Stearns Ginny E, Burtner Patricia, Keenan Kristina M, Qualls Clifford, Phillips John
Occupational Therapy Program, Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
NeuroRehabilitation. 2009;24(2):95-108. doi: 10.3233/NRE-2009-0459.
Constraint-Induced Movement Therapy (CIMT) is a therapeutic intervention using constraint of the less-affected limb and intensive use of the hemiplegic extremity in individuals with hemiplegia. The purpose of this study was to determine whether children with cerebral palsy (CP) who have undergone a 2-week function-based CIMT show improved hand function and underlying muscle activation changes associated with functional gains.
Six children with hemiplegic CP participated in the study, receiving 4 hours of therapy 5 days a week coupled with bi-valve casts worn 8-12 hours for 14 days. Outcome measures of grip strength, pinch strength, dexterity tests and electromyography (EMG) were compared before, immediately post- and 3 months post-intervention.
Repeated measures ANOVA and post hoc paired t-tests showed significant group improvements in all strength and dexterity measures (p < 0.05). EMG analysis showed significant increases in muscle activation on pinch measures (p = 0.05). Visual inspection of the EMG data suggested increased muscle activation during grip and a decrease in the muscle activation required during dexterity tasks.
Our preliminary results support CIMT for improving strength and dexterity in children with hemiplegic CP. Further studies with greater sample sizes and longer study periods are recommended to determine muscle activation changes post CIMT.
强制性运动疗法（CIMT）是一种治疗干预方法，通过限制偏瘫患者未受影响肢体的活动，并强化使用偏瘫肢体。本研究的目的是确定接受了为期2周的基于功能的强制性运动疗法的脑瘫（CP）儿童是否表现出手功能改善以及与功能改善相关的潜在肌肉激活变化。
六名偏瘫型脑瘫儿童参与了本研究，每周5天接受4小时的治疗，并佩戴双瓣石膏8 - 12小时，持续14天。在干预前、干预后即刻和干预后3个月比较握力、捏力、灵巧性测试和肌电图（EMG）等结果指标。
重复测量方差分析和事后配对t检验显示，所有力量和灵巧性指标均有显著的组内改善（p < 0.05）。肌电图分析显示捏力测量时肌肉激活显著增加（p = 0.05）。对肌电图数据的直观检查表明，握力时肌肉激活增加，灵巧性任务时所需的肌肉激活减少。
我们的初步结果支持强制性运动疗法可改善偏瘫型脑瘫儿童的力量和灵巧性。建议进行更大样本量和更长研究周期的进一步研究，以确定强制性运动疗法后肌肉激活的变化。
