{"title":"脑刺激和约束诱导运动治疗单侧脑瘫儿童:一项随机对照试验。","authors":"Juhi Gupta, Sheffali Gulati, Upinder Pal Singh, Atin Kumar, Prashant Jauhari, Biswaroop Chakrabarty, Ravindra Mohan Pandey, Renu Bhatia, Suman Jain, Achal Srivastava","doi":"10.1177/15459683231174222","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>There is a crucial need to devise optimum rehabilitation programs for children with cerebral palsy (CP).</p><p><strong>Objective: </strong>This study aimed to assess the feasibility, safety, and efficacy of combining 6-Hz primed, low-frequency, repetitive transcranial magnetic stimulation (rTMS) with modified constraint-induced movement therapy (mCIMT) in improving upper limb function in children with unilateral CP.</p><p><strong>Methods: </strong>Children aged 5 to 18 years with unilateral CP were randomized (23 in each arm) to receive 10 sessions of mCIMT with real rTMS (intervention arm) or mCIMT with sham rTMS (control arm), on alternate weekdays over 4 weeks. The primary outcome was the difference in mean change in Quality of Upper Extremity Skills Test (QUEST) scores. Secondary outcomes were changes in QUEST domain scores, speed and strength measures, CP quality of life (CP-QOL) scale scores, and safety of rTMS.</p><p><strong>Results: </strong>All 46 children completed the trial except one. At 4 weeks, the mean change in total QUEST scores was significantly higher in the intervention arm as compared to the control arm (11.66 ± 6.97 vs 6.56 ± 4.3, <i>d</i> = 5.1, 95% CI 1.7-8.5, <i>P</i> = .004). Change in \"weight bearing\" and \"protective extension\" domain score was significantly higher for children in the intervention arm. These improvements were sustained at 12 weeks (<i>P</i> = .028). CP-QOL scores improved at 12 weeks. No serious adverse events were seen.</p><p><strong>Conclusion: </strong>A 6-Hz primed rTMS combined with mCIMT is safe, feasible, and superior to mCIMT alone in improving the upper limb function of children with unilateral CP.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03792789.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 5","pages":"266-276"},"PeriodicalIF":3.7000,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Brain Stimulation and Constraint Induced Movement Therapy in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial.\",\"authors\":\"Juhi Gupta, Sheffali Gulati, Upinder Pal Singh, Atin Kumar, Prashant Jauhari, Biswaroop Chakrabarty, Ravindra Mohan Pandey, Renu Bhatia, Suman Jain, Achal Srivastava\",\"doi\":\"10.1177/15459683231174222\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>There is a crucial need to devise optimum rehabilitation programs for children with cerebral palsy (CP).</p><p><strong>Objective: </strong>This study aimed to assess the feasibility, safety, and efficacy of combining 6-Hz primed, low-frequency, repetitive transcranial magnetic stimulation (rTMS) with modified constraint-induced movement therapy (mCIMT) in improving upper limb function in children with unilateral CP.</p><p><strong>Methods: </strong>Children aged 5 to 18 years with unilateral CP were randomized (23 in each arm) to receive 10 sessions of mCIMT with real rTMS (intervention arm) or mCIMT with sham rTMS (control arm), on alternate weekdays over 4 weeks. The primary outcome was the difference in mean change in Quality of Upper Extremity Skills Test (QUEST) scores. Secondary outcomes were changes in QUEST domain scores, speed and strength measures, CP quality of life (CP-QOL) scale scores, and safety of rTMS.</p><p><strong>Results: </strong>All 46 children completed the trial except one. At 4 weeks, the mean change in total QUEST scores was significantly higher in the intervention arm as compared to the control arm (11.66 ± 6.97 vs 6.56 ± 4.3, <i>d</i> = 5.1, 95% CI 1.7-8.5, <i>P</i> = .004). Change in \\\"weight bearing\\\" and \\\"protective extension\\\" domain score was significantly higher for children in the intervention arm. These improvements were sustained at 12 weeks (<i>P</i> = .028). CP-QOL scores improved at 12 weeks. No serious adverse events were seen.