Li Huawei1 Ma Bingxiang1 Feng Yu2
(1Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou, Henan 450000, China; 2Ningbo Rehabilitation Hospital, Ningbo, Zhejiang 315020, China)
Abstract: Objective To observe the clinical efficacy of scalp acupuncture in the treatment of language disorders in cerebral palsy (cerebral palsy). Methods Sixty-one children who met the diagnostic criteria of cerebral palsy and also combined with language disorder were randomly divided into 31 cases in the treatment group and 30 cases in the control group. Both groups were given speech training, basic treatment (massage, exercise therapy, physiotherapy), and a 12-week course of treatment. The improvement of the children’s speech disorders was assessed at the end of the treatment course. Results (1) The children in both groups showed improvement in language disorders after treatment, with a total effective rate of 77.42% in the treatment group; 63.33% in the control group, with significant differences between the two groups (P < 0.05). (2) The total effective rate of language disorder in children with cerebral palsy in the age group of 1 to 3 years was 80.00%, which was higher than that in the age group of 3 to 6 years, and the difference was statistically significant. Conclusion:Both groups showed improvement in language disorders in children with cerebral palsy, with the treatment group being better than the control group. For the age of correction of language disorders in cerebral palsy, the efficacy is good within 3 years of age, so early treatment is the key to this disease. Li Huawei, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
Keywords: cerebral palsy; language disorder; clinical study; scalp acupuncture
Cerebral palsy (CP) is a movement disorder and postural abnormality caused by brain damage or developmental defects from prenatal to 1 month after birth [1]. It is often accompanied by co-occurring disorders such as mental retardation, speech disorders, and epilepsy. Domestic data [2] show that about 80% of children with cerebral palsy have varying degrees of language impairment. Language impairment directly affects the cognitive development and future learning and socialization of the child. Therefore, it is important to find an effective and easy-to-use method for the treatment of language disorders in cerebral palsy for the comprehensive rehabilitation of children with cerebral palsy. In our department, we applied scalp acupuncture to treat language disorders in children with cerebral palsy, and achieved good results, which are reported as follows.
1. Materials and methods
1.1 Source of cases.
All cases were from children diagnosed with cerebral palsy combined with language disorder who were hospitalized from October 2008 to October 2009 in the Pediatric Encephalopathy Treatment and Rehabilitation Center of the First Affiliated Hospital of Henan College of Traditional Chinese Medicine. There were 37 male cases and 24 female cases; 40 cases were aged 1 to 3 years old and 21 cases were aged 3 to 6 years old.
1.2 Diagnostic criteria
1.2.1 Diagnostic criteria of pediatric cerebral palsy: refer to the definition, diagnostic conditions and typology of cerebral palsy adopted by the National Symposium on Pediatric Cerebral Palsy [1].
1.2.2 Diagnostic criteria of language disorders
The Chinese version of the Chinese version of the China Rehabilitation Research Center (CRRC version) evaluation method of children’s speech delay (S-S method) and the dysarthria assessment method were used [3].
1.3 Criteria for inclusion of cases
1.3.1 Inclusion criteria
(1) Those who meet the diagnostic criteria of pediatric cerebral palsy and have combined language disorders.
(2) Age between 1 and 6 years old.
(3) The parents of the children were informed and agreed to cooperate with the clinical observation.
(4) normal hearing or mild hearing impairment, brainstem auditory evoked potentials: binaural hearing response threshold ≤50dB.
(5) Normal intelligence screening or mild intelligence impairment, DST intelligence screening score ≥ 60.
1.3.2 Exclusion criteria
(1) Other neurological diseases similar to this disease.
(2) Exclusion of children with serious primary diseases of major organs such as heart, liver and kidney.
(3) Combined diseases of the hematological and endocrine systems.
(4) organic diseases of the articulatory and phonatory organs
(5) Those with severe hearing, visual and intellectual impairment and frequent seizures; hearing exclusion criteria: binaural hearing response threshold of brainstem auditory evoked potentials >50dB; DST intelligence screening exclusion criteria: those with a score <60.
