Sakzewski Leanne, Gordon Andrew, Eliasson Ann-Christin
Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, University of Queensland, Queensland, Australia
Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
J Child Neurol. 2014 Aug;29(8):1077-90. doi: 10.1177/0883073814533150. Epub 2014 May 11.
Children with unilateral cerebral palsy experience difficulties with unimanual and bimanual upper limb function, impacting independence in daily life. Targeted upper limb therapies such as constraint-induced movement therapy, bimanual training, and combined approaches have emerged in the last decade. This article reviews the scientific rationale underpinning these treatments and current evidence to improve upper limb outcomes and goal attainment. Intensive models of therapy achieved modest to strong effects to improve upper limb function compared to usual care. Dose-matched comparisons of bimanual and unimanual training demonstrated similar gains in upper limb outcomes. The optimum timing, dose and impact of repeat episodes of intensive upper limb therapies require further investigation. Characteristics of children who achieve clinically meaningful outcomes remain unclear. Key components of intervention include collaborative goal setting with families and intensive repetitive, incrementally challenging, task practice. Choice of treatment approach should be governed by child/family goals and preferences, individual, and contextual factors.
单侧脑瘫儿童在单手和双手上肢功能方面存在困难，这影响了他们日常生活的独立性。在过去十年中，出现了诸如强制性运动疗法、双手训练和综合方法等有针对性的上肢治疗方法。本文回顾了这些治疗方法的科学依据以及当前改善上肢治疗效果和实现治疗目标的证据。与常规护理相比，强化治疗模式在改善上肢功能方面取得了适度到显著的效果。双手训练和单手训练的剂量匹配比较显示，上肢治疗效果的提升相似。强化上肢治疗重复疗程的最佳时机、剂量和影响仍需进一步研究。实现具有临床意义治疗效果的儿童特征尚不清楚。干预的关键组成部分包括与家庭共同设定目标，以及强化重复、逐步增加难度的任务练习。治疗方法的选择应根据儿童/家庭的目标和偏好、个体及环境因素来决定。
