康复学报 (Apr 2025)
Effects of Game-Based Integrative Neuromuscular Training Combined with Conventional Rehabilitation on Children with Spastic Hemiplegia
Abstract
ObjectiveTo observe the effects of game-based integrative neuromuscular training (INT) combined with conventional rehabilitation on children with spastic hemiplegia (SH).MethodsA total of 40 children with SH receiving rehabilitation treatment in the Department of Rehabilitation of Children's Hospital Affiliated to Shandong University from January to June 2023 were randomly divided into control group and experimental group using the random number table method, with 20 cases in each group. During the course of the treatment, three cases in the control group dropped out due to early discharge, one case dropped out due to botulinum toxin injection and two cases dropped out due to early discharge in the experimental group. Finally, 17 cases were included in each group. The control group received conventional rehabilitation treatment (occupational therapy, paraffin therapy, and low-frequency pulsed electrical stimulation) and conventional motor training (muscle strength training, joint range of motion training, balance training and gait training), 20 minutes each item, once a day, five times a week for 12 weeks. The experimental group received game-based integrative neuromuscular training in addition to the the conventional rehabilitation treatment of the control group, including strength training, speed and agility training, dynamic stability training, plyometric training, core stability training, 20 minutes a time, once a day, five times a week for 12 weeks. Before and after treatment, BioNeuro biofeedback instrument and Flexcomp Infiniti System surface electromyography analysis system were used to measure and calculate the root mean square (RMS) values of the quadriceps, hamstrings, gastrocnemius and adductor muscles on the affected side under passive stretching; Microfet2 handheld muscle strength tester was used to measure the muscle strength of the hip flexors, hip extensors, knee flexors, knee extensors, ankle dorsiflexors and ankle plantar flexors on the affected side; Gross Motor Function Measure 88 (GMFM-88) scores in dimensions D and E were used to evaluate the gross motor function; Berg Balance Scale (BBS) was used to evaluate the balance function; 10-meter walk test (10MWT) was used to evaluate the walking ability.Results(1) Lower limb RMS: compared with those before treatment, the RMS values of the hamstrings, quadriceps, gastrocnemius and adductor muscles in the affected limb under passive stretching decreased significantly in both groups after treatment, and the differences were statistically significant (P<0.05). Compared with the control group, the RMS values of the hamstrings, quadriceps, gastrocnemius and adductor muscles in the affected limb were significantly lower in the experimental group after treatment, and the differences were statistically significant (P<0.05). (2) Lower limb muscle strength: compared with that before treatment, the muscle strength of the hip flexors, hip extensors, knee flexors, knee extensors, ankle dorsiflexors and ankle plantar flexors in the affected limb in both groups increased significantly after treatment, and the differences were statistically significant (P<0.05). Compared with the control group, the muscle strength of the hip flexors, hip extensors, knee flexors, knee extensors and ankle plantar flexors in the affected limb were significantly higher in the experimental group after treatment, and the differences were statistically significant (P<0.05). (3) Scoring of GMFM-88, BBS and 10MWT: compared with those before treatment, the GMFM-88 scores in dimensions D and E, BBS score, and 10MWT in both groups after treatment increased significantly, and the differences were statistically significant (P<0.05). Compared with the control group, the GMFM-88 score in dimension D and BBS score in the experimental group were significantly higher after treatment, and the differences were statistically significant (P<0.05).ConclusionGame-based integrative neuromuscular training can effectively reduce the muscle tone of the lower limbs in children with SH, improve lower limb muscle strength, gross motor function, and balance function, which is worthy of clinical promotion.
