国的病例超过500万。在各种形式的脑瘫中，痉挛性脑瘫（SCP）约占80%3。患有SCP的儿童患有脑损伤，导致肌肉痉挛、感觉功能下降、肌肉协调受损和平衡能力下降，所有这些都阻碍了独立行走和日常活动。目前用于增强SCP儿童粗大运动功能的康复措施包括核心稳定性训练4、任务导向训练5、约束诱导运动疗法6和镜像视觉反馈疗法7等活动。这些措施可以通过改善外周器官的功能，自下而上调节和重塑中枢神经系统，从而改善儿童的临床症状。 
经颅磁刺激 （TMS）8,9 是一种无痛、非侵入性且安全的治疗方法。rTMS是指在发出单一命令后，以相等的时间间隔连续释放刺激，这是常规重复刺激模式之一。它基于电磁感应和电磁转换的原理，通过刺激线圈施加瞬态电流，形成脉冲磁场穿透颅骨，产生感应电流，刺激神经元，触发一系列生理生化反应。rTMS 已被应用于神经系统疾病的监测、评估和治疗，为探索大脑的结构和功能提供了一种新的方法10。现有研究11,12 表明 rTMS 对脑瘫儿童的肢体痉挛和运动功能具有不同的治疗效果。此外，rTMS治疗结合其他康复技术的效果更为明显。
AOT 是一种利用镜像神经元系统 （MNS） 建立运动学习和记忆的康复方法13,14。AOT的本质是让观察者仔细观察视频中的动作，然后尽力模仿他们所观察到的。观察过程可能会触发称为 MNS 的神经网络中的激活，类似于当一个人亲自参与执行这些动作时发生的激活15，这为 AOT 提供了神经生理学基础。AOT 已显示出在改善运动障碍患者的运动技能方面取得成功，在脑瘫患者的中风恢复和上肢运动功能恢复方面产生了积极成果16,17。
我们之前的研究发现，基于镜像神经元系统的AOT可以有效提高脑瘫儿童的平衡和行走能力18。此外，研究19 表明，rTMS可以改善SCP患儿的肌肉痉挛、运动和步态，但应用于脑瘫患儿的rTMS治疗标准尚未统一，探索rTMS不同参数对CP患儿的影响，提供个性化、精准的治疗标准是一个亟待解决的问题。我们相信，将rTMS与AOT相结合有潜力发展成为一种有价值的脑瘫神经康复物理治疗策略。rTMS 和 AOT 都刺激了 SCP20 儿童的大脑皮层，从而有助于粗大运动功能的发育。本研究旨在了解rTMS和AOT的联合治疗是否比常规治疗或单独使用rTMS或AOT能取得更大的协同效应。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>K6 multimedia scene interactive training system</td>
			<td>Hunan Le Jiekang technology Co., LTD</td>
			<td></td>
			<td>Program implementation</td>
		</tr>
		<tr>
			<td>KLW-SLL type spa machine for children</td>
			<td>Nanjing Kanglongwei Technology Industrial Co., LTD</td>
			<td></td>
			<td>Conventional therapy</td>
		</tr>
		<tr>
			<td>Pulse magnetic field stimulator model YRD CCY-II</td>
			<td>Shenzhen Yingzhi technology Co., LTD</td>
			<td></td>
			<td>Program implementation</td>
		</tr>
		<tr>
			<td>SPSS26 software</td>
			<td>IBM</td>
			<td></td>
			<td>Statistic analysis</td>
		</tr>
	</tbody>
</table>

repeated transcranial magnetic stimulation combined with action observation training in children with spastic cerebral palsy

本研究介绍了一项使用 2 x 2 因子设计的随机对照试验的结果，比较了重复经颅磁刺激 （rTMS） 和动作观察训练 （AOT） 干预方法对痉挛性脑瘫 （SCP） 儿童痉挛状态、平衡功能和运动功能的影响。该研究旨在调查两种干预措施的组合是否比单独治疗或传统治疗产生更大的改善。
本研究对象患儿按照随机数表随机分为常规组、rTMS组、AOT组、联合干预组4组。四组患儿均接受常规康复治疗，在此基础上给予不同治疗方案的康复治疗方案。常规组无其他治疗，rTMS组接受rTMS，AOT组接受AOT，联合干预组接受rTMS和AOT联合干预。他们每周接受 5 天的培训，持续 12 周。在训练计划开始时和完成 12 周的治疗时评估了痉挛、平衡功能、步行能力和粗大运动功能评分的变化。
共有 64 名患有 SCP 的儿童完成了这项研究，并对他们的结果进行了分析。实验组总粗大运动功能效率为87.50%，明显高于常规组的25.00%、rTMS组的62.50%和AOT组的68.75%。初步结果表明，rTMS和AOT联合干预能有效改善儿童的平衡功能和运动功能，且联合干预的治疗效果优于常规治疗、rTMS或AOT单独使用。最后，明确了联合干预的临床疗效和最佳治疗参数，为治疗师为SCP患儿进行下肢功能康复提供临床依据。

