Lidman Git, Nachemson Ann, Peny-Dahlstrand Marie, Himmelmann Kate
Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Regional Rehabilitation Center, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
Dev Med Child Neurol. 2015 Aug;57(8):754-61. doi: 10.1111/dmcn.12739. Epub 2015 Mar 22.
To investigate the effects of repeated botulinum toxin A (BoNT-A) injections combined with occupational therapy, including a splint, compared with occupational therapy alone on hand function in children with unilateral spastic cerebral palsy (USCP), in all International Classification of Functioning, Disability and Health (ICF) domains.
This was a randomized controlled study, population-based and evaluator-blinded for primary outcome (October 2004 to September 2010). Twenty children (14 males; median age 3y 1mo) with USCP, recruited at a rehabilitation centre in Sweden, were assigned to one of two parallel groups using concealed allocation. In the course of one year, 10 children received occupational therapy, while 10 received repeated BoNT-A plus occupational therapy (BoNT-A/OT). Primary outcome (Assisting Hand Assessment [AHA]), and secondary outcome measures (range of movement [ROM], and Canadian Occupational Performance Measure), were measured at baseline, 3, 6, 9, and 12 months.
AHA revealed a superior effect in the BoNT-A/OT group at 12 months: 6 out of 10 improved compared with 1 out of 10 in the occupational therapy group (p<0.03). A 95% Peskun exact confidence interval for the difference in proportions is given as 0.01 to 0.81. Secondary outcomes improved in both groups.
Repeated BoNT-A/OT appeared superior to occupational therapy alone for bimanual performance in young children with USCP. Active ROM and goal performance improved in both groups.
在《国际功能、残疾和健康分类》（ICF）的所有领域中，研究重复注射A型肉毒毒素（BoNT-A）联合包括夹板在内的职业治疗与单纯职业治疗相比，对单侧痉挛性脑瘫（USCP）患儿手部功能的影响。
这是一项基于人群的随机对照研究，对主要结局采用评估者盲法（2004年10月至2010年9月）。在瑞典一家康复中心招募的20名USCP患儿（14名男性；中位年龄3岁1个月），采用隐蔽分配法被分配到两个平行组之一。在一年的时间里，10名儿童接受职业治疗，而10名儿童接受重复BoNT-A联合职业治疗（BoNT-A/OT）。在基线、3、6、9和12个月时测量主要结局（辅助手评估[AHA]）和次要结局指标（运动范围[ROM]和加拿大职业表现测量）。
AHA显示，在12个月时BoNT-A/OT组效果更佳：10名中有6名改善，而职业治疗组10名中只有1名改善（p<0.03）。比例差异的95%佩斯昆精确置信区间为0.01至0.81。两组的次要结局均有所改善。
对于USCP幼儿的双手操作，重复BoNT-A/OT似乎优于单纯职业治疗。两组的主动ROM和目标表现均有所改善。
