Keywords: Electrical stimulation of the parietal nucleus of the cerebellum; cerebral palsy; WeeFIM scale
Cerebral palsy (CP) is a syndrome of nonprogressive brain injury in children due to various reasons, which is mainly manifested as a variety of disorders of central motor, intellectual, and speech disorders, and it seriously affects the children's longevity, development, life, and the ability to receive a normal education, and it is one of the major disabilities among the children. It is one of the major disabilities among children and brings great pain and burden to the families and society. In recent years, on the basis of modern rehabilitation therapy, we have achieved good therapeutic effect by using the treatment method of electrical stimulation of the parietal nucleus of the cerebellum (FNS) with the cerebral circulation function therapeutic instrument.
1 Data and Methods
1.1 General information 45 cases of children with cerebral palsy who came to our hospital for rehabilitation treatment from December 2001 to May 2005 were taken as the subjects of the study, and all of them met the diagnostic criteria established by the National Conference on Pediatric Cerebral Palsy [1], among which there were 17 cases of neonatal infections, 12 cases of perinatal asphyxia, and 16 cases of surgical operations and injuries. The youngest was 0?6 years old, the oldest was 6 years old, and the average age was 3?6 years old. They were randomly divided into 21 cases in the conventional rehabilitation treatment group and 24 cases in the conventional rehabilitation plus electrical stimulation treatment group, and the differences between the two in terms of gender, age, duration of disease and score value were not significant (P>0?05), and were comparable.
1.2 Methods All children with cerebral palsy received comprehensive rehabilitation therapy based on conventional medication, including acupuncture, tuina massage, exercise therapy, occupational therapy and speech correction, etc. The treatment group added FNS on the basis of the above methods of treatment, and used the Cerebral Circulatory Functional Therapeutic Apparatus (CVFT-011M) produced by Shanghai Renhe Medical Equipment Company, with the main electrodes placed in the mastoid region on both sides.
2 Results
2.1 Assessment Criteria The comprehensive assessment of children with cerebral palsy was performed using the Pediatric Functional Independence Rating Scale - WeeFIM Scale [2]. The scale can comprehensively assess the motor, cognitive, verbal and social functions of the children.
2.2 Assessment results Before treatment, the WeeFIM score of the treatment group was (41?27±12?69), and the WeeFIM score of the control group was (40?93±11?57), and the difference between the two was not significant (P>0?05). The values of WeeFIM score in treatment and control group after treatment were (89?14±34?92), (65?92±27?67) respectively. The difference between the two was significant (P<0?05). WeeFIM ratings of the two groups, see Table 1.
Table 1 Results of WeeFIM scores of the two groups after treatment (omitted)
3 Discussion
The main pathological damages of cerebral palsy can be broadly classified into two kinds: hemorrhagic and ischemic; hemorrhagic pathological damages may be due to the more fragile cerebral blood vessels in the perinatal period, imperfect neurodevelopment, and the poorer ability to regulate the cerebral blood flow; ischemic damages There may be softening of cerebral vessels, cortical atrophy or atrophic lobular sclerosis. The recovery of its sequelae is slow, and it is important to improve the efficacy and shorten the course of the disease.
The cerebral circulation function therapeutic instrument is to stimulate the parietal nucleus area of the cerebellum by using frequency synthesized therapeutic currents, and its mechanism of action is roughly as follows: (1) cerebral protection effect. The cerebral protection zone is located in the watershed area of lateral blood flow, consistent with the dorsal part of the sensorimotor cortex, the ventral part of the pyriform cortex, and the medial part of the hippocampus and the dorsal amygdala [3].FNS increases the local cerebral blood flow (rCBF) in this zone, improves microcirculation and maintains high levels during stimulation, prevents delayed and secondary damage to the neurons in the semidarktic area and does not increase the local metabolism, which improves the cerebral damage [4]. (2) The motor disorder after brain injury is related to the damage of parietal cortex and subcortical pyramidal fibers on the one hand, and subcortical conduction block on the other hand.FNS can significantly increase the number of neurons containing 5-HT in the cerebral cortex, hippocampus, and hypothalamus etc., so that the synthesis of 5-HT in neurons is increased and the increase of excitatory transmitters can improve the motor conduction, and promote the restoration of the limb function [5]. (3) Brain tissue necrosis is irreversible, neurons can not be regenerated, but it has plasticity, brain tissue compensation can be carried out through both functional compensation and structural repair. mRNA expression of growth-related proteins in the peripheral neurons of the lesion can be significantly increased by FNS, suggesting that regeneration of nerve fibers at the site is active, mainly for the residual neuron synapses to germinate, grow, and lengthen the axon to the site of disinhibited, thereby achieving functional reconstruction, and this medium- and long-term neuron regeneration is also possible. The regeneration of nerve fibers in the middle and late stages of the disease can promote the recovery of limb motor function in patients [5]. (4) Leukocytes play an important role in brain damage, and they cause direct or indirect damage to neural tissues by blocking microvessels, increasing blood viscosity, and releasing various enzymes, tissue factors, and other toxic substances.FNS can reduce the activity of myeloperoxidase (MPO) in local brain cells and tissues and reduce the infiltration of leukocytes, which can alleviate the damage to the brain [6].
In summary, FNS increases rCBF, reduces leukocyte infiltration, and decreases the number of necrotic neurons by expanding cerebral blood vessels, releasing neurotransmitters, repairing neurons, and improving leukocyte rheology, among other possible mechanisms, which is conducive to the restoration of physiological functions of damaged brain tissues, and reduces or disappears the symptoms in order to achieve the goal of treating the disease.The effect of FNS in conjunction with various kinds of rehabilitation on the ADLs of children with cerebral palsy has been shown to be significant. FNS combined with various rehabilitation therapies has an important role in the improvement of ADLs and functional independence level of children with cerebral palsy, and is one of the effective means of treating children with cerebral palsy.
References
1 Lin Qing? Pediatric cerebral palsy? Beijing: Huaxia Publishing House, 2000, 7