Background:The integration of therapeutic approaches is increasingly recommended for children with cerebral palsy, to enhance outcomes. Nevertheless, clinicians still opt for separate or combined therapies based on little credible knowledge. Objective:This study endeavored to evaluate the effect ofbotulinum neurotoxin-A (BoNT-A) injection and reciprocal neuromuscular electrical stimulation (rNMES) and their combination on the upper extremity function in children with spastic hemiplegia. Methods:Sixty-four children with spastic hemiplegia (aged 6– 10 years) were randomly assigned to four treatment-based groups [group I (BoNT-A), group II (rNMES), group III (combined BoNT-A and rNMES), and group IV (Control)]. All children received a physical rehabilitation program, thrice/week over three months. Unilateral upper-limb function, bimanual hand function, and real-time arm-hand function were assessed using Melbourne Assessment (MA), Assisting Hand Assessment (AHA), and Pediatric Motor Activity Log (PMAL) scales respectively pre-treatment, post-treatment, and at 6 months follow-up. Results:Post-treatment, group III achieved greater improvement in MA, AHA, and PMAL compared to other groups (all P < 0.05), and the difference remained in favor of group III at the follow-up (all P < 0.05). Conclusions:This study suggests that BoNT-A and rNMES combined are more effective than either of them alone to enhance upper-extremity function in children with spastic hemiplegia.

中文翻译：

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A型肉毒杆菌神经毒素注射后交互电刺激治疗脑瘫儿童的功能结果：一项随机对照试验

背景：越来越多地建议对脑瘫儿童进行治疗方法的整合，以提高结果。尽管如此，临床医生仍然基于很少的可信知识选择单独或联合治疗。目的：本研究旨在评估肉毒杆菌神经毒素-A（BoNT-A）注射液和交互神经肌肉电刺激（rNMES）及其联合对痉挛性偏瘫患儿上肢功能的影响。方法：将 64 名痉挛性偏瘫儿童（6-10 岁）随机分配到四个治疗组[I 组（BoNT-A）、II 组（rNMES）、III 组（联合 BoNT-A 和 rNMES） ，和组 IV（对照）]。所有孩子都接受了身体康复计划，三个月内每周三次。单侧上肢功能，使用墨尔本评估 (MA)、辅助手评估 (AHA) 和小儿运动活动日志 (PMAL) 量表分别在治疗前、治疗后和 6 个月时评估双手手功能和实时手臂功能跟进。结果：治疗后，III组MA、AHA、PMAL均较其他组有较大改善（均P < 0.05），且随访时差异仍有利于III组（均P < 0.05）。结论：本研究表明，对于痉挛性偏瘫患儿，BoNT-A 和 rNMES 联合使用比单独使用任何一种均能更有效地增强上肢功能。并在 6 个月的随访中。结果：治疗后，III组MA、AHA、PMAL均较其他组有较大改善（均P < 0.05），且随访时差异仍有利于III组（均P < 0.05）。结论：本研究表明，对于痉挛性偏瘫患儿，BoNT-A 和 rNMES 联合使用比单独使用任何一种均能更有效地增强上肢功能。并在 6 个月的随访中。结果：治疗后，III组MA、AHA、PMAL均较其他组有较大改善（均P < 0.05），且随访时差异仍有利于III组（均P < 0.05）。结论：本研究表明，对于痉挛性偏瘫患儿，BoNT-A 和 rNMES 联合使用比单独使用任何一种均能更有效地增强上肢功能。