Department of Neurological and Vision Sciences, University of Verona, Verona, Italy.
Eur J Phys Rehabil Med. 2009 Dec;45(4):493-500. Epub 2009 Nov 24.
Constraint-induced movement therapy (CIT) is a rehabilitation intervention put forward by Taub and colleagues for sensorimotor disorders in children with hemiparesis, comprising consisting of the restraint of the unaffected arm and concurrent intensive training of the affected arm for six hours/day for two weeks. The aim of this study was to evaluate the effectiveness of a modified CIT program (mCIT) characterized by restraining the unaffected hand with a cotton mitten during daily activities and a reduced intensity training program for two h/week for five weeks.
Ten children (age: 1-9 years) with hemiparetic cerebral palsy were enrolled in a randomized, cross-over study in which the effects of a mCIT and a conventional physiotherapy program were compared. The amount of use and the functional performance of the affected arm were evaluated by means of two specifically devised tests (Use and Function Test). A further test evaluated functional performance during bimanual tasks. These measures showed a good inter-rater and inter-session reliability. All tests were administered before, at the end and four weeks after treatment.
Significant differences between the two therapeutic approaches were evidenced in both affected arm use (P=0.008) and function (P=0.018). These improvements maintained at the follow-up (Use Test P=0.07; paretic arm function P=0.012). Bimanual function performance showed a trend towards improvement in both post-treatment and follow-up testing. The conventional physiotherapy group did not show any improvement in any outcome measure.
The mCIT program proposed in the present study showed to be a promising rehabilitative procedure in children with congenital arm paresis after cerebral palsy.
限制诱导运动疗法（CIT）是 Taub 及其同事为偏瘫儿童的感觉运动障碍提出的一种康复干预措施，包括每天将未受影响的手臂固定 6 小时，并同时对受影响的手臂进行强化训练两周。本研究的目的是评估一种改良 CIT 方案（mCIT）的有效性，该方案的特点是在日常活动中用棉手套固定未受影响的手，并减少每周 2 小时的强化训练。
10 名偏瘫脑瘫儿童参加了一项随机交叉研究，比较了 mCIT 和常规物理疗法的效果。通过两项专门设计的测试（使用和功能测试）评估受影响手臂的使用量和功能表现。进一步的测试评估了双手任务中的功能表现。这些措施显示出良好的评定者间和评定间可靠性。所有测试均在治疗前、治疗结束时和治疗后 4 周进行。
两种治疗方法在受影响手臂的使用（P=0.008）和功能（P=0.018）方面均有显著差异。这些改善在随访时仍然存在（使用测试 P=0.07；患肢功能 P=0.012）。双手功能表现显示出在治疗后和随访测试中均有改善的趋势。常规物理疗法组在任何结果测量中均未显示出任何改善。
本研究提出的 mCIT 方案在脑瘫后先天性手臂瘫痪的儿童中显示出有前途的康复治疗方法。
