Hand function in children with hemiplegic cerebral palsy: prospective follow-up and functional outcome in adolescence
Hand function in children with hemiplegic cerebral palsy: prospective follow-up and functional outcome in adolescence
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DOI：
10.1017/s0012162203000173
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发表时间：
2003-02-01
影响因子：
3.8
通讯作者：
Oleari, G
中科院分区：
文献类型：
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作者：
Fedrizzi, E;Pagliano, E;Oleari, G
这项前瞻性研究的目的是确定一组31名偏瘫型脑瘫儿童（16名男性，15名女性）的手部损伤和残疾的结果，这些儿童连续被转介到我们的康复服务，平均年龄为2岁零7个月，平均年龄为12岁零9个月。手功能评估方案包括视频记录程序：一个评估抓地力，另一个评估受影响的手自发使用的程度。在开始和最新的后续评估表明，该系列作为一个整体有更大的手损伤自发操作比抓握任务。4岁之前的手功能与11岁以上的最新评估结果相比，握力没有显著改善，而自发的手使用保持稳定。除了一个在第一次评估时有良好抓握和手部使用评分的孩子外，其他所有孩子都保持了一段时间，除非他们没有接受手部功能障碍的治疗。在开始时得分较低的儿童中，随着时间的推移，抓握比自发使用手的改善更明显，主要发生在早年。这些结果表明，评估真实的残疾的偏瘫儿童受影响的手，抓地力评估是不够的，需要一个仪器评估自发的手使用双边操作。此外，对于手部损伤较严重的儿童，应在早期计划针对手部功能的强化治疗，而对于受影响较小的儿童，定期随访就足够了。
The aim of this prospective study was to determine the outcome of affected hand impairment and disability in a group of 31 children (16 males, 15 females) with hemiplegic cerebral palsy who were referred consecutively to our rehabilitation service and followed from a mean age of 2 years and 7 months to a mean age of 12 years and 9 months. The hand function assessment protocol consisted of video-recorded procedures: one to assess grip and the other to assess the extent of spontaneous use of the affected hand. Assessments at outset and at latest follow-up showed that the series as a whole had greater hand impairment in spontaneous manipulation than in gripping tasks. Comparison of hand function before age 4 years with the latest assessment over age 11 years revealed a nonsignificant improvement in grip, whereas spontaneous hand use remained stable. All but one of the children who had good grip and hand use scores at first assessment maintained them over time unless they were not treated for hand dysfunction. Among the children with low scores at outset, the improvement over time was more marked in grip than spontaneous hand use and occurred mainly in the early years. These results suggest that to evaluate the real disability of the affected hand in children with hemiplegia, grip assessment is insufficient and that an instrument assessing spontaneous hand use in bilateral manipulation is required. Furthermore, intensive treatment focused on hand function should be planned in the early years for children with more severe hand impairment, whereas regular follow-up is sufficient for less affected children.