Cohen-Holzer Marilyn, Sorek Gilad, Kerem Julie, Schless Simon, Freedman Rachel, Rotem Hemda, Schweitzer Maayan, Katz-Leurer Michal
a Pediatric and Adolescent Rehabilitation Center , Alyn Hospital , Jerusalem , Israel.
b Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine , Tel-Aviv University , Ramat Aviv, Israel.
Phys Occup Ther Pediatr. 2016 Nov;36(4):376-87. doi: 10.3109/01942638.2015.1108379. Epub 2016 Jan 6.
To examine whether level of manual ability modifies the response to an intensive program combining modified constraint and bimanual training on arm functioning children with unilateral cerebral palsy (UCP).
Thirty-four children aged 6-11 years, with Manual Ability Classification System (MACS) levels I-III (I:8, II:15, III:11), participated in a 2-week program, combining an hour of modified constraint with 5 hr of bimanual practice daily. The Assisting Hand Assessment (AHA) and the Jebsen-Taylor Test of Hand Function (JTTHF) were done pre-, post-, and 3-months post-intervention.
Mean AHA logits unit scores increased overtime (F2;50 = 5, p = 0.01). There was no significant difference in AHA logits units change score between MACS levels (F4;56 = 1.4, p = 0.22). JTTHF scores did not change for either the affected or less-affected hand, although a significant interaction of time and MACS level was found in the less-affected side (F4;58 = 6.5, p < 0.01). Children in MACS levels I and II improved by similar degrees, in comparison to children at MACS level III who demonstrated significantly greater change over time.
While a similar trend of improvement was found in the bimanual abilities of children at all MACS levels, only