| Cerebral palsy(CP)describes a group of permanent disorders of movement and posture causing activity limitations,leading the most common movement disorder to children.Accompanying many intellectual handicap,language barrier,epileptic pain and visual,auditory disorders.There are a variety of rehabilitation treatment methods for cerebral palsy,mainly including internationally recognized physical exercise therapy,occupational therapy,drug therapy and surgical treatment,etc.,but most single treatment methods are not satisfactory in clinical efficacy,so the current clinical treatment of cerebral palsy is mostly combined therapy.Scalp acupuncture(SA)is one of several specialized acupuncture techniques,and it has been used widely in China to alleviate several CP symptoms,despite the deficiency of high-quality evidence related to this practice.Therefore,we plan to conduct a protocol of systematic review aimed at systematically reviewing all the clinical evidence on the effectiveness of scalp acupuncture for treating CP in children.This paper consists of two parts: systematic review and clinical study,SR to evaluate the clinical effectiveness of SA in the treatment of children with cerebral palsy,to explore the clinical evaluation of scalp acupuncture and pyonex in the treatment of spastic cerebral palsy motor dysfunction,and to establish a proven and effective treatment program for promotion.Objective:The goal of this systematic review is to estimate the effectiveness of SA on CP motor dysfunction.observe the problems in previous studies,the effective common acupoints and evaluate the effectiveness of SA treatment.To explore the improvement of gross motor function,muscle tension and range of motion of children with spastic cerebral palsytreated with scalp acupuncture combined with pyonex in treatment,observe its clinical efficacy,and observe the advantages and safety of comprehensive therapy compared with rehabilitation therapy in the intervention of children with spastic cerebral palsy.Methods:1.Systematic Review: The following electronic databases will be searched from inception to DEC,2019 MEDLINE,Pub Med,EMBASE,Cochrane Library,Chinese National Knowledge Infrastrctu-re(CNKI),Chinese Scientific Journals Database(VIP),Wan-fang Database,and Chinese Biomedical Literature Database(CBM),Korean Traditional Knowledge Portal,Km-base.All published English,Chinese and Korean articles randomized controlled trials will be included.Randomized controlled trials of cerebral palsy treated with SA or SA combined program combined with rehabilitation therapy were collected,and literature was strictly screened.Data extraction,quality evaluation and systematic qualitative or quantitative analysis were performed on the included literatures,and clinical research characteristics of SA in the treatment of pediatric cerebral palsy were summarized.2 Randomize Clinical Trial: A randomized,controlled,loading design was used in this study.Children with spastic cerebral palsy were randomly divided into two groups,the control group was given rehabilitation therapy,and the treatment group was given rehabilitation therapy plus head acupuncture combined with pyonex in treatment;The total treatment for 12 weeks,followed up for 12 weeks.Gross Motor Function Classification System(GMFCS),Gross Motor Function Measure D and E(GMFM-D,E),Functional independence measure Children’s Edition(Wee FIM),Range of Motion(ROM)and Modified Ashworth Scale were evaluated before treatment,8 weeks after treatment,12 weeks after treatment,and 12 weeks after follow-up.The scores were evaluated by ITT and PPS.Results:1.Systematic Review: A total of 23 RCT studies that met the criteria were included in this SR,involving a total of 2055 children with cerebral palsy.The results of 7 studies suggested that SA plus Rehabilitation therapy was more effective than single use of rehabilitation therapy.In addition,5 studies suggested that the efficacy of acupuncture + rehabilitation +combined regimen was better than that of rehabilitation alone.An study was used to observe the efficacy of SA + body acupuncture + rehabilitation VS rehabilitation.The results indicated that there was no statistical significance between the two groups and the effect of acupuncture could not be confirmed.The general characteristics of other studies were too poor,and the sample size of a single test was too small,and the methodology quality is not high enough to be persuasive.A total of 22 acupoints were involved in the study,and the top5 in frequency of use were: DU20,scalp motor area,scalp balance area,EX-HN1,scalp Foot Motor Sensory area.The 23 included studies showed Large heterogeneity between data sources was noted,so it was difficult to conduct a meaningful meta-analysis.This systematic review sugg ests that scalp acupuncture therapy may have a certain effect on the improvement of motor dysfunction in children with cerebral palsy.2 Randomize Clinical Trial(1)General information compared to baselineA total of 106 children with cerebral palsy were included,including 52 in the treatment group and 1 case of abscission.In the control group of 50 cases,1 case fell off and 2 case was removed.There were 65 males and 41 females.There were no significant statistical differences between the two groups in gender,age,course of disease,type of cerebral palsy,GMFCS,GMFM,Wee FIM,ROM and improved Ashworth scores between the two groups.