Brandão Marina B, Ferre Claudio, Kuo Hsing-Ching, Rameckers Eugene A A, Bleyenheuft Yannick, Hung Ya-Ching, Friel Kathleen, Gordon Andrew M
Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
Teachers College, Columbia University, New York, NY, USA.
Neurorehabil Neural Repair. 2014 Jun;28(5):452-61. doi: 10.1177/1545968313516871. Epub 2013 Dec 27.
Background High-intensity training aims to improve hand function in children with unilateral spastic cerebral palsy (USCP). However, the extent to which skill training is required is not known. Objectives To compare the effects of intensive bimanual training with and without structured progression of skill difficulty, on manual dexterity, bimanual hand use, daily functioning, and functional goals in children with USCP. Method Twenty-two children were randomized to structured practice group (SPG) or unstructured practice group (UPG), and received 6 h/d training during 15 days. Children from the SPG were engaged in fine and gross motor bimanual activities, with skill progression and goal training. Children from UPG performed the same activities without skill progression or goal training. Participants were evaluated before, immediately and 6 months after training by a physical therapist blinded to group allocation. The primary outcomes were the Jebsen-Taylor Test of Hand Function (JTTHF) and Assisting Hand Assessment (AHA). Secondary outcomes included the Canadian Occupational Performance Measure (COPM), Pediatric Evaluation of Disability Inventory (PEDI), and ABILHAND-Kids. Results Both groups showed similar improvements in the JTTHF, AHA, ABILHAND-Kids, COPM-satisfaction, and PEDI (P < .05). A significant interaction in the COPM-performance scale (P = .03) showed superior improvements of the SPG immediately, but not 6 months, after the intervention.
Children from both groups demonstrated improvements in dexterity and functional hand use. This suggests that for intensive bimanual approaches, intensive training at such high doses may not require structured practice to elicit improvements. However, there may be immediate added benefit of including goal training.
背景 高强度训练旨在改善单侧痉挛性脑瘫（USCP）患儿的手部功能。然而，所需技能训练的程度尚不清楚。目的 比较有和没有技能难度结构化进阶的强化双手训练对USCP患儿手部灵巧性、双手使用、日常功能和功能目标的影响。方法 22名儿童被随机分为结构化练习组（SPG）或非结构化练习组（UPG），并在15天内接受每天6小时的训练。SPG组的儿童参与精细和粗大运动的双手活动，包括技能进阶和目标训练。UPG组的儿童进行相同的活动，但没有技能进阶或目标训练。由对分组不知情的物理治疗师在训练前、训练结束时和训练后6个月对参与者进行评估。主要结局指标是杰布森-泰勒手部功能测试（JTTHF）和辅助手评估（AHA）。次要结局指标包括加拿大职业表现测量（COPM）、儿童残疾评定量表（PEDI）和儿童ABILHAND。结果 两组在JTTHF、AHA、儿童ABILHAND、COPM满意度和PEDI方面均有相似改善（P < 0.05）。COPM表现量表存在显著交互作用（P = 0.03），表明SPG组在干预后立即有更好的改善，但6个月后并非如此。
两组儿童在灵巧性和功能性手部使用方面均有改善。这表明对于强化双手训练方法，如此高剂量的强化训练可能不需要结构化练习就能产生改善。然而，纳入目标训练可能会有即时的额外益处。
