Repeated Transcranial Magnetic Stimulation Combined with Action Observation Training in Children with Spastic Cerebral Palsy

Children with spastic cerebral palsy (SCP) have limb spasticity, movement disorders, and abnormal posture due to injury to the cerebral cortex motor area, resulting in inability to stand and walk normally. Therefore, alleviating limb spasticity and enhancing gross motor function in children with SCP have become important therapeutic goals.

This study is a product of real application of cerebral palsy in children. In the investing case, the clinic efficacy of repetitive transcranial magnetic stimulation combined with movement observation training for the recovery of gross motor function. Repetitive transcranial magnetic stimulation is an important result in treating children with cerebral palsy when movement observation training and effectively relieves the spasticity and enhance the motor function.

Compared with one treatment alone, rTMS combined with AOT intervention can achieve better clinic efficacy. In this study, conventional treatments such as exercise, hydrotherapy, massage, as well as repetitive transcranial magnetic stimulation therapy, movement observation training, and the repetitive transcranial magnetic stimulation therapy combined with movement observation training rehabilitation techniques were used. To begin, analyze the baseline data collected from the recruited children diagnosed with spastic cerebral palsy.

Confirm that the data includes the name, sex, age, cerebral palsy spasticity type, gross motor functional classification, cognitive level, ankle foot orthosis wear, previous or current medical treatment, and surgical history. To assess rehabilitation, examine the lower limb achilles tendon reflex of a child by dorsaflexing the child's foot and knocking the tendon with a percussion hammer. Hold the child's ankle and flex it to feel any resistance and assess the muscle tension of the ankle plantar flexor group.

To examine the clonus, hold the child's popliteal fossa and push it until the foot is dorsaflexed. Analyze the balance function of the child as per the pediatric balance scale. Next, make the child walk as fast as possible on a 15 meter runway.

Start timing the child at 12 meters. Stop the timer at the two meter mark to measure the time taken to walk 10 meters. To evaluate the gross motor function level of the child, select a standing position in Area D.Ask the child to walk, run, and jump in Area E for the gross motor function measure.

Calculate the score according to the degree of completion to get the total area scores. Using the given equations, assess the clinical effectiveness of the gross motor function interventions. To assess the effect of different therapeutic models, divide the children into a conventional group, rTMS group, and AOT group, and a combination intervention group.

Ask the children to perform exercises such as muscle strength exercises, balance training, or walking for 30 minutes to assess the effectiveness of exercise therapy. Next to begin hydrotherapy, adjust the water temperature of a hydrotherapy machine to 37 to 38 degrees Celsius. Click on the bubble bath button to begin hydrotherapy.

Instruct the child to stand up, turn around, and take alternate steps with both feet in the water. Once the hydrotherapy is concluded, place the child in a prone position to begin massage treatment. Perform massage treatment by alternately pinching and pushing along both sides of the coronary artery and bladder meridian.

Alternatively, apply pressure on acupuncture spots from the top down, or rhythmically lift and pinch each of the leg muscles. For the children of the rTMS group, explain the process of the treatment and possible responses to their guardians. Next place the child in a supine position.

Place the nasal occipital line on the positioning cap in the midline of the child's head. The line should be at the cross point between the nasal occipital line and the temporal parietal line. Next, fix a recording electrode to the abdominal muscle of the abductor pollicis brevis.

Then place a reference electrode on the tendon of the abductor pollicis brevis and a bottom electrode to the waist. Launch the computer application on the rTMS instrument. Input the basic information and diagnosis of the participant and determine the treatment plan.

Now place the stimulation coil and make a coil tangent to the scalp at a 45 degree angle. Choose a stimulation intensity of 30%and stimulate the M1 region corresponding to the abductor pollicis brevis using manual monopulse. Observe the motor evoked potentials interface graph on the software and gradually reduce the stimulation intensity.

Click on the Confirm icon, save the RMT record and then enter the treatment parameter setting page. For the RMT treatment, set the stimulation frequency to five hertz, the stimulation intensity to 100%RMT, the stimulation number to 15, the stimulation time to three seconds, repetition time to 80, and the total number of pulses to 1, 200. Observe the child's reaction to the treatment.

For action observation training, start with body movement videos designed by professional physiotherapists. Position the child in a quiet room about five meters away from an 86 inch television. Have the physiotherapist explain each body movement to the children first, then show the videos to them.

After watching the movements, ask the children to imitate the movements. After 12 weeks of different rehabilitation treatments, have a doctor reevaluate the clinical efficacies of the various parameters. Record the guardian's satisfaction and feedback on the treatment plan.

After 12 weeks of training, the comprehensive spasticity scale scores of all four groups significantly decreased. The combination intervention group showed significantly greater changes than the other three groups. The scores of the pediatric balance scale, 10 meter walking speed, and gross motor function measure of all four groups significantly increased after the treatment.

Again, the scores of the combination intervention group improved the most. The total efficacy rate of gross motor function in the combination intervention group was the highest.