Institute of Neuroscience, Université catholique de Louvain, Belgium.
Res Dev Disabil. 2013 Sep;34(9):3014-28. doi: 10.1016/j.ridd.2013.05.047. Epub 2013 Jun 29.
Children with hemiplegic cerebral palsy (HCP) exhibit long-term functional deficits. One of the most debilitating is the loss of prehension since this may impair functional independence. This loss of prehension could be partly due to sensory deficits. Identifying the underlying causes of prehension deficits and their potential link with sensory disorders is important to better adapt neurorehabilitation. Here we provide an overview of precision grip and sensory impairments in individuals with HCP, and the relation between them, in order to determine whether the sensory impairments influence the type and magnitude of deficits as measured by studies of prehensile force control. Pubmed and Scopus databases were used to search studies from 1990 to 2012, using combinations of the following keywords: fingertip force; grip force; precision grip; sensory deficit; sensory impairment; tactile discrimination; with cerebral palsy. Of the 190 studies detected through the systematic search; 38 were finally included in the systematic part of this review. This review shows that sensory deficits are common and are likely underestimated using standard clinical assessments in HCP. Some studies suggest these deficits are the basis of predictive motor control impairments in these individuals. However, children with HCP retain some ability to use predictive control, even if it is impaired in the more affected hand. Intensive practice and initial use of the less affected hand, which has only subtle sensory deficits, has been shown to remediate impairments in anticipatory motor control during subsequent use of the more affected hand. Implications for motor and sensory rehabilitation of individuals with HCP are discussed.
患有偏瘫型脑瘫（HCP）的儿童会表现出长期的功能缺陷。其中最严重的缺陷之一是丧失抓握能力，因为这可能会损害其功能独立性。这种抓握能力的丧失可能部分是由于感觉缺陷。确定抓握能力缺陷的根本原因及其与感觉障碍的潜在联系，对于更好地适应神经康复非常重要。在这里，我们提供了一个关于 HCP 个体的精确抓握和感觉障碍的概述，以及它们之间的关系，以确定感觉障碍是否会影响通过抓握力控制研究测量的缺陷的类型和程度。我们使用了 Pubmed 和 Scopus 数据库，通过组合以下关键词搜索了 1990 年至 2012 年的研究：指尖力；握力；精确抓握；感觉缺陷；感觉障碍；触觉辨别；脑瘫。通过系统搜索检测到的 190 项研究中，最终有 38 项被纳入本综述的系统部分。本综述表明，感觉缺陷在 HCP 中很常见，并且使用标准的临床评估可能会低估这些缺陷。一些研究表明，这些缺陷是这些个体运动预测控制受损的基础。然而，HCP 儿童仍然具有一定的使用预测控制的能力，即使在受影响更严重的手中，这种能力也受到了损害。研究表明，通过密集练习和最初使用受影响较小的手，即使该手仅有轻微的感觉缺陷，也可以纠正在后续使用受影响较大的手时对预期运动控制的损伤。讨论了对 HCP 个体进行运动和感觉康复的影响。
