Primed low-frequency repetitive transcranial magnetic stimulation and constraint-induced movement therapy in pediatric hemiparesis: a randomized controlled trial.
Primed low-frequency repetitive transcranial magnetic stimulation and constraint-induced movement therapy in pediatric hemiparesis: a randomized controlled trial.
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DOI：
10.1111/dmcn.12243
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发表时间：
2014-01
影响因子：
3.8
通讯作者：
Carey JR
中科院分区：
文献类型：
--
作者：
Gillick BT;Krach LE;Feyma T;Rich TL;Moberg K;Thomas W;Cassidy JM;Menk J;Carey JR
本研究旨在探讨6赫兹预置低频重复经颅磁刺激(RTMS)联合强制性运动疗法(CIMT)促进先天性偏瘫患儿偏瘫手功能恢复的可行性和有效性。19例8~17岁的先天性偏瘫患儿(男10例，女9例；平均年龄10岁，SD 2岁10个月；手动能力分级I-III级)接受了5次rTMS(n=10)或rTMS(n=9)，每天交替使用CIMT。CIMT包括连续13天的长臂铸造和5次皮肤检查。每个孩子总共接受了10个小时的一对一治疗。主要的结果测量是辅助手评估(AHA)，次要的结果变量是加拿大职业表现测量(COPM)和立体诊断。使用Wilcoxon符号秩和检验来分析测试前后组内分数的差异。协方差分析用于计算经基线调整的组间平均差异。用Fisher‘s精确检验比较AHA原始分数的个体变化与4分的最小可检测差异(SDD)。所有接受治疗的参与者都完成了研究。AHA的改善在两组之间有显著差异(p=0.007)。在次要结果指标上没有发现显著差异。RTMS/CIMT组的10名参与者中有8名表现出比SDD更大的改善，而在假rTMS/CIMT组的9名参与者中只有2名表现出这种改善(p=0.023)。未发生严重不良事件。预置、低频rTMS联合CIMT治疗小儿偏瘫安全、可行、有效。现在需要进行更大规模的临床试验。
The aim of this study was to determine the feasibility and efficacy of five treatments of 6Hz primed, low-frequency, repetitive transcranial magnetic stimulation (rTMS) combined with constraint-induced movement therapy (CIMT) to promote recovery of the paretic hand in children with congenital hemiparesis. Nineteen children with congenital hemiparesis aged between 8 and 17 years (10 males, nine females; mean age 10y 10mo, SD 2y 10mo; Manual Ability Classification Scale levels I-III) underwent five sessions of either real rTMS (n=10) or sham rTMS (n=9) alternated daily with CIMT. CIMT consisted of 13 days of continuous long-arm casting with five skin-check sessions. Each child received a total of 10 hours of one-to-one therapy. The primary outcome measure was the Assisting Hand Assessment (AHA) and the secondary outcome variables were the Canadian Occupational Performance Measure (COPM) and stereognosis. A Wilcoxon signed-rank sum test was used to analyze differences between pre- and post-test scores within the groups. Analysis of covariance was used to compute mean differences between groups adjusting for baseline. Fisher’s exact test was used to compare individual change in AHA raw scores with the smallest detectable difference (SDD) of 4 points. All participants receiving treatment finished the study. Improvement in AHA differed significantly between groups (p=0.007). No significant differences in the secondary outcome measures were found. Eight out of 10 participants in the rTMS/CIMT group showed improvement greater than the SDD, but only two out of nine in the sham rTMS/CIMT group showed such improvement (p=0.023). No serious adverse events occurred. Primed, low-frequency rTMS combined with CIMT appears to be safe, feasible, and efficacious in pediatric hemiparesis. Larger clinical trials are now indicated.
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影响因子：
2.6
作者：
Boyd R;Sakzewski L;Ziviani J;Abbott DF;Badawy R;Gilmore R;Provan K;Tournier JD;Macdonell RA;Jackson GD
通讯作者：
Jackson GD
影响因子：
4.2
作者：
Carey, James R.;Evans, Chad D.;Pascual-Leone, Alvaro
通讯作者：
Pascual-Leone, Alvaro
影响因子：
48
作者：
Kirton, Adam;Chen, Robert;deVeber, Gabrielle
通讯作者：
deVeber, Gabrielle
影响因子：
5.5
作者：
Cheeran, Binith;Talelli, Penelope;Rothwell, John C.
通讯作者：
Rothwell, John C.
影响因子：
2.9
作者：
Holmefur, Marie;Krumlinde-Sundholm, Lena;Eliasson, Ann-Christin
通讯作者：
Eliasson, Ann-Christin