Teachers College, Columbia University, New York, NY 10027, USA.
Neurorehabil Neural Repair. 2011 Oct;25(8):692-702. doi: 10.1177/1545968311402508. Epub 2011 Jun 23.
Constraint-induced movement therapy (CIMT) promotes hand function using intensive unimanual practice along with restraint of the less-affected hand. CIMT has not been compared with a treatment with equivalent dosing frequency and intensity in children with cerebral palsy (CP).
The authors report a randomized trial comparing CIMT and a bimanual intervention (hand-arm intensive bimanual therapy; HABIT) that maintains the intensity of practice associated with CIMT but where children are engaged in functional bimanual tasks.
A total of 42 participants with hemiplegic CP between the ages of 3.5 and 10 years (matched for age and hand function) were randomized to receive 90 hours of CIMT or an equivalent dosage of functional bimanual training (HABIT) conducted in day-camp environments. A physical therapist blinded to treatment allocation tested hand function before and after treatment. The primary outcomes were changes in Jebsen-Taylor Test of Hand Function (JTTHF) and Assisting Hand Assessment (AHA) scores. Secondary measures included the Goal Attainment Scale (GAS).
Both the CIMT and HABIT groups demonstrated comparable improvement from the pretest to immediate posttest in the JTTHF and AHA (P < .0001), which were maintained at 6 months. GAS, however, revealed greater progress toward goals for the HABIT group (P < .0001), with continued improvement across test sessions for both groups (P < .0001).
Both CIMT and bimanual training lead to similar improvements in hand function. A potential benefit of bimanual training is that participants may improve more on self-determined goals.
强制性运动疗法（CIMT）通过对非优势手进行限制的同时，对优势手进行密集的单臂练习，从而促进手功能恢复。目前尚未有研究将 CIMT 与具有相同剂量频率和强度的治疗方法在脑瘫患儿中进行比较。
作者报道了一项随机试验，比较了 CIMT 和双手干预（双手强化训练；HABIT），该试验保持了与 CIMT 相关的练习强度，但让患儿进行功能性双手任务。
共有 42 名年龄在 3.5 至 10 岁之间（根据年龄和手功能匹配）的偏瘫脑瘫患儿被随机分为 CIMT 组或接受 90 小时功能性双手训练（HABIT）组，这两种治疗方法的剂量相同，均在日间营地环境中进行。一名对治疗分配情况不知情的物理治疗师在治疗前后对患儿的手部功能进行测试。主要结果是 Jebsen-Taylor 手功能测试（JTTHF）和辅助手评估（AHA）评分的变化。次要措施包括目标达成量表（GAS）。
CIMT 和 HABIT 组在 JTTHF 和 AHA 测试中，从预测试到即时后测试都表现出相当的改善（P<0.0001），且在 6 个月时仍保持改善。然而，GAS 显示 HABIT 组在目标方面取得了更大的进展（P<0.0001），且两组在整个测试过程中都在持续进步（P<0.0001）。
CIMT 和双手训练都能对手部功能产生相似的改善。双手训练的潜在益处是，患儿可能在自我决定的目标上取得更大的进步。