(2)GMFM score comparisonThe GMFM-D(standing section)evaluation within the group was significantly higher than that before treatment in each observation period and follow-up period after treatment between the two groups,with statistical difference.In comparison between groups,12 weeks after treatment,the treatment group was higher than the control group,and there was a statistical difference between the two groups(P<0.05).The GMFM-E(walking,jumping and running section)evaluation within the group was compared with that before treatment,and the two groups were significantly higher in each observation period and follow-up period after treatment,with statistical difference.In comparison between groups,8 weeks after treatment,the treatment group was higher than the control group,and there was a statistical difference between the two groups(P<0.05).(3)Modified Ashworth score comparisonCompared with before treatment,adductor muscle MAS assessment in the two groups decreased significantly in each observation period and follow-up period after treatment,and there was a statistical difference.In comparison between groups,the scores of the treatment group were lower than the control group at 12 weeks follow-up,and there was statistical significance between the two groups(P<0.05).The hamstring MAS between the two groups was significantly lower than that of the control group at 12 weeks after treatment,and there was statistical significance(P<0.05).Gastrocnemius MAS of the two groups decreased significantly in each observation period and follow-up period after treatment,with statistical difference.In comparison between groups,12 weeks after treatment,the score of the treatment group was lower than that of the control group,with statistical significance between the two groups(P<0.05).(4)Weefim score comparisonWeefim evaluation within the group was compared with that before treatment,the two groups in each observation period and follow-up period after treatment significantly increased,with statistical difference.The comparison between groups was higher in the treatment group than in the control group 12 weeks after treatment,and there was a statistical difference between the two groups(P<0.05).(5)ROM score comparisonCompared with before treatment,the range of motion of dorsal flexion joint in the two groups decreased significantly in each observation period and follow-up period after treatment,with statistical difference.However,there was no significant difference between the treatment group and the control group(P>0.05).Compared with before treatment,the popliteal fossa Angle in the array was significantly higher in the two groups during the treatment period,with a statistically significant difference.The comparison between groups was higher in the treatment group than in the control group 12 weeks after treatment,and there was a statistical difference between the two groups(P<0.05).Compared with before treatment,the range of motion of femoral horn joint in the two groups was significantly higher in each observation period and follow-up period after treatment,with statistical difference.However,there was no significant difference between the treatment group and the control group(P>0.05).Conclusion:1.This systematic review suggests that scalp acupuncture therapy may have a certain effect on the improvement of motor dysfunction in children with cerebral palsy.The e ffective common acupoints were DU20,scalp motor area,scalp balance area,EX-HN1,scalp Foot Motor Sensory area.,The common acupuncture method is flat acupunct ure,and rapid twisting and turning technique is used after needle insertion.2.Both scalp acupuncture combined with pyonex in treatment and simple rehabilitation treatment are effective for motor dysfunction of children with spastic cerebral palsy.3.Scalp acupuncture combined with pyonex in treatment has a longer lasting effect than rehabilitation alone,and has a better effect than rehabilitation alone on gross motor function and reduction of muscle tension,and can improve walking,jumping and running functions earlier. |
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