康复学报 (Dec 2020)
Effect of Extracorporeal Shock Wave combined with Occupational Therapy on Forearm Pronation Disorder in Children with Spastic Cerebral Palsy
Abstract
Objective:To observe the effect of extracorporeal shock wave combined with occupational therapy therapy on forearm pronation disorder in children with spastic cerebral palsy(SCP).Methods:A total of 42 children with SCP were randomly divided into the control group and the observation group, with 21 cases in each group in the children rehabilitation department of the affiliated Nanhai maternity and children's Hospital of Guangzhou university of traditional Chinese medicine from January to December 2019.The control group was given targeted occupational therapy, including upper limb forearm pronator stretching therapy, neurophysiological therapy(Bobath technology), proprioceptive neuromuscular facilitation therapy(PNF); game type occupational training including placing objects in forearm supination position, supination grasping stick, supination fetching game, palm and back game, etc..The above training was conducted once a day, 30 minutes per time, six times a week, three months as a course of treatment, continuous treatment for two courses.The observation group was given extracorporeal shock wave therapy on the basis of the control group.The child with SCP was in a comfortable position and the forearms of the upper limbs were placed on the plane so that it could free its own gravity.The abdomen of pronator teres muscle was impacted with the probe of shock wave therapeutic instrument(pressure intensity: 1.0-1.5 bar;frequency: 8-10 Hz;impact times: 1 000-2 000 times).Three to five minutes each time, once every three days, twice a week, three months as a course of treatment, continuous treatment for two courses.Before treatment, after treatment for three months and six months, the modified Ashworth scale(MAS)was used to evaluate the spasticity of forearm pronator muscles;the active range of motion(AROM)of forearm supination was measured by joint range of motion protractor;and the fine motor quotient(FMQ)of hands was evaluated by Peabody development motor scale-fine motor(PDMS-FM).Results:Before treatment, there was no significant difference in MAS score, AROM angle and FMQ score between two groups(P>0.05).Compared with before treatment, the MAS scores of the two groups decreased significantly after treatment for three and six months, and the AROM angle and FMQ score increased significantly, the difference was statistically significant(P<0.05).Compared with the control group at the same time after treatment, MAS score of the observation group was significantly lower, AROM angle and FMQ score were significantly higher, the difference was statistically significant(P<0.05).Conclusion:Extracorporeal shock wave combined with occupational therapy therapy can effectively improve the degree of upper limb spasticity and forearm supination joint activity in children with spastic cerebral palsy, and improve the fine motor function of hands.
