Forced use of the upper extremity in cerebral palsy: A single-case design
Forced use of the upper extremity in cerebral palsy: A single-case design
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DOI：
10.5014/ajot.51.10.824
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发表时间：
1997-11-01
影响因子：
2.9
通讯作者：
McDonnell, E
中科院分区：
文献类型：
--
作者：
Crocker, MD;MacKayLyons, M;McDonnell, E
客观的。肌肉失衡和运动控制不良可能会影响脑瘫儿童的日常职业功能。当身体的一侧比另一侧功能更好时，孩子们通常会更喜欢使用较少参与的上肢来完成游戏和自我护理活动，因为他们知道另一只手的功能不那么有效。这项研究检验了一种方法，旨在通过指导孩子来克服这种习得性不使用受影响上肢的情况。注意这个肢体并增加他使用它的其他动机。研究假设是，用休息夹板限制较少受累的手会导致痉挛性脑瘫儿童更多地使用受累较多的手。方法。最初，两名脑瘫儿童参与了这项单受试者 ABA 设计研究，但只有一名受试者遵守夹板佩戴时间表并完成了研究。该受试者是一名 2 岁女孩，右侧的参与程度高于左侧。在实验阶段，她在一天中醒着的大部分时间里都在较少受影响的手上戴了一个休息夹板，以限制其使用。数据收集时间为 7 周（夹板前 2 周、夹板前 3 周、夹板后 2 周）和 6 个月的随访。通过分析她在 15 分钟自由游戏录像、使用皮博迪精细运动发育量表项目以及完成每日手指喂食任务期间的表现，测量了参与程度较高的肢体的使用情况。结果。夹板固定后，参与较多的肢体的质量、数量和使用方式都有所改善，并且在随访中发现一些持续改善明显，受试者增加了对其参与较多的手臂和手的自主控制，并更自发地使用它们来完成日常活动。结论。尽管这种单例设计的结果令人鼓舞，但有必要进行进一步的随机对照设计研究，以确定强制使用技术在较大人群中的有效性。
Objective. Muscle imbalance and poor control of movement can have an impact on the daily occupational functioning of children with cerebral palsy. When one side of the body functions better than the other, children will often prefer to use the less-involved upper extremity for completion of play and self-care activities because they have learned that the other hand does not function as effectively. This study examined a method purported to overcome this learned nonuse of the affected upper extremity by directing the child; attention to this extremity and increasing his other motivation to use it. The research hypothesis was that restriction of the less-involved hand with a resting splint would result in increased use of the more-involved hand in a child with spastic cerebral palsy.Method. Initially, two children with cerebral palsy participated in this single-subject, ABA design study, but only one subject complied with the splint-wearing schedule and completed the study. This subject was a 2-year-old girl with greater involvement of the right side than the left. During the experimental phase, she wore a resting splint on her less-involved hand for most of the waking hours of the day to restrict its use. Data were collected over a 7-week period (2 weeks presplinting, 3 weeks splinting, 2 weeks postsplinting) and at a 6-month follow-up. Use of the more-involved extremity was measured through analysis of her performance during 15-min videotaped sessions of free play, administration of items from the Peabody Developmental Fine Motor Scales, and completion of a daily finger-feeding task.Results. An improvement in quality quantity, and variety of use of the more-involved extremity after splinting, with some continuing improvement evident at follow-up, was found The subject had increased voluntary control of her more-involved arm and hand and used them more spontaneously for completion of daily occupations,Conclusions. Although the results of this single-case design are encouraging, further research with a randomized, controlled design is necessary to determine the effectiveness of the forced-use technique with a larger population.