1.4 Study methods
Children with cerebral palsy language disorders who met the enrollment criteria were randomly divided into two groups, namely the treatment group and the control group. Parallel controls between the two groups, and before-and-after controls within the groups were used.
1.5 Treatment methods
1.5.1 Treatment group
Scalp acupuncture treatment points were taken: Sishen acupuncture, Zhi San acupuncture, Temporal San acupuncture, Speaking Point, Baihui, Speech Zone 1, Speech Zone 2, Speech Zone 3, and Motor Zone were the main points. The acupuncture needles were retained for 30 minutes once a day, and the treatment was carried out 6 days a week with 1 day of rest for 12 weeks.
1.5.2 Control group: no scalp acupuncture treatment.
1.5.3 Basic treatment: tui na massage, exercise therapy twice a day, 30 minutes per treatment, 6 days a week, 1 day of rest, 12 weeks of treatment; language training: one-to-one format, 12 weeks of treatment; physical therapy according to the child’s motor disorders, muscle strength, muscle tone, spastic muscle, muscle excitation, Chinese medicine fumigation and other items, once a day, 6 days a week, 1 day of rest, 12 weeks of treatment.
1.6 Observation indexes
1.6.1 Efficacy indexes
The Chinese version of the China Rehabilitation Research Center (CRRC version) evaluation method of children’s speech delay (S-S method) and dysarthria assessment method were used.
1.6.2 Criteria for determining efficacy
1.6.2.1 Efficacy criteria for language delay.
According to the “Chinese Rehabilitation Medicine Treatment Standards” of the Medical Secretary of the Ministry of Health of the People’s Republic of China, the following criteria were used
(1) Significant effect: language development delay, language development comprehension ability improved by two stages, and language expression ability improved.
(2) Effective: Delayed language development, one stage of improvement in language development and comprehension, and some improvement in language expression.
(3) Ineffective: No significant improvement in language delay.
1.6.2.2 Efficacy criteria for dysarthria
According to the evaluation criteria of the Chinese Rehabilitation Medicine Treatment Standards by the Medical Secretary of the Ministry of Health of the People’s Republic of China
(1) Significantly effective: abnormal diction corrected by ≥50%, dysarthria and salivation disappeared, dysarthria speed increased significantly, range of motion expanded, speech clarity improved.
(2) Effective: abnormal articulation correction <50%, dysarthria and salivation reduced, and motor function of the articulatory organs improved.
(3) Ineffective: The abnormal articulation and the improvement of articulatory movement were not obvious.
1.7 Statistical analysis
The data were statistically processed with SPSS13.0 statistical software, and the count data were analyzed using the columnar data analysis independent sample rate 2 test, and the measurement data were analyzed using t-test and other statistical methods.
2. Results
2.1 Clinical efficacy of language disorders in children with cerebral palsy
Table 1 Results of children in two groups assessed by S-S [n(%)
Group
Apparent effect
Effective
Ineffective
Total effective
Treatment group
4(12.90%)
20(64.52%)
7(22.58%)
24(77.42%)
Control group
2(6.67%)
17(56.67%)
11(36.67%)
19(63.33%)
The total efficacy of the two groups was analyzed by columnar information independent sample rate 2 test, 2 = 4.667, P = 0.031 (bilateral), P < O.05, and the difference was statistically significant, indicating that the total effective rate of the treatment group was better than that of the control group.
2.2 Relationship between age and efficacy
Table 2 Relationship between efficacy and age (n)
Age
Number of cases
Apparent effect
Effective
Ineffective
1 to 3 years old
20
3
14
3
～6 years old
11
1
6
4
Total
31
4
20
7
The efficacy of the two age groups was analyzed by columnar data independent sample rate 2 test, 2 = 7.091, P = 0.008 , P < 0.05, the difference is statistically significant, indicating that the efficacy of the age group of 1 to 3 years is better than that of more than 3 years.
