| BackgroundCerebral palsy is one of the most serious disabled diseases which are harmful for the health of children. This disease seriously affects children’s daily life, activity and participation, quality of life of the patients, and brings heavy burdens to society and family. The Parents and clinicians often focus on the children’s motor function in the process of rehabilitation, however, they pay little attention to psychological behavior disorders in children with CP. At present, scholars start to attach importance to the researches about psychological behavior disorders in children with CP, with the application of ICF-CY (International Classification of Functioning, Disability and Health-Children and Youth Version, ICF-CY) during rehabilitation. In the clinical study, we investigated psychological behavior disorders in408cases of children with CP. We preliminary grasped some reliable data about psychological behavior disorders in children with CP. In the experiment part, we observed the effects of acupuncture Baihui(DU20) and Sishencong (EX-HN1) on performance of rats subjected to hypoxia-ischemia with neurobehavioral test, and explored the underlying mechanism with immunohistochemical staining, TUNEL staining, Western blot analysis. The data showed that the protection of acupuncture treatment against hypoxia-ischemic injury was related with inhibition of hippocampal neurons apoptosis, up-regulation of BDNF, GDNF expression, promotion the synaptic plasticity. The current study was divided into two parts as follows.Part one Clinical features of children with CP comorbid psychological and behavioral disordersObjectiveIn the present study, we aimed to①investigate the comorbidity rate of psychological behavior disorders in children with CP at different ages.②analyze the factors that affected children with CP comorbid psychological and behavioral disorders, and the epidemiological information of high-risk groups.③summarize the related risk factors for children with CP in our country.④provide valuable information for the development of rehabilitation medicine about CP in china.MethodsWe degined a case-control study for this survery.408cases of children aged2-6years with CP were recruited from inpatient and outpatient department in Nanhai maternity children’s hospital affiliated to Guangzhou University of Chinese Medicine, XiangYa rehabilitation hospital of HuNan provience, and Dongguan maternal and child health hospital from2012June to2013December. The general data such as demographic data, risk factors was collected by trained professionals. In addition, psychological and behavioral disorders comorbid conditions, CBCL scales, GMFcs (gross motor function classification system)evaluation, and traditional Chinese medicine and Western medicine clinical types were also investigated. At last, we summarized the rate of children with CP comorbid psychological behavior disorders and the influenced factors.Results1. Children with CP (2-3years old):The data showed that CBCL scores, comorbid rate of bad habits, sleep disorders, mood disorders, excretion disorders were significantly higer than normal children (P<.0.05). Bad habits of comorbid rate in CP were lose temper52.2%, thumb sucking27.1%, feeding difficulties26.1%, nail bitingl8.8%, breath holding17.1%, the partial eclipse14%, stutter1%, hit head3.4%, pica0.5%. Comorbid rate of sleep disorder were night waking34.8%, difficulty falling asleep24.6%, sleep terrors10.1%, bruxism7.2%, nightmare1.0%. The comorbidity rate of emotional disorders were separation anxiety51.7%, panic attacks32.9%, phobia13%, generalized anxiety disorder0.5%. The comorbidity rate of excretion disorder was30.9%. 4-6years old:The comorbid rate of bad habits, sleep disorders, mood disorders, excretion disorders were also significantly higer than normal children group (P<.0.05). Bad habits of comorbid rate in CP were lose temper56.7%, nail biting37.6%, thumb sucking36.0%, the partial eclipse19.7%, feeding difficulties16.9%, breath holding10.1%, hit head5.1%, trichologia and pica0.5%. Comorbid rate of sleep disorder were night waking33.1%, difficulty falling asleep17.4%, bruxism15.7%, sleep terrors10.7%, nightmare1.7%. The comorbidity rate of emotional disorders were panic attacks21.3%, separation anxiety19.7%, phobia10.1%, obession10.1%, generalized anxiety disorder4.3%. The comorbidity rate of excretion disorder was30.9%.2. Children with CP(aged2-3years old):The clinical type and GMFcs of CP were the main factors which affected CBCL sleep factor scores. The sleep factor scores of CP were significantly different among diverse TCM syndrome types and clinical types (P<0.05). The sleep factor score level of mixed type CP were higher than that in other types, and the sleep problem factor score of CP with liver and kidney deficiency were significantly higher than other TCM clinical type (P<0.05). The differences of social withdrawal, depression, sleep problems, somatic action scores were significant among different GMFcs (P<0.05). The main factors that affected occurrence of bad habits in CP were culture degree of nursing, GMFcs grade level, gender, and the type of CP. The comorbid rate of difficult feeding in CP among diverse clinical types were significant different (P<0.05). The rate of feeding difficulties in mixed type of CP were significantly higher than that of other clinical types (P <0.05). Besides, the comorbidity rate of breath holding and difficult feeding were significantly different among diverse GMFcs classification (P<0.05). The comorbidity rate of breath holding and difficult feeding in V grade CP were significantly higher than that in other grade children (P<0.05). The comorbidity rates of sleep difficulty and bruxism were significantly different among diverse cultural levels of caregivers(P<0.05). The main factors that affected occurrence of sleep disorders in CP were clinical types, caregivers’s culture degree, and family income level. The comorbidity rate of night waking was significantly different among clinical types (P<0.05), the data indicated that comorbidity rate of night waking in mixed type CP was notably higher than that in other clinical types (P<0.05). Moreover, factors that affected occurrence of emotional disorders in CP were caregiver’s culture degree and clinical types. The comorbid rate of phobia was statistically different among clinical types (P<0.05), and the comorbidity rate of phobia in mixed type CP was significantly higher than other clinical