Abstract: Objective To observe the effects of eccentric exercise combined with constraint-induced movement therapy(CIMT) on the upper limb function and activities of daily living in children with spastic hemiplegic cerebral palsy, so as to provide reference for the clinical treatment and rehabilitation. Methods A total of 42 children with spastic hemiplegic cerebral palsy, who were treated in Nantong Maternal and Child Health Care Hospital from January 2020 to June 2021 and met the inclusion criteria, were enrolled in this study and were randomly divided into combined group(n=21) and control group(n=21). Both combined group and control group received traditional rehabilitation and CIMT, while the combined group received eccentric exercise therapy additionally. The upper limb flexor muscle tension, upper limb and hand function and activities of daily living of the two groups were assessed by the modified Ashworth scale(MAS), Carroll upper extremities functional test(UEFT), modified Barthel index(MBI) and root mean square value(RMS) of the surface electromyography of the biceps brachii, and were compared before and after 12-week treatment. Results Before treatment, the MAS score, UEFT score, MBI score and RMS of the surface electromyography of the biceps brachii were not significantly different between combined group and control group(P＞0.05). After 12 weeks of treatment, both UEFT score and MBI score of the two groups were significantly improved than those before treatment(P＜0.05), and the scores of the combined group increased more significantly than the control group(t=2.641, 7.258, P＜0.05). The MAS scores and RMS in the two groups were significantly lower than those before treatment(P＜0.05), and the scores of the combined group were significantly lower than those of the control group(Z=2.706, t=3.623, P＜0.05). Conclusions Eccentric contraction training combined with CIMT can improve the tension of the elbow flexion muscle, the upper limb motor function and activities of daily living in children with spastic hemiplegic cerebral palsy, which is worthy of wide use in clinic.

Key words: eccentric contraction, constraint-induced movement therapy, spastic hemiplega, upper limb motor function, surface electromyography

摘要： 目的 观察分析离心收缩训练联合强制诱导运动疗法(CIMT)对痉挛型偏瘫脑瘫儿童上肢运动功能及表面肌电特征的影响,为临床儿童康复治疗提供参考。方法 选取2020年1月—2021年6月就诊于南通市妇幼保健院的符合纳入标准的42例痉挛型偏瘫脑瘫儿童随机分为联合组和对照组,每组21例。对照组采用常规康复训练及CIMT治疗,联合组在对照组基础上,进行离心收缩训练治疗。比较治疗前和治疗12周后两组儿童的改良Ashworth肌张力评定量表(MAS)、Carroll上肢功能评定量表(UEFT)、改良Barthel指数(MBI)得分以及表面肌电图(sEMG)检测的患侧肱二头肌的均方根值(RMS)。结果 治疗前,两组儿童的MAS评分、UEFT评分、MBI评分及肱二头肌表面肌电RMS组间比较,差异均无统计学意义(P＞0.05);治疗后,联合组和对照组UEFT评分、MBI评分均较治疗前明显提高(P＜0.05),且联合组较对照组的两项评分提高更明显(t=2.641、7.258,P＜0.05);而联合组和对照组MAS评分、肱二头肌表面肌电RMS均较组内治疗前明显降低(P＜0.05),且联合组较对照组降低更明显,差异均有统计学意义(Z=2.706、t＝3.623,P＜0.05)。结论 离心收缩训练联合强制诱导运动疗法可以更显著改善痉挛型偏瘫儿童屈肘肌群痉挛状态,提高上肢运动功能和日常生活活动能力,值得临床推广。

关键词: 离心收缩, 强制诱导运动疗法, 痉挛型偏瘫, 上肢运动功能, 表面肌电图