</p><p><strong>Conclusion: </strong>A 6-Hz primed rTMS combined with mCIMT is safe, feasible, and superior to mCIMT alone in improving the upper limb function of children with unilateral CP.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03792789.</p>\",\"PeriodicalId\":56104,\"journal\":{\"name\":\"Neurorehabilitation and Neural Repair\",\"volume\":\"37 5\",\"pages\":\"266-276\"},\"PeriodicalIF\":3.7000,\"publicationDate\":\"2023-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"2\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurorehabilitation and Neural Repair\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/15459683231174222\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurorehabilitation and Neural Repair","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/15459683231174222","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 2
摘要
背景:为脑瘫儿童设计最佳的康复方案是一个至关重要的需要。目的:探讨6hz低频重复经颅磁刺激(rTMS)联合改良约束诱导运动疗法(mCIMT)改善单侧cp患儿上肢功能的可行性、安全性和有效性。5至18岁的单侧CP儿童随机(每组23人)接受10次mCIMT与真实rTMS(干预组)或mCIMT与假rTMS(对照组)，在4周的交替工作日。主要结果是上肢技能测试(QUEST)得分质量平均变化的差异。次要结果是QUEST域评分、速度和力量测量、CP生活质量(CP- qol)量表评分和rTMS安全性的变化。结果:除1例患儿外，其余46例患儿均完成了试验。4周时，干预组的QUEST总分平均变化显著高于对照组(11.66±6.97 vs 6.56±4.3,d = 5.1, 95% CI 1.7-8.5, P = 0.004)。干预组儿童在“负重”和“保护性延伸”领域得分的变化显著较高。这些改善持续到12周(P = 0.028)。CP-QOL评分在12周时改善。未见严重不良事件。结论:6hz启动rTMS联合mCIMT在改善单侧cp患儿上肢功能方面是安全、可行的，且优于单独mCIMT。
Brain Stimulation and Constraint Induced Movement Therapy in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial.
Background: There is a crucial need to devise optimum rehabilitation programs for children with cerebral palsy (CP).
Objective: This study aimed to assess the feasibility, safety, and efficacy of combining 6-Hz primed, low-frequency, repetitive transcranial magnetic stimulation (rTMS) with modified constraint-induced movement therapy (mCIMT) in improving upper limb function in children with unilateral CP.
Methods: Children aged 5 to 18 years with unilateral CP were randomized (23 in each arm) to receive 10 sessions of mCIMT with real rTMS (intervention arm) or mCIMT with sham rTMS (control arm), on alternate weekdays over 4 weeks. The primary outcome was the difference in mean change in Quality of Upper Extremity Skills Test (QUEST) scores. Secondary outcomes were changes in QUEST domain scores, speed and strength measures, CP quality of life (CP-QOL) scale scores, and safety of rTMS.
Results: All 46 children completed the trial except one. At 4 weeks, the mean change in total QUEST scores was significantly higher in the intervention arm as compared to the control arm (11.66 ± 6.97 vs 6.56 ± 4.3, d = 5.1, 95% CI 1.7-8.5, P = .004). Change in "weight bearing" and "protective extension" domain score was significantly higher for children in the intervention arm. These improvements were sustained at 12 weeks (P = .028). CP-QOL scores improved at 12 weeks. No serious adverse events were seen.
Conclusion: A 6-Hz primed rTMS combined with mCIMT is safe, feasible, and superior to mCIMT alone in improving the upper limb function of children with unilateral CP.
期刊介绍：
Neurorehabilitation & Neural Repair (NNR) offers innovative and reliable reports relevant to functional recovery from neural injury and long term neurologic care. The journal''s unique focus is evidence-based basic and clinical practice and research. NNR deals with the management and fundamental mechanisms of functional recovery from conditions such as stroke, multiple sclerosis, Alzheimer''s disease, brain and spinal cord injuries, and peripheral nerve injuries.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