3. Discussion
The main clinical manifestations of cerebral palsy with language disorders are delayed language development, inability to speak at several years of age, unclear articulation and abnormal speech intonation in mild cases, and inability to speak in sentences in severe cases. The main clinical manifestations of cerebral palsy with language disorder are delayed speech development, inability to speak at the age of several years, inability to compose sounds, abnormal voice intonation, or inability to form sentences or even complete aphasia. “This disease is mostly due to congenital fetal endowment. This disease is mostly caused by congenital deficiency of fetal endowment, loss of liver and kidney, loss of nourishment, weakness of qi and blood, and loss of filling of brain orifices. Scalp acupuncture has the functions of awakening the brain and opening the orifices, moving qi and resolving phlegm, filling the marrow, nourishing yin and invigorating blood, unblocking the meridians, and adjusting yin and yang. In the chapter of Ling Shu – Evil Qi Hidden House Disease Form, it is written that “the blood and qi of the 12 meridians and 365 channels all go up to the face and go to the orifices”. Zhang Jingyue of the Ming Dynasty also explained in his “Jing Yue Quan Shu” that “the essence of the five viscera and six bowels all rise in the head”, indicating that the head is closely related to the functions of the organs of the viscera in the human body. The “Spiritual Pivot – Sea Theory” points out: “The brain is the sea of marrow, and its infusion lies on its cover (Baihui), and down in the Fengfu.” Therefore, the head acupuncture point is chosen to treat brain lesions, which can reach all the yang, distribute qi and blood, and clear the orifices.
According to recent research on neurological mechanisms and brain function, it is believed that cerebral palsy speech disorders are caused by brain damage, injury to the “language center”, as well as dysfunction of the hearing and visual information input systems and the tongue and other organs of spoken language composition. The scalp acupuncture points also have corresponding functional brain areas: the Sishen acupuncture point is at the top of the head, corresponding to the projection area of the anterior aortic trunk of the brain, so it can improve the blood circulation of the anterior cerebral artery and excite the function of the cortical sensory area. Zhi san needles should be in the frontal cortex of the brain, which is where the emotional intelligence is located, and can improve intelligence. Temporal three needles from the anatomical point of view, the temporal bone is the thinnest compared to other skulls, its bone seam is the most intensive, modern research found that the head brain acupuncture effect of acupuncture, mostly related to the conduction of the bone seam, so close to the bone seam of the head acupuncture effect is better. This area is rich in neurovascularity and is sensitive to acupuncture and other stimuli. The temporal three needles are located in the lateral part of the head, the temporal lobe cortical projection area, and close to the central anterior and posterior gyrus, and the temporal lobe is closely related to learning and remembering language, so the temporal three needles have an important role in language. These acupoints can improve the blood supply to the brain, brain function, and the “language center” of the brain, thus improving the symptoms of language disorders.
In this study, after 12 weeks of treatment, the treatment group used scalp acupuncture in 31 children, of which 4 cases (12.9%) were effective, 20 cases (64.52%) were effective, 7 cases (22.58%) were ineffective, and the total number of effective and effective cases was 24, with an overall efficiency of 77.42%. The total number of effective and effective cases was 19, and the total effective rate was 63.33%. Both groups had an improvement effect on language disorder, and by statistical analysis, the efficacy of scalp treatment for cerebral palsy language disorder was considered better than that of the control group (P < O.05).
There were 31 children in the scalp acupuncture group, including 20 children aged 1 to 3 years old, with 3 cases of significant effect, 14 cases of effective effect, and 3 cases of ineffective effect, with a total effective rate of 85.00%, and 11 children in the group aged 3 to 6 years old, with 1 case of significant effect, 7 cases of effective effect, and 3 cases of ineffective effect, with a total effective rate of 63.63%. After statistical analysis, the difference in the total effective rate between the two groups was statistically significant, and the efficacy was considered better in children aged 1 to 3 years. This result is consistent with the findings of Zhang Quanming and Jin Rui [4]. Thus, the treatment of language disorders in children with cerebral palsy should be carried out as early as possible, and up to 3 years of age is a critical period for children’s language development and the early stage of brain injury, so early diagnosis and early rehabilitation training are crucial for language recovery in children with cerebral palsy.
Scalp acupuncture is simple, easy to master, and effective in treating speech disorders in children with cerebral palsy. However, patience and confidence of parents and elimination of psychological barriers of parents and children, as well as changing the language environment of children with cerebral palsy, are also essential in the process of treatment.