Eugster-Buesch Francisca, de Bruin Eling D, Boltshauser Eugen, Steinlin Maja, Küenzle Christoph, Müller Elisabeth, Capone Andrea, Pfann Renat, Meyer-Heim Andreas
Rehabilitation Centre Affoltern am Albis, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.
J Pediatr Rehabil Med. 2012;5(2):65-74. doi: 10.3233/PRM-2012-0198.
The aim of this study was to elucidate the feasibility, efficacy, and sustainability of a home-based, two-week, forced-use therapy (FUT) program for children with hemiplegic cerebral palsy (CP).
A single-blinded, randomized controlled design was chosen. The Melbourne Assessment of Unilateral Upper Limb Function (MA) was carried out at baseline, pretest, post-test, and follow-up at two weeks, three months, and 12 months. Additionally, a questionnaire was used to evaluate the clinical relevance and integration of FUT in the home setting. 23 children, ages six to 16 years, took part in the study and were randomized into either an intervention group (n=12, mean age 9.8 ± 3.5 years) or a control group ($n=$ 11, mean age 11.7 ± 3.7 years). The intervention consisted of constraint of the unaffected hand for six hours per day and promotion of different activities of daily living according to an age-related manual for the use of the non-constraint hand.
Unpaired t-tests for the change in MA scores relative to the pre-test values showed no difference between the groups at any time point: post-test (p=0.304), two weeks (p=0.193), or three months (p=0.957). Improvements in Activities of Daily Living (ADLs) assessed by questionnaires were observed by 64% of parents of the intervention group. Fifty-five percent of parents stated that the FUT program was exhausting and only 45% indicated that they achieved constraint for 6 hours per day.
Our results evaluating a home-based FUT program of 14 days show no statistically significant improvement of upper extremity function in children with CP. The lack of compliance and absence of structured exercises proved to be considerable pitfalls of the home-based FUT program. Therefore, future home based FUT concepts should put special emphasis on the close monitoring and support of children and their families, as well as the integration of structured exercise sessions.
本研究旨在阐明一项针对偏瘫型脑瘫（CP）儿童的为期两周的居家强制使用疗法（FUT）项目的可行性、有效性和可持续性。
采用单盲随机对照设计。在基线、预测试、后测试以及两周、三个月和十二个月的随访时进行墨尔本单侧上肢功能评估（MA）。此外，使用一份问卷来评估FUT在家庭环境中的临床相关性和整合情况。23名年龄在6至16岁的儿童参与了该研究，并被随机分为干预组（n = 12，平均年龄9.8 ± 3.5岁）或对照组（n = 11，平均年龄11.7 ± 3.7岁）。干预措施包括每天限制健侧手使用6小时，并根据一份与年龄相关的使用非限制手的手册促进不同的日常生活活动。
相对于预测试值，MA得分变化的非配对t检验显示，在任何时间点两组之间均无差异：后测试（p = 0.304）、两周（p = 0.193）或三个月（p = 0.957）。干预组64%的家长观察到通过问卷评估的日常生活活动（ADL）有所改善。55%的家长表示FUT项目让人疲惫，只有45%的家长表示他们每天实现了6小时的限制。
我们对一项为期14天的居家FUT项目的评估结果显示，CP儿童的上肢功能在统计学上没有显著改善。事实证明，缺乏依从性和缺乏结构化练习是居家FUT项目的重大缺陷。因此，未来的居家FUT概念应特别强调对儿童及其家庭的密切监测和支持，以及结构化练习课程的整合。
