| BackgroundCerebral Palsy,referred to as CP,is the syndrome of non progressive brain injury and developmental defects caused by the beginning of conception,which is mainly manifested as central movement disorder and abnormal posture.The World Health Organization reported the cerebral palsy prevalence rate was 1 per thousand to 5 per thousand.China reported the prevalence rate of children with cerebral palsy was 1.2 per thousand to 2.7 per thousand.With the high survival rate of premature infants and low birth weight infants,the incidence of children with cerebral palsy is increasing year by year.At present,our country has 400?500 million children with cerebral palsy,with the increase of 30 to 40 thousand patients eath year.The disability rate is 42%?45%.Cerebral palsy has become one of the main diseases that cause physical disability in China.Spastic cerebral palsy is the most common type of cerebral palsy,accounting for about 60-70%.This type of cerebral palsy is mainly caused by the damage of vertebral system,often accompanied by increased muscle tension.And the increased muscle tension is often accompanied by tendon contracture,joint deformity and leads to lifelong disability.Therefore,how to decrease the muscle tension and relieve the limbs spasticity is the key to the treatment of spastic cerebral palsy.According to the clinical practice for more than 30 years of my tutor,the treatment acupuncture of children with spastic cerebral palsy has definite curative effect.But many western physicians of neurology medicine and rehabilitation have negative viewpoint that pain stimulation of acupuncture can aggravate spasm,leading to limb muscle tension increased.Especially Yin meridian acupuncture,which can stimulate spasm side part directly,is against by most of the clinical physicians.Although there are a lot of reports that acupuncture can reduce the muscle tension of spastic cerebral palsy and relieve spasm,but its evaluation criteria are subjective,single,can not be accepted and convinced by many clinicians.The clinical research part,through randomized controlled trial,adapted acupuncture treatment and select different acupoints on Yin and Yang channels for children with spastic cerebral palsy,to evaluate the effectiveness of acupuncture in reducing muscle tension by using the modified Tardieu scale and surface electromyography,and then provide a more effective method for the clinical treatment of the disease.The experimental part studied the effectiveness of acupuncture in behavior of model rats with spastic cerebral palsy,adapted Westemblot,immunohistochemistry and TUNEL staining methods to explore the protein expression of GDNF and cleaved-caspase3,neuron apoptosis after acupuncture treatment.The repair mechanism of spastic cerebral palsy model rats were studied.This paper is divided into two parts,as follows.Part one Clinical study on the effect of acupuncture on lower extremity' muscle tension of Children with spastic cerebral palsyObjectiveThrough randomized controlled trial,On the basis of the conventional evaluation method,this study adapted acupuncture therapy and selected different acupoints on Yin and Yang channels to treat for children with spastic cerebral palsy,in order to explore the value of acupuncture in improving the muscle tension of children with spastic cerebral palsy by using the modified Tardieu scale and surface electromyography,and provide a more curative method for rehabilitation treatment of children with spastic cerebral palsy.MethodsAll cases were 2?6 years old children with spastic cerebral Palsy collected from Children's rehabilitation outpatient and inpatient in Nanhai maternity and children's Hospital affiliated to Guangzhou University of Traditional Chinese Medicine during June 2015 to November 2016.90 cases of the children with spastic cerebral palsy were collected in accord with the diagnostic criteria and inclusion criteria.All the subjects were randomly divided into 3 groups,including the acupuncture group I(Yin meridians acupuncture group and conventional rehabilitation therapy),acupuncture group II(Yang meridians acupuncture group and conventional rehabilitation therapy)and control group(conventional rehabilitation therapy).Eath group contained 30 cases respectively.The research adapted modified Ashworth scale(MAS),clinical spasticity index(CSI),Modified Tardieu scale(MTS),the spasm angle and gastrocnemius muscle surface electromyograPhy detection(sEMG),to explore the change of the limb muscle tension level,clinical spasticity index,spasm angle,surface electromyography scores of gastrocnemius muscle before and after treatment.And the differences of curative effect among the three groups were compared.Results1.The baseline data of the study were compared among the three group,including gender,gestational age,birth weight,delivery mode,head circumference,age,disease duration,muscle strength,gross motor function classification,gross motor function test,motion DQ,muscle tension,clinical spasticity index and other aspects.The result showed that There was no significant difference among the three groups(P>0.05).Three groups were comparable.2.In terms of muscle tension classification assessed by MAS,there was significant difference among three groups of children after treatment(P<0.01);Compared with the control group,the group ? and the group ? had significantly lower muscle tension after treatment(iP<0.01).There was no significant difference between the acupuncture group ?and the group ? in the muscle tension score(P>0.05).Compared with before treatment,there was significant difference between the acupuncture group ? and the acupuncture group? after treatment(P<0.05),and there was no significant difference in the control group(P>0.05).3.In the aspect of spasticity index,there was significant difference among the mean of the three groups after treatment(P<0.01).Compared with the control group,the mean of the acupuncture group ? and group ? was significantly lower after treatment(P<0.05).There was no significant difference between the group ? and the group ?