Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium.
Eur J Paediatr Neurol. 2012 May;16(3):257-65. doi: 10.1016/j.ejpn.2011.08.001. Epub 2011 Sep 22.
In children with unilateral cerebral palsy (CP), development of arm and hand function is often compromised by the underlying motor and sensory impairments. However, knowledge about the evolution of arm and hand function in this population is limited.
The aims were to map the evolution of scores on upper limb measures over one year in children with unilateral CP and to identify factors that influence time trends.
Eighty-one children (43 males, 38 females; mean age 9y11mo (SD 3y3mo) range 5-15 y) were tested at baseline, at 6 and 12 months. According to the International Classification of Functioning, Disability and Health, body function measurements included passive range of motion, muscle tone, manual muscle strength and grip strength. Activity measurements included the Melbourne Assessment, the Jebsen-Taylor test, the Assisting Hand Assessment and the Abilhand-Kids questionnaire. Age, gender, etiology (congenital or acquired lesions) and Manual Ability Classification System (MACS) levels were analyzed as predictive factors, using mixed models.
Scores for grip strength (p = 0.001) and manual dexterity (Jebsen-Taylor test, p < 0.0001) increased significantly over time. MACS level (p = 0.03) and etiology (p = 0.02) had a significant influence on the time evolution of the Jebsen-Taylor scores. Other assessments showed no significant changes.
Motor impairments, movement quality and hemiplegic hand use in bimanual tasks do not spontaneously improve over one year, except for an age-related change in grip strength. However, an improvement was observed in manual dexterity, suggesting that some children can learn more adaptive movement strategies.
在患有单侧脑瘫（CP）的儿童中，手臂和手部功能的发育通常因潜在的运动和感觉障碍而受到影响。然而，对于该人群手臂和手部功能的演变知之甚少。
本研究旨在描绘单侧脑瘫儿童在一年内上肢测量指标得分的演变，并确定影响时间趋势的因素。
81 名儿童（43 名男性，38 名女性；平均年龄 9 岁 11 个月（SD 3 岁 3 个月），年龄范围 5-15 岁）在基线、6 个月和 12 个月时接受了测试。根据国际功能、残疾和健康分类，身体功能测量包括被动关节活动度、肌肉张力、手动肌肉力量和握力。活动测量包括墨尔本评估、Jebsen-Taylor 测试、辅助手评估和 Abilhand-Kids 问卷。使用混合模型分析年龄、性别、病因（先天性或后天性病变）和手动能力分类系统（MACS）水平作为预测因素。
握力（p = 0.001）和手灵巧性（Jebsen-Taylor 测试，p < 0.0001）得分随时间显著增加。MACS 水平（p = 0.03）和病因（p = 0.02）对 Jebsen-Taylor 评分的时间演变有显著影响。其他评估没有显示出显著的变化。
除了与年龄相关的握力变化外，一年中运动障碍、运动质量和偏瘫手在双手任务中的使用不会自发改善。然而，手灵巧性有所改善，表明一些儿童可以学习更适应的运动策略。
