Sakzewski Leanne, Miller Laura, Ziviani Jenny, Abbott David F, Rose Stephen, Macdonell Richard A L, Boyd Roslyn N
Faculty of Health, Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia.
Dev Med Child Neurol. 2015 Jun;57(6):539-47. doi: 10.1111/dmcn.12702. Epub 2015 Jan 27.
To determine whether short-term intensive group-based therapy combining modified constraint-induced movement therapy and bimanual therapy (hybrid-CIMT) is more effective than an equal total dose of distributed individualized occupational therapy (standard care) on upper limb motor and individualized outcomes.
Fifty-three children with unilateral cerebral palsy (69% males; mean age 7y 10mo, SD 2y 4mo; Manual Ability Classification System level I, n=24; level II, n=23) were randomly allocated, and 44 received either hybrid-CIMT (n=25) or standard care (n=19). Standard care comprised six weekly occupational therapy sessions and a 12-week home programme. Outcomes were assessed at baseline, 13 weeks, and 26 weeks after treatment.
Groups were equivalent at baseline. Standard care achieved greater gains on satisfaction with occupational performance after intervention (estimated mean difference -1.2, 95% CI -2.2 to -0.1; p=0.04) and Assisting Hand Assessment at 26 weeks (estimated mean difference 3.1, 95% CI 0.2-6.0; p=0.04). Both groups demonstrated significant improvements in dexterity of the impaired upper limb, and bimanual and occupational performance over time. The differences between groups were not clinically meaningful.
There were no differences between the two models of therapy delivery. Group-based intensive camps may not be readily available; however, individualized standard care augmented with a home programme may offer an effective alternative but needs to be provided at a sufficient dose.
确定基于小组的短期强化治疗，即结合改良的强制性诱导运动疗法和双手疗法（混合强制性诱导运动疗法），在上肢运动和个体化结局方面是否比同等总剂量的分散式个体化职业治疗（标准护理）更有效。
53名单侧脑瘫儿童（69%为男性；平均年龄7岁10个月，标准差2岁4个月；手动能力分类系统I级，n = 24；II级，n = 23）被随机分配，44名接受了混合强制性诱导运动疗法（n = 25）或标准护理（n = 19）。标准护理包括每周6次职业治疗课程和一个为期12周的家庭训练计划。在治疗前基线、治疗后13周和26周对结局进行评估。
两组在基线时相当。标准护理在干预后对职业表现的满意度方面取得了更大的改善（估计平均差异-1.2，95%置信区间-2.2至-0.1；p = 0.04），在26周时的辅助手评估方面也有改善（估计平均差异3.1，95%置信区间0.2 - 6.0；p = 0.04）。随着时间的推移，两组在上肢受损的灵活性、双手和职业表现方面均有显著改善。两组之间的差异在临床上无意义。
两种治疗模式之间没有差异。基于小组的强化训练营可能不容易获得；然而，辅以家庭训练计划的个体化标准护理可能是一种有效的替代方案，但需要提供足够的剂量。
