Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Dev Med Child Neurol. 2013 Jun;55(6):527-33. doi: 10.1111/dmcn.12113. Epub 2013 Mar 5.
This study investigated the effects of a theme-based ('magic') variation of the hand-arm bimanual intensive therapy programme, in two different countries, in improving activity performance for children with hemiplegia, including those with severe movement restrictions.
Twenty-three children with spastic hemiplegia (13 males, 10 females; mean age 10y 7mo, range 7-15y; Manual Ability Classification System level I, two; level II, 13; level III, eight), participated in one of three, 2-week, summer camps. A within-participant experimental design was used with the Assisting Hand Assessment and Children's Hand Experience Questionnaire as primary outcome measures. Evaluations occurred immediately before the first day, on the last day, and 3 months after intervention. Two groups underwent additional assessments 2 weeks before the camp.
Significant intervention effects were seen on the Assisting Hand Assessment (p=0.002) and on the Children's Hand Experience Questionnaire (p<0.001), the latter maintained at follow-up. The affected hand was reported to be used in 25% of bimanual activities before the camp, progressing to 93% after camp, and decreasing to 86% at follow-up. Severity of impairment did not influence progress.
This themed approach to intensive intervention showed positive results in bimanual use, with improvements in independence sustained at follow-up. Although children across camps and motor severity made progress, some questions remain about intensity and duration of intervention to optimize longer-term outcomes.
本研究旨在探讨主题式（“魔法”）手部-手臂双手密集治疗方案的效果，该方案在两个不同国家实施，以提高偏瘫儿童的活动表现，包括运动受限严重的儿童。
23 名痉挛性偏瘫儿童（13 名男性，10 名女性；平均年龄 10 岁 7 个月，范围 7-15 岁；手动能力分类系统 1 级，2 级，13 级；3 级，8 级）参加了为期两周的三个夏令营之一。采用参与者内实验设计，主要结局指标为辅助手评估和儿童手部体验问卷。评估在干预前的第一天、最后一天和干预后 3 个月进行。两组在营地前两周进行了额外的评估。
辅助手评估（p=0.002）和儿童手部体验问卷（p<0.001）均显示出显著的干预效果，后者在随访时保持不变。受影响的手在营地前 25%的双手活动中被报告使用，在营地后增加到 93%，随访时减少到 86%。损伤严重程度不影响进展。
这种主题式密集干预方法在手的使用方面显示出积极的结果，独立性的提高在随访时得以维持。尽管各个营地和运动严重程度的儿童都取得了进展，但关于干预的强度和持续时间以优化长期结果仍存在一些问题。
