关键词: 脑性瘫痪, 经颅磁刺激, 肌力, 痉挛型脑瘫, 肌痉挛, 运动功能, 康复

Abstract: Background　Rehabilitation treatment is of vital importance to both physical and mental health of children with spastic cerebral palsy.But responses to regular comprehensive training are not satisfactory in such patients.Transcranial magnetic stimulation can promote the recovery of brain functions by using magnetic fields to stimulate the central nervous system.Core strength training is a kind of rehabilitation targeting on resultant strength of core muscles，which can systematically improve the physical and mental state.Objective　To explore the application value of transcranial magnetic stimulation combined with core strength training in children with spastic cerebral palsy.Methods　448 children with spastic cerebral palsy were recruited from the Second Hospital of Hebei Medical University from 2016 to 2017，and were divided into routine group （148 cases），control group （150 cases） and study group （150 cases） by a random number table，receiving routine rehabilitation treatment，routine rehabilitation treatment with core strength training，routine rehabilitation treatment with core strength training and transcranial magnetic stimulation，respectively.Muscle spasticity measured by the Modified Tardieu Scale （MTS），and gross motor function measured by the Gross Motor Function Measure （GMFM） at baseline，at the end of 1-month and 3-month treatment were collected.And ankle joint motion and gait speed were evaluated at the end of the treatment.Results　Intervention method and time showed interactive effect on MTS score and GMFM score （P<0.001）．And both of them exerted significant main effects on MTS score and GMFM score（P<0.05）．Compared with baseline，MTS score decreased and GMFM score increased significantly at 1 and 3 months after treatment in all groups（P<0.05）．Moreover，MTS score decreased and GMFM score increased significantly at 3 months after treatment in all groups compared with at 1 month after treatment （P<0.05）．Intergroup comparisons indicated that at 1 and 3 months after treatment，higher MTS score and lower GMFM score were found in routine group than other two groups，and were also found in study group instead of control group（P<0.05）．At the end of treatment，ankle joint motion was found to be better than the baseline in all groups（P<0.001）．But it differed significantly across the groups（P<0.001）．In particular，it was improved less in routine group than in other groups（P<0.05），and improved less in control group compared with study group （P<0.05）．Post-treatment gait speed differed significantly across the groups（F=111.695，P<0.001）．Specifically，it was slower in routine group than in other groups（P<0.05），and was slower in control group than that of study group （P<0.05）．Conclusion　Routine rehabilitation training combined with transcranial magnetic stimulation and core strength training can improve the muscle spasticity and gross motor function，and increase the ankle motion and gait speed，so it is worthy of extensive use.

Key words: Cerebral palsy, Transcranial magnetic stimulation, Muscle strength, Muscle spasm, Motor function, Rehabilitation