Effectiveness of Modified Constraint-Induced Movement Therapy in Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial
Effectiveness of Modified Constraint-Induced Movement Therapy in Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial
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DOI：
10.1177/1545968309359767
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发表时间：
2010-07-01
影响因子：
4.2
通讯作者：
Geurts, Alexander C.
中科院分区：
文献类型：
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作者：
Aarts, Pauline B.;Jongerius, Peter H.;Geurts, Alexander C.
背景在单侧痉挛性脑瘫（CP）儿童中，只有有限的证据证明改良的强制性运动疗法（mCIMT）的有效性。Objective.研究在单侧痉挛性CP儿童中进行6周mCIMT后进行2周双手特定任务训练（mCIMT-BiT）是否在定性和定量方面比相同持续时间的常规护理（UC）更能改善患肢的自发使用。方法.招募年龄在2.5至8岁、手动能力分类系统（MACS）评分为I、II或III的单侧痉挛性CP儿童，并随机分配至mCIMT-BiT组（每周3次，每次3小时）：6周的mCIMT，随后进行为期2周的目标导向双手游戏和自我护理活动的特定任务培训）或者对于UC组，每周1.5小时的更一般的身体或职业锻炼加上鼓励使用受影响的手。主要结果指标是辅助手评估和ABILHAND-Kids。次要结果是墨尔本单侧上肢功能评估、加拿大职业表现测量和目标达成量表。结果28名儿童被分配到mCIMT-BiT组，24名分配到UC组。除墨尔本外，mCIMT-BiT组的所有主要和次要结局指标均显示出显著改善。结论在基线上肢功能相对较好的儿童中，mCIMT之后进行目标导向双手游戏和自我护理活动的任务特定训练是改善受影响上肢自发使用的有效干预措施。
Background. In children with unilateral spastic cerebral palsy (CP), there is only limited evidence for the effectiveness of modified constraint-induced movement therapy (mCIMT). Objective. To investigate whether 6 weeks of mCIMT followed by 2 weeks of bimanual task-specific training (mCIMT-BiT) in children with unilateral spastic CP improves the spontaneous use of the affected limb in both qualitative and quantitative terms more than usual care (UC) of the same duration. Methods. Children with unilateral spastic CP with Manual Ability Classification System (MACS) scores I, II, or III and aged 2.5 to 8 years were recruited and randomly allocated to either the mCIMT-BiT group (three 3-hour sessions per week: 6 weeks of mCIMT, followed by 2 weeks of task-specific training in goal-directed bimanual play and self-care activities) or to 1.5 hours of more general physical or occupational weekly plus encouragement to use the affected hand for the UC group. Primary outcome measures were the Assisting Hand Assessment and the ABILHAND-Kids. Secondary outcomes were the Melbourne Assessment of Unilateral Upper Limb Function, the Canadian Occupational Performance Measure, and the Goal Attainment Scale. Results. Twenty-eight children were allocated to mCIMT-BiT and 24 to UC. Except for the Melbourne, all primary and secondary outcome measures demonstrated significant improvements in the mCIMT-BiT group. Conclusion. mCIMT followed by task-specific training of goal-directed bimanual play and self-care activities is an effective intervention to improve the spontaneous use of the more affected upper limb in children with relatively good baseline upper extremity function.