(P>0.05).Compared with the mean before treatment,the mean of the spasticity index among the three groups was significantly lower after treatment(P<0.01).There was significantly different among three groups after treatment(P<0.05).Compared with the control group,acupuncture group ? showed extremely significant improvement of spasticity after treatment(P<0.01);compared with the control group,spasticity of acupuncture group ? was significantly improved(P<0.05);there was no significant difference between acupuncture group ? and acupuncture group ?(P>0.05).Compared with before treatment,there was a significant difference between group ?and group ? after acupuncture treatment(P<0.01).There was no significant difference in the control group(P>0.05).4.In the aspect of adductor spasm,there was no significant difference among three groups after treatment(P>0.05).In the aspect of hamstring,ankle plantar flexor spasm angle,the overall mean of the three groups after treatment had extremely significant difference(P<0.01);the difference between before and after treatment had significant increased among three groups(P<0.05);compared with the control group,the overall mean after treatment and the differences before and after treatment of group ?,group ? was significantly increased(P<0.05);there was no significant difference between acupuncture group ? and acupuncture group ?(P>0.05).Compared with the mean before treatment,the overall mean of different parts of the lower limb spasticity angle after treatment had a extremely significant increase(P<0.01).5.In the aspect of iEMG of the gastrocnemius muscle,the overall mean after treatment and the iEMG difference had significant difference among three groups(P<0.05).Compared with the control group,the iEMG mean after treatment of group ? and group ? had significantly decreased,and the iEMG mean of the difference before and after treatment had significantly increased(P<0.05),while there was no significant difference between acupuncture group ? and ? group(P>0.05).In the aspect of right gastrocnemius muscle,the overall iEMG mean of the three groups after treatment was significantly lower than that before treatment(P<0.05);in the aspect of left gastrocnemius muscle,the overall iEMG mean of acupuncture group ? and acupuncture group ? after treatment was significantly decreased(P<0.05),the control group had no significant difference(P>0.05).6.There was a negative correlation between the iEMG difference of the gastrocnemius muscles before and after acupuncture treatment and the birth weight and gestational age of the acupuncture group ?.ConclusionThe results showed that the acupuncture treatment(especially the Yin meridian points)did not increase the muscle tension of children with spastic cerebral palsy.The acupuncture can reduce lower limb muscle tension,improve limb spasticity,improve spasm angle of hamstring and ankle plantar flexor,reduce gastrocnemius muscle EMG of children with spastic cerebral palsy.Acupuncture has a good clinical effect for spasticity of children with spastic cerebral palsy.Acupuncture treatment with different acupoints on Yin and Yang channels had no significant difference in clinical curative effectPart two Experimental study of acupuncture on spastic cerebral palsy ratsObjectiveThrough the establishment of rat model of spastic cerebral palsy induced by ischemia and hypoxia,the study observed the effect of acupuncture on expression of related protains and the behavior of the model rats of spastic cerebral palsy,further explained the intrinsic mechanism--how acupuncture can improve movement function and promote damage repair of spastic cerebral palsy model rats.Methods50 SPF level Wistar rats in 7 days old(including 10 standby),were divided into 5 groups in accordance with the random number table,8 rats in each group,including normal group,sham operation group,model control group with spastic cerebral palsy,acupuncture group I(Yin Meridian points),acupuncture group II(Yang Meridian Points).The normal group deal without any treatment,the sham operation group was separated from the left common carotid artery without ligation after anesthesia.After the success establishment of model rats consistent with the standard,rats were randomly divided into model group,acupuncture group I(Yin Meridians points),acupuncture group II(Yang Meridians points).Before and after the acupuncture treatment,the slope experiment and screen test were done.After one week of acupuncture treatment,and the brain tissue was obtained,HE staining was used to observe the pathological changes of the cerebral cortex;the protains expression of cleaved-caspase3 and glial cell line derived neurotrophic factor(GDNF)were detected by Western blot test;Immunohistochemical staining was performed to detect the protein expression of GDNF;TUNEL staining was performed to detect neuronal apoptosis.ResultsThe motor function of spastic cerebral palsy rats decreased.The nuclei of neurons in cortex were significantly reduced,the apoptosis was increased,the expression of cleaved-caspase3 was up-regulated,and the expression of GDNF was down regulated;Compared with the model group,acupuncture can to some extent improve movement function of the experimental animal,inhibit cell apoptosis and decrease the expression of cleaved-caspase3 and promote GDNF expression.There is no enough evidence that acupuncture treatment with different acupoints on Yin and Yang Channels has significant curative effect.ConclusionsAcupuncture can improve the movement and coordination ability of spastic cerebral palsy rats,inhibit nerve cell apoptosis of spastic cerebral palsy model rat,promote nerve cell repair.Its mechanism may be related to the decrease of cleaved-caspase3 Protein level,increase the activation level of GDNF. |
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