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 coordination, and decreased balance capabilities, all of which hinder independent walking and daily activities. Current rehabilitation measures for enhancing gross motor function in children with SCP encompass activities such as core stability training4, task-oriented training5, constraint-induced movement therapy6, and mirror visual feedback therapy7. These measures can improve clinical symptoms of children by regulating and reshaping the central nervous system from bottom to top by improving the functions of peripheral organs. 
Transcranial magnetic stimulation (TMS)8,9 is a painless, non-invasive, and safe therapeutic method. rTMS refers to the continuous release of stimuli at equal intervals after a single command, which is one of the regular repetitive stimulation patterns. Based on the principle of electromagnetic induction and electromagnetic conversion, it applies transient currents through stimulation coils to form a pulsed magnetic field to penetrate the skull, generate induction current to stimulate neurons and trigger a series of physiological and biochemical responses. rTMS has been applied to the monitoring, evaluation, and treatment of neurological diseases, providing a novel approach to exploring the structure and function of the brain10. Existing studies11,12 have shown that rTMS has varying therapeutic effects on limb spasms and motor function in children with CP. Moreover, the effect of rTMS treatment combined with other rehabilitation techniques is more noticeable. 
AOT is a rehabilitation method that utilizes the Mirror Neuron System (MNS) to establish motor learning and memory13,14. The essence of AOT is to make the observer carefully observe actions in the video and subsequently try their best to imitate what they observed. The observing process might trigger activation in the neural network known as MNS, akin to the activation that occurs when one is personally engaged in executing those actions15, which provides a neurophysiological basis for AOT. AOT has shown success in improving motor skills in patients with movement disorders, yielding positive outcomes in stroke recovery and rehabilitation of upper limb motor function in cerebral palsy patients16,17. 
Our previous studies have found that AOT based on the mirror neuron system could effectively improve the balance and walking ability of children with cerebral palsy18. In addition, studies19 have shown that rTMS can improve muscle spasticity, movement, and gait in children with SCP, but treatment standards of rTMS applied to children with cerebral palsy have not been unified, and it is an urgent problem to explore the influence of different parameters of rTMS on children with CP, to provide a personalized and precise treatment standard. We believe that combining rTMS with AOT has the potential to develop into a valuable physical therapy strategy for the neurological rehabilitation of cerebral palsy. Both rTMS and AOT stimulated the cerebral cortex in children with SCP20, thereby aiding gross motor function development. This study aimed to find out whether the combination of rTMS and AOT could achieve a greater synergistic effect than conventional treatment or rTMS or AOT alone.

作者聚焦： 重复经颅磁刺激结合脑瘫的运动观察

反复经颅磁刺激联合动作观察训练治疗儿童痉挛性脑瘫

This study is a product of real application of cerebral palsy in children. And the investing case, the clinic efficacy of repetitive transcranial magnetic stimulation combined with movement observation training for the recovery of gross motor function. Repetitive transcranial magnetic stimulation is an important result in treating children with cerebral palsy, when movement observation training, and effectively relieve the specificity and enhance the motor function.Compared with one treatment alone, rTMS combined with AOT intervention can achieve better clinic efficacy. In this study, conventional treatments such as exercise, hydrotherapy, massage, as well as repetitive transcranial magnetic stimulation therapy, movement observation training, and the repetitive transcranial magnetic stimulation therapy combined with movement observation training, rehabilitation techniques were used.

本文介绍了64例SCP患儿（补充表S1 和 补充文件1）的结果，他们按照数字表法随机分为4组，给予不同的康复措施，为期12周。在整个过程中，参与的儿童均未出现头痛、头晕、癫痫发作等不良反应。
四组儿童的人口统计数据如 表1所示。治疗前，脑瘫的性别比、年龄、痉挛性类别、GMFCS、GDDS发育商数（GDDS DQ）、辅助器具（踝足矫形器或助?...

痉挛型脑瘫（SCP）患儿因脑皮层运动区域损伤，出现肢体痉挛、运动障碍、姿势异常等症状，导致无法正常站立和行走。因此，缓解SCP患儿肢体痉挛和增强粗大运动功能已成为重要的治疗目标。

This study presents the results of a randomized controlled trial utilizing a 2 x 2 factorial design, comparing the effects of repeated transcranial ...

这项研究是脑瘫在儿童中实际应用的产物。而投资案例中，重复经颅磁刺激结合运动观察训练对粗大运动功能恢复的临床疗效。重复经颅磁刺激是治疗脑瘫患儿的重要成果，在进行运动观察训练时，能有效缓解特异性，增强运动功能。与单独使用一种治疗相比，rTMS联合AOT干预可以达到更好的临床疗效。在这项研究中，使用了运动、水疗、按摩等常规治疗，以及重复经颅磁刺激疗法、运动观察训练和重复经颅磁刺激疗法结合运动观察训练、康复技术。

repeated-transcranial-magnetic-stimulation-combined-with-action

Research

JoVE Journal

Medicine

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

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.

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.

作者聚焦： 重复经颅磁刺激结合脑瘫的运动观察

作者聚焦：重复经颅磁刺激结合脑瘫的运动观察