| Objective: To investigate the effects of rehabilitation training and ESWTon the gastrocnemius muscles and soleus spasticity and motor function inchildren with Cerebral Palsy, and seek a new treatment for the therapy of thechildren with Cerebral Palsy.Methods:66cases with diagnosed Cerebral Palsy were gathered fromMarch of2014to October of2014in the department of pediatric neurologyand rehabilitation of the first hospital of Jilin University. According to thewillingness of the children’s parents, the cases were divided into two groups:the control group (32cases), and the ESWT group (34cases). The controlgroup and ESWT group were both divided into three subgroups (A1,A2,A3；Ae1,Ae2,Ae3)base on the age at initiation of therapy. The control group andESWT group were both stratified into two subgroups(M1,M2;Me1,Me2)according to the Modified Ashworth Scale(MAS). Thecontrol group receiced conventional physical therapy program. The childrenreceived once per day,30minutes per program,6days per week for6months;the ESWT group received conventional physical therapy program and ESWT.The pressure pulses were focused in the hypertonic gastrocnemius musclesand soleus muscles.1500shots were used mainly to the gastrocnemiusmuscles and soleus. The energy applied was0,030mJ/mm2. The frequencythat was used was10Hz, one session/wk for6months. Clinical examinationinclude passive range of motion(pROM), Modified Ashworth Scale(MAS)ofspasticity muscles,was examined at the time points before and at the end of1st,3rd,6thmonth and before and post treatment every time after the initiation of treatment among the two groups, and the GMFM was assessed atthe time points before and at the end of the3rd,6thmonth, and the Gesell wasassessed at the time points before and at the end of the6thmonth.Results:(1) The general characteristics of two groups: There was no significantdifference in the comparison of the age, sex and high risk factor in the twogroups.(2) Comparison of pROM before and after the treatment: The pROMwere increased in the two groups after the treatment when compared withthose in the groups prior to treatment respectively. After six months of thetreatment, pROM of the two groups were statistically significant whencompared with those in the groups prior to treatment respectively. Of whichthe ESWT group had higher pROM. and differences of pROM after the1st,3rdmonth between the two groups were statistically significant. Thedifferences of pROM after the6thmonth between the two groups were notsignificant.(3) Comparison of MAS before and after the treatment: The MAS weredecreased in the two groups after the treatment when compared with those inthe groups prior to treatment respectively. After six months of the treatment,MAS of the two groups were statistically significant when compared withthose in the groups prior to treatment respectively. Of which the ESWT grouphad higher MAS. and differences of MAS after the1st,3rdmonth between thetwo groups were statistically significant. The differences of MAS after the6thmonth between the two groups were not significant.(4) Comparison of GMFM before and after the treatment: The GMFMwere increased in the two groups after the treatment when compared withthose in the groups prior to treatment respectively. After six months of thetreatment, GMFM of the two groups were statistically significant when compared with those in the groups prior to treatment respectively. Thedifferences of GMFM between the two groups were not significant.(5) Comparison of the DQ scores of Gesell before and after the treatment:The DQ scores of Gesell of every item have no significant differences whencompared with those in the groups prior to treatment respectively. Thedifferences of DQ scores of Gesell of every item between the two groups werenot significant.(6) Comparison of pROM pre-treatment and post-treatment every time:The pROM was increased post-treatment when compared with thatpre-treatment respectively every time the1sttime treatment,1stmonth,3rdmonth and6thmonth. There was a significant difference when compared withthat pre-treatment respectively.(7) Comparison of pROM among A1, A2, A3: There was no significantdifference among the three groups in the pROM.(8) Comparison of MAS among A1, A2, A3: There was no significantdifference among the three groups in the MAS.(9) Comparison of the mean change from baseline in the GMFM amongA1, A2，A3: The score of each group was A1>A2>A3. There was a significantdifference when compared with A1, A2groups. No other significantdifferences were observed.(10) Comparison of the mean change from baseline in the MAS betweenM1and M2: The M2group improved more significantly than M1in both1stmonth and3rdmonth.(11) Comparison of the mean change from baseline in GMFM betweenM1and M2: The score of each group was M1>M2. No other significantdifferences were observed.(12) The side effects：During the six months follow-up, abnormality wasnot found. Conclusion:(1) The effect of rehabilitation training combined with ESWT is moreeffective than simple rehabilitation training in the treatment of children withCP.(2) Rehabilitation training combined with ESWT provided a effectiveand safe procedure for reduction of spasticity and improvement of motorfunction.(3) Early intervention is important to gain a good outcome in childrenwith CP.(4) The improvement of motor skills is related to the baseline level ofspasticity. |
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