Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais.
Clin Rehabil. 2010 Jul;24(7):639-47. doi: 10.1177/0269215510367974. Epub 2010 Jun 8.
To evaluate the effects of constraint-induced movement therapy on the use of the affected arm and on daily functioning in children with hemiplegic cerebral palsy.
A single-blinded randomized clinical trial.
Sixteen children with cerebral palsy randomized to intervention (n = 8, 4 males, 4 females, mean age 5 years and 6 months) and control groups (n = 8, 4 males, 4 females, mean age 6 years and 7 months).
Non-affected arm of intervention group was restricted for 10 hours/ day and the affected arm intensively trained for 3 hours/day for two weeks. The intervention protocol included one week of bimanual functional training following constraint therapy. The control group maintained usual rehabilitation throughout the intervention period.
Pediatric Evaluation of Disability Inventory (self-care domain) and an adapted version of the Jebsen-Taylor test were administered before and after intervention, and at one month follow-up. General linear models tested differences in gain scores and the number needed to treat estimated relative effectiveness of intervention protocol for functional skills and independence in self-care.
Results are reported for 15 children who completed assessments and intervention. Higher gains were observed in the intervention group for functional skills and independence post intervention (d(functional skills) = 1.61, P =0.0134; d(independence)=1.37; P =0.0001) and follow-up (d(functional skills) = 2.08, P =0.004; d(independence) = 0.85; P =0.0016). No group difference in manual dexterity gains was observed. Low indices of number needed to treat (1.75 and 2.33) illustrate clinical relevance of intervention.
The protocol associating constraint-induced movement therapy and bimanual functional training was effective in promoting daily living functioning among children with cerebral palsy.
评估强制性运动疗法对偏瘫脑瘫患儿患侧上肢使用和日常生活功能的影响。
单盲随机临床试验。
16 名脑瘫患儿随机分为干预组（n=8，4 男 4 女，平均年龄 5 岁 6 个月）和对照组（n=8，4 男 4 女，平均年龄 6 岁 7 个月）。
干预组非患侧手臂限制使用 10 小时/天，患侧手臂每天强化训练 3 小时，共 2 周。干预方案包括强制性运动疗法后一周的双手功能性训练。对照组在整个干预期间保持常规康复治疗。
在干预前、后和 1 个月随访时，采用残疾儿童评估量表（自理领域）和 Jebsen-Taylor 测试的改编版进行评估。采用一般线性模型检验治疗方案对功能技能和自理独立性增益评分的差异，并估计相对治疗效果的需要治疗人数。
完成评估和干预的 15 名儿童报告了结果。干预组在干预后和随访时（功能技能 d 值=1.61，P=0.0134；自理独立性 d 值=1.37，P=0.0001）和随访时（功能技能 d 值=2.08，P=0.004；自理独立性 d 值=0.85，P=0.0016）的功能技能和自理独立性方面有更高的增益。在手灵活性增益方面，两组间无差异。低的需要治疗人数指数（1.75 和 2.33）表明干预具有临床相关性。
联合强制性运动疗法和双手功能性训练的方案可有效促进脑瘫患儿的日常生活功能。
