Sakzewski Leanne, Provan Kerry, Ziviani Jenny, Boyd Roslyn N
Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.
Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.
Res Dev Disabil. 2015 Feb;37:9-16. doi: 10.1016/j.ridd.2014.10.050. Epub 2014 Nov 24.
This study aimed to compare efficacy of two dosages of modified constraint induced movement therapy (mCIMT) and bimanual therapy on upper limb and individualized outcomes for children with unilateral cerebral palsy. This secondary analysis included two separate randomized trials that compared equal doses (high or low) of mCIMT to bimanual therapy; Study 1 (full dose--60 h) n=64 and; Study 2 (half dose--30 h) n=18 for children aged five to 16 years with unilateral cerebral palsy. Outcomes for both studies included the Melbourne Assessment of Unilateral Upper Limb Function, Assisting Hand Assessment, Jebsen Taylor Test of Hand Function and Canadian Occupational Performance Measure which were administered at baseline, three and 26 weeks. Mixed linear modelling was used to compare between dose (e.g. "full dose" to "half dose" of either mCIMT or bimanual therapy) on outcomes at three and 26 weeks post-intervention. There were no significant differences between groups at baseline, however, on average the half dose mCIMT group was younger with better hand function compared to the other groups. The full compared to half dose mCIMT group achieved greater gains in bimanual performance at three weeks and dexterity and quality of movement at 26 weeks. There were no between group differences for bimanual therapy doses. Half dose groups receiving either mCIMT or bimanual therapy did not make significant within group gains on any upper limb motor outcome, however gains in occupational performance were clinically meaningful. These results suggest that a half dose (30 h) of either mCIMT or bimanual therapy may not be sufficient to impact upper limb outcomes, but made clinically meaningful gains in occupational performance for school aged children with UCP.
本研究旨在比较两种剂量的改良强制性诱导运动疗法(mCIMT)和双手疗法对单侧脑瘫儿童上肢功能及个体化治疗效果的影响。这项二次分析纳入了两项独立的随机试验,将等量(高剂量或低剂量)的mCIMT与双手疗法进行比较;研究1(全剂量——60小时),n = 64;研究2(半剂量——30小时),n = 18,研究对象为5至16岁的单侧脑瘫儿童。两项研究的评估指标包括墨尔本单侧上肢功能评估、辅助手评估、杰布森-泰勒手功能测试和加拿大职业表现测量,这些评估在基线、3周和26周时进行。采用混合线性模型比较干预后3周和26周时不同剂量(如mCIMT或双手疗法的“全剂量”与“半剂量”)对治疗效果的影响。基线时各组之间无显著差异,然而,平均而言半剂量mCIMT组比其他组年龄更小,手功能更好。与半剂量mCIMT组相比,全剂量mCIMT组在3周时双手协调性和26周时灵活性及运动质量方面有更大改善。双手疗法不同剂量组之间无差异。接受mCIMT或双手疗法半剂量治疗的组在任何上肢运动指标上均未取得显著组内改善,但职业表现方面的改善具有临床意义。这些结果表明,半剂量(30小时)的mCIMT或双手疗法可能不足以影响上肢治疗效果,但对学龄期单侧脑瘫儿童的职业表现有临床意义上的改善。