Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial
Constraint-Induced Movement Therapy for Cerebral Palsy: A Randomized Trial
复制标题
强迫诱导运动疗法治疗脑性瘫痪的随机试验
DOI：
10.1542/2021-053121
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发表时间：
2021-11-01
期刊：
影响因子：
8
通讯作者：
Lo, Warren
中科院分区：
文献类型：
--
作者：
Ramey, Sharon Landesman;DeLuca, Stephanie C.;Lo, Warren
目的：采用儿童偏瘫上肢和手部运动项目（CHAMP）的多中心随机对照试验，比较两种剂量和两种约束类型的强制性运动疗法（CIMT）与常规疗法（UCT）的疗效。CHAMP将118名2至8岁的轻偏瘫型脑瘫儿童随机分为5种治疗方法，在基线、治疗结束、治疗后6个月。主要的盲法结果是辅助手评估;皮博迪运动发育量表，第二版，视觉运动整合;和上肢技能测试分离运动质量。父母在儿童残疾评估量表-计算机自适应测试日常活动和儿童运动活动日志多久量表上对功能进行评分。分析集中在盲法和家长报告的结果和排名顺序增益在所有measures.RESULTS：结果不同的统计学意义分析时，个别盲法的结果。家长报告和排名顺序收益。一致的是，高剂量CIMT，无论限制类型如何，在6个月时产生了最大的短期和长期增益模式（仅偶然发生的概率为1.7%）以及视觉运动整合和分离运动的显著增益。奥布莱恩的等级顺序分析显示，高剂量CIMT比中等剂量或UCT产生更大的改善。与UCT组相比，所有CIMT组在父母报告的功能方面均有显著改善。儿童UCT也显示客观收益（例如，48%超过了最小的可检测辅助手评估的变化，相比之下，71%的高剂量CIMT在治疗结束时）。结论：CHAMP提供了新的，虽然复杂的结果：虽然大多数个人盲的结果低于统计学意义的组间差异，高剂量CIMT始终产生最大的改善在两个时间点。一个意想不到的发现涉及UCT向更高剂量的转变，与以前的报告相比，结果有所改善。
OBJECTIVES: With the Children with Hemiparesis Arm and Hand Movement Project (CHAMP) multisite factorial randomized controlled trial, we compared 2 doses and 2 constraint types of constraint-induced movement therapy (CIMT) to usual customary treatment (UCT).METHODS: CHAMP randomly assigned 118 2- to 8-year-olds with hemiparetic cerebral palsy to one of 5 treatments with assessments at baseline, end of treatment, and 6 months posttreatment. Primary blinded outcomes were the assisting hand assessment; Peabody Motor Development Scales, Second Edition, Visual Motor Integration; and Quality of Upper Extremity Skills Test Dissociated Movement. Parents rated functioning on the Pediatric Evaluation of Disabilities Inventory-Computer Adaptive Test Daily Activities and Child Motor Activity Log How Often scale. Analyses were focused on blinded and parent-report outcomes and rank-order gains across all measures.RESULTS: Findings varied in statistical significance when analyzing individual blinded outcomes. parent reports, and rank-order gains. Consistently, high-dose CIMT, regardless of constraint type, produced a pattern of greatest short- and long-term gains (1.7% probability of occurring by chance alone) and significant gains on visual motor integration and dissociated movement at 6 months. O'Brien's rank-order analyses revealed high-dose CIMT produced significantly greater improvement than a moderate dose or UCT. All CIMT groups improved significantly more in parent-reported functioning, compared with that of UCT. Children with UCT also revealed objective gains (eg, 48% exceeded the smallest-detectable assisting hand assessment change, compared with 71% high-dose CIMT at the end of treatment).CONCLUSIONS: CHAMP provides novel albeit complex findings: although most individual blinded outcomes fell below statistical significance for group differences, high-dose CIMT consistently produced the largest improvements at both time points. An unexpected finding concerns shifts in UCT toward higher dosages, with improved outcomes compared with previous reports.