A Randomised Trial of Constraint Induced Movement Therapy and Botulinum Toxin A in children with Congenital Hemiplegia.

在工业化世界中，有100多万21岁以下的儿童患有先天性偏瘫。这是最常见的脑瘫类型，占被诊断为这种终生疾病的儿童的36%。我们打算确定与传统技术相比，一种有前景的新治疗方法是否在提供更好的和持久的益处方面有效。偏瘫儿童通常具有正常上学的智力能力；然而，手臂受损会降低日常生活活动的独立性，并可能损害他们参与教育、休闲和职业角色的能力。此前，我们已经证明，痉挛儿童的上肢康复计划在提高参与度和生活质量方面是有效的。我们还表明，康复结合A型肉毒杆菌毒素(Botox)可以进一步改善功能活动。我们相信，一种新的治疗方法，即约束诱导运动疗法(CIMT)，已经在成人中风患者中得到了有效的应用，它也可能对先天性偏瘫儿童的治疗有利。在CIMT中，未受损的手臂被戴在手套中，以促进受损手臂(偏瘫手臂)的使用。我们预测，与标准的康复联合肉毒杆菌毒素治疗相比，CIMT将提供更好和更持久的益处。我们研究的主要目的是在对照试验中检验这一假说。第二个目的是加深我们对上肢功能变化背后的中枢神经血管机制的理解。为了实现这一目标，我们将使用功能磁共振成像(FMRI)和经颅磁刺激(TMS)来测量大脑控制运动的部分的中枢激活。提高我们对这种情况所涉及的机制的了解是朝着提供更有效和更持久的治疗迈出的重要的下一步。

Congenital hemiplegia occurs in over 1 million children under 21 years of age in the industrialized world. It is the most common type of cerebral palsy, accounting for 36 percent of children diagnosed with this lifelong condition. We intend to determine if a promising new treatment approach is effective in providing a superior and lasting benefit, compared to conventional techniques. Children with hemiplegia usually have the intellectual capacity to attend normal school; however the impaired arm reduces independence in activities of daily living and can compromise their ability to participate in educational, leisure and vocational roles. Previously we have shown that a program of upper limb rehabilitation in children with spasticity was effective in improving participation and quality of life. We have also shown that rehabilitation combined with Botulinum toxin A (Botox) can further improve functional activity. We believe that a new method of therapy, that has been used effectively in Adults with stroke, called Constraint Induced Movement Therapy (CIMT) may also be beneficial in the treatment of children with congenital hemiplegia. In CIMT, the unimpaired arm is constrained in a glove to promote use of the impaired arm (hemiplegic arm). We predict that, combined with the Botox treatment, CIMT will provide a superior and longer lasting benefit compared to standard rehabilitation combined with Botox. The primary aim of our study is to test this hypothesis in a controlled trial. A secondary aim is to further our understanding of the central neurovascular mechanisms underlying changes in upper limb function. To achieve this, we will use Functional Magnetic Resonance Imaging (fMRI) and Transcranial Magnetic Stimulation (TMS) to measure central activation in the parts of the brain controlling movement. Improving our understanding of the mechanisms involved in this condition is an essential next step towards providing a more effective and long lasting treatment.