The University of Queensland, Queensland Cerebral Palsy and Research Rehabilitation Centre, School of Medicine, Brisbane, Australia.
Dev Med Child Neurol. 2010 Sep;52(9):811-6. doi: 10.1111/j.1469-8749.2009.03588.x. Epub 2010 Jan 28.
This study explores the relationship between unimanual capacity and bimanual performance for children with congenital hemiplegia aged 5 to 16 years. It also examines the relationship between impairments and unimanual capacity and bimanual performance.
Participants in this cross-sectional study attended a screening assessment before participating in a large, randomized trial. They comprised 70 children with congenital hemiplegia (39 males, 31 females; mean age 10 y 6 mo, SD 3 y); 18 were classified in the Manual Ability Classification System level I, 51 in level II, and one in level III. Eighteen were in Gross Motor Function Classification System, level I and 52 in level II. Sixty-five participants had spasticity and five had dystonia and spasticity. Fifteen typically developing children (7 males, 8 females; mean age 8 y 8 mo, SD 2 y 7 mo), matched to study participants for age and sex, were recruited as a comparison group for measures of sensation, grip strength, and movement efficiency. Outcome measures for unimanual capacity were the Melbourne Assessment of Unilateral Upper Limb Function (MUUL), and the Jebsen-Taylor Hand Function Test (JTHFT). The Assisting Hand Assessment (AHA) evaluated bimanual performance. Upper limb impairments were measured using assessments of stereognosis, moving two-point discrimination, spasticity, and grip strength.
There was a strong relationship between unimanual capacity (MUUL) and bimanual performance (AHA; r=0.83). Linear regression indicated MUUL and stereognosis accounted for 75% of the variance in AHA logit scores. Sensory measures were moderately correlated with unimanual capacity and bimanual performance. Age, sex, and grip strength did not significantly influence bimanual performance. There was no difference between children with right- and left-sided hemiplegia for motor performance.
Findings of our study confirm a strong relationship between unimanual capacity and bimanual performance in a cohort of children with congenital hemiplegia. However, the directionality of the relationship is unknown and therapists cannot assume improvements in unimanual capacity will lead to gains in bimanual performance.
本研究旨在探讨 5 至 16 岁先天性偏瘫儿童单手能力与双手表现之间的关系，并研究损伤与单手能力和双手表现之间的关系。
本横断面研究的参与者在参加大型随机试验之前接受了筛选评估。参与者包括 70 名先天性偏瘫儿童（39 名男性，31 名女性；平均年龄 10 岁 6 个月，标准差 3 岁）；18 名患儿被归类为手动能力分类系统 1 级，51 名患儿为 2 级，1 名患儿为 3 级。18 名患儿为粗大运动功能分类系统 1 级，52 名患儿为 2 级。65 名患儿存在痉挛，5 名患儿存在痉挛伴张力障碍。招募 15 名年龄和性别与研究参与者相匹配的正常发育儿童（7 名男性，8 名女性；平均年龄 8 岁 8 个月，标准差 2 岁 7 个月）作为感觉、握力和运动效率测量的对照组。单手能力的测量结果包括墨尔本单侧上肢功能评估（MUUL）和杰普森-泰勒手功能测试（JTHFT）。辅助手评估（AHA）评估双手表现。使用两点辨别觉、感觉、痉挛和握力评估来测量上肢损伤。
单手能力（MUUL）与双手表现（AHA；r=0.83）之间存在很强的关系。线性回归表明，MUUL 和实体觉解释了 AHA 对数得分的 75%的方差。感觉测量与单手能力和双手表现中度相关。年龄、性别和握力对双手表现没有显著影响。右侧和左侧偏瘫患儿的运动表现没有差异。
我们的研究结果证实了先天性偏瘫儿童队列中单手能力与双手表现之间存在很强的关系。然而，关系的方向性尚不清楚，治疗师不能假设单手能力的提高会导致双手表现的提高。
