The Effect And Mechanism Of RTMS Combined With CIMT On Hand Function In Children With Hemiplegic Cerebral Palsy

Background and purpose:Cerebral palsy is the most common cause of dysfunction in children.The prevalence is about 2‰-5‰,which is mainly manifested as motor development disorders and posture abnormalities.Hemiplegic cerebral palsy accounts for about 44%of all cerebral palsy,mainly due to lateral limb dysfunction,especially in the upper limbs,which limits the child’s social life ability and leads to poor quality of life.As a result,the number of studies on interventions for upper limb function in children with hemiplegic cerebral palsy has grown exponentially over the past decade.At present,there are many methods for the rehabilitation of cerebral palsy,but the overall effect is not very satisfactory.The purpose of this study was to observe The effect and mechanism of repetitive transcranial magnetic stimulation combined with CIMT on hand function in children with hemiplegic cerebral palsy.Methods:Forty children with hemiplegic cerebral palsy,aged 2.5-6 years(21males and 14 females,average age（50.06 months;43.83 months）,MACSⅠ-Ⅱ,were randomly divided into（1）true stimulation group:CIMT+rTMS^（+）（n=17）;（2）Pseudo-stimulation group:CIMT+rTMS^（-）（n=18）.Each subject was evaluated before treatment,2 weeks after treatment,and 6 months after treatment.CIMT intervention was performed for 10 days,2 hours per day,Another 1-hour home training was conducted,and the wearing time of restrictive gloves was not less than 6 hours.The rTMS intervention was 10 days,20 min/day,and was located in the M1 region of the healthy side of the brain.The parameters were:1 Hz,90%MT,and 1200 pulses.Main outcome indicators The Melbourne Unilateral Upper Limb Function Rating Scale（MA2）,the secondary indicators are the Upper Limb Selective Motion Control Scale（SCUES）,the Infant-Junior Middle School Social Ability Scale（SM）,the Overall Hand Function Evaluation Score（GRS）,the improvement Ashworth Scale（MAS）and adverse reactions.Correlation statistical analysis was performed using SPSS 25.0.Chi-square test,Wilcoxon signed rank sum test,Fisher exact probability method,simple effect analysis,and repeated measures analysis of variance were used to compare the differences of various indicators.Results:MA flexibility,MA fluency and SM were significantly different between the groups（p<0.05）;MA-range of movement,MA-accuracy,MA-dexterity,MA-fluency,MA-total score,SCUES healthy and affected sides,MAS,GRS,SM were significantly different within the group（p<0.05）;Overall,scores increased at 2 and 6months after treatment compared to before treatment.Subjects did not fall off and no adverse events occurred during treatment.Conclusion:rTMS combined with CIMT can significantly improve the hand function of children with hemiplegic cerebral palsy,and the effect of the true stimulation group is higher than that of the pseudo stimulation group The safety is good,and the coordination of children is high.It is worth promoting.In the future,large samples,randomized controlled studies are needed,and their long-term effects need to be observed.