types (P<0.05). In addition, we found that GMFcs levels affected occurrence of excretion disorder in CP, and the comorbid rate of excretion disorder in grade Ⅳ CP is significantly higher than that in other grades (P<0.05).4-6years old children with CP:GMFcs grades affected depression, aggressive factor score of CBCL scales in children with CP. The depression, aggressive factor scores of CBCL scales in grade III CP were significantly higher than that of other grades (P<0.05). The bad communication factor scores of ataxic and spastic CP is notably higher than other types, and depression and social withdrawal factor scores of CBCL in phlegm and blood stasis type CP were significantly higher than that of other clinical types (P<0.05). Besides, we found that TCM type, caregiver’s culture degree, Paralyzed parts, and the clinical types of CP affected occurrence of bad habits in CP. The comorbid rates of separation anxiety and hitting head in CP were significantly different among diverse clinical types (P<0.05), and the comorbid rates of separation anxiety, head banging in hypotonia type CP were significantly higher than that in other types (P<0.05). The comorbidity rate of nail biting, feeding difficulty, head banging in CP were significantly different among different GMFcs classification and TCM types (P<0.05). The comorbidity rate of nail biting in grade I CP was markedly higher than that in other grade children (P<0.05). The comorbidity rates of difficult feeding and hitting head in grade IICP were significantly higher than other grade (P<0.05). The comorbid rate of difficlult feeding in strong liver spleen weak type CP was significantly higher than other type CP, and head banging in both spleen and kidney deficiency type CP was notebaly higher than other children (P<0.05). The results also showed that main factors that affected occurrence of sleep disorders in CP were GMFcs grade, TCM type. The comorbidity rates of difficulty in falling asleep, bruxism in CP were significantly different among GMFcs grades (P<0.05). The comorbidity rate of bruxism and difficult sleeping in grade V CP were significantly higher than that of other GMFcs grade (P<0.05). Gender, clinical type of CP, paralysis of parts, GMFcs, caregivers’s culture degree and TCM type affected occurrence of mood disorders in CP. The comorbidity rate of phobia in children with CP among different GMFcs grade was statistically significant (P<0.05), and the comorbid rate of phobia in grade I children was significantly different compared with other levels (P <0.05). The comorbidity rate of obsession in CP was significantly different among caregiver’s culture degrees (P<0.05), and the comorbidity rate of obsession in CP whose caregiver’s was high school degreee was significant different compared with other children (P<0.05).3. The risk factors for children with CP in China were early pregnancy having a sleep cold history, intrauterine hypoxia, low birth weight, fetal macrosomia, premature delivery, bad sleep in maternal stage and pathological jaundice.Conclusion1. The comorbid rate of psychological behavior disorders in children with CP were significantly higher than that of normal children at the same age. Comorbid mood disorders, sleep disorders, excretion disorder and bad habits are most common in psychological behavior disorders.2. The outcome of children with CP comorbid psychological behavior disorder was affected by gender, GMFcs grade, caregiver’s culture degree, the clinical type of CP, family income and TCM type, not a independent factor.3. The clinical characteristics of psychological behavior disorders in cerebral palsy children are depend on their different ages, gender and grade of GMFcs level, degree of nursing culture, cerebral palsy of traditional Chinese medicine clinical type, household income.4. At present, the risk factors for children with CP in China were early pregnancy having a sleep cold history, intrauterine hypoxia, low birth weight, fetal macrosomia, premature delivery, bad sleep in maternal stage and pathological jaundice.Part two The intervention effect and mechanism of acupuncture therapy on behavior disorders in a rat model of cerebral palsyObjectiveWe designed the study to investigate the effects of acupuncture therapy on behavior disorders and the mechanisms in a rat model of cerebral palsy. Methods60specified-pathogens free(SPF)Sprague Dawley rats (7days old)were randomly divided into3groups:sham, hypoxia-ischemia (HI), and HI plus acupuncture treatment (AT) group. Left common carotid artery was sectioned between double ligatures to induced ischemia. After waked, the rats were put into a closed container where were exposured to systemic hypoxia environment containing8%oxygen and92%nitrogen for3.5h. Sham operation group only isolated left common carotid artery. While, the rats in HI and AT groups were subjected to hypoxia-ischemia. The abilities of learning and memory, mood changes were observed at different time points. TUNEL staining was used to detect hippocampal neurons apoptosis, then we performed western blot to evaluate the expression of cleaved-caspase3to further identify the neurons apoptosis. BDNF, GDNF expression were detected by western blotting and immunohistochemistry. Moreover, ultrastructural changes of synapsis were observed with transmission electron microscopyResultsThe abilities of learning and memory were decreased after hypoxic-ischemia, and the moods of rats were changed in rats underwent hypoxic-ischemia. Apoptotic cells were notably increased in hippocampal CA1and CA3regions. The expression levels of cleaved-caspase3, GDNF and BDNF were up-regulated, and synaptic ultrastructure were severely damaged in HI group. Compared with HI group, acupuncture treatment significantly improved the abilities of learning and memory and emotion, inhibited cell apotosis, and down-regulated the expression of cleaved-caspase3. In addition, the data showed that acupuncture treatment markedly increased expression levels of BDNF, GDNF in hippocampus. We also found that acupuncture treatment promote the reconstruction of synaptic ultrastructure after hypoxia-ischemia.ConclusionsAcupuncture treatment have neuroprotective effects on hypoxic-ischemic injury. It improve behavior disorders which may be achieved by inhibiting apoptosis, regulating expression of neurotrophic factors, promoting reconstruction of synaptic ultrastructure after hypoxia-ischemia. |
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