網手套電刺激用於偏癱痙攣型腦性麻痺兒童上肢功能：先驅研究

Mesh-glove Electrical Stimulation on Upper Extremity Function in Children with Spastic Hemiplegic Cerebral Palsy: a Pilot Study

彭健瑋(Chien‐Wei Peng) ； 陳嘉玲(Chia‐Ling Chen) ； 林光麟(Kuang‐Lin Lin) ； 林克忠(Keh‐Chung Lin) ； 吳菁宜(Ching‐Yi Wu) ； 劉文瑜(Wen‐Yu Liu) ； 陳協慶(Hsieh‐Ching Chen)

《台灣復健醫學雜誌》 44卷4期 (2016/12) Pp. 201-209

https://doi.org/10.6315/2016.44(4)04

摘要

前言：神經肌肉電刺激是改善腦性麻痺(cerebral palsy)兒童上肢痙攣和動作功能的非侵入性治療方法之一。然而，有些兒童在接受神經肌肉電刺激時會感到不舒服。網手套電刺激(Mesh-glove electrical stimulation, MGES)是一種體感覺電刺激。近期研究顯示，對於腦性麻痺兒童上肢痙攣降低有顯著的療效。本研究旨在探討MGES對腦性麻痺兒童上肢功能及日常生活之療效。方法：本研究採兩組前後測實驗設計。參與者為8名3-12歲腦性麻痺兒童，分派至實驗組(MGES)及控制組(traditional rehabilitation, TR)。在治療前後使用修正版阿修伍爾斯氏痙攣量表(Modified Ashworth Scale, MAS)，上肢技巧品質測驗(Quality of Upper Extremity Skills Test, QUEST)，積木與盒子測驗(Box and Block Test, BBT)，兒童專用功能性自主評量量表(Functional Independence Measure for Children, WeeFIM)作為療效評估。MGES組之患側手接受電刺激合併上肢復健治療，介入劑量為每次90分鐘、一週2次、持續12週。本研究使用廣義估計方程式(general estimation equation, GEE)比較兩組前後測分數改變量，顯著水平設為p ＜ .05。結果：GEE分析結果顯示，MGES組在MAS的痙孿程度降低大於TR組(p＜ .01)，且MGES組在QUEST和BBT與TR組比較呈現較多的上肢動作品質及靈巧度進步(p＜ .01)，在WeeFIM的自我照顧分數上比TR組也有較佳進步(p＜ .03)。結論：本研究結果顯示，MGES可改善偏癱痙攣型腦性麻痺兒童上肢之痙攣及日常功能，因此，可做為治療這群兒童上肢障礙的另一項輔助治療。由於本研究受試者有限，未來需要較大樣本來驗證研究發現。

關鍵字

網手套電刺激(mesh-glove electrical stimulation) ； 腦性麻痺(cerebral palsy) ； 體感覺電刺激(somatosensory electrical stimulation) ； 上肢(upper extremity) ； 動作功能(motor function)

並列摘要

Introduction: Neuromuscular electrical stimulation is one of the non-invasive treatments for improving spasticity of upper extremity (UE) and motor function in children with cerebral palsy (CP). However, some children felt uncomfortable in receiving the neuromuscular electrical stimulation. The mesh-glove electrical stimulation (MGES) is one kind of somatosensory electrical stimulation. Recently, there were few researches indicating that MGES causes positive effectiveness for the spasticity control of UE in children with CP. This study aims to investigate the treatment effects of MGES on UE function and daily function in children with CP. Methods: This controlled trial is based on a pre- and post-treatment study design. Eight children with CP, aged 3-12 years, were classified into the experimental (MGES) and control (traditional rehabilitation, TR) groups. Outcome measures, including the Modified Ashworth Scale (MAS), the Quality of Upper Extremity Skills Test (QUEST), the Box and Block Test (BBT), and the Functional Independence Measure for Children (WeeFIM), were assessed before and after the treatments. The MGES group received electrical stimulation on their affected UE and motor training for 90 minutes, twice a week for 12 weeks. A general estimation equation (GEE) model was used to measure the outcome changes between two groups. The significance level was set at p＜ .05. Results: GEE showed MGES group had greater decrease in the spasticity, measured by MAS, than TR group (p＜ .01). The MGES group had greater improvement in UE quality and manual dexterity, measured by QUEST and BBT, than the TR group (p＜ .01). The MGES group also induced greater gains in self-care, measured by WeeFIM, than the TR group (p＜ .03). Conclusion: The results show that MGES may induce greater gains in UE function and daily function in children with spastic hemiplegic CP. Therefore, MGES may be used as an adjunct therapy in the treatment of UE dysfunctions in these children. Due to the limitation of the small sample size, further studies should recruit larger sample size to validate the findings.

並列關鍵字

mesh-glove electrical stimulation ； cerebral palsy ； somatosensory electrical stimulation ； upper extremity ； motor function

參考文獻

Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007;109:8-14."

Bax M, Goldstein M, Rosenbaum P, et al. Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 2005;47(8):571-6."

Mäenpää H, Jaakkola R, Sandström M, et al. Electrostimulation at sensory level improves function of the upper extremities in children with cerebral palsy: a pilot study. Developmental Medicine & Child Neurology 2004;46:84-90."

Shamsoddini A, Amirsalari S, Hollisaz MT, et al. Management of spasticity in children with cerebral palsy. Iran J Pediatr 2014;24(4):345-51."

Wright PA, Durham S, Ewins DJ, et al. Neuromuscular electrical stimulation for children with cerebral palsy: a review. Arch Dis Child 2012;97(4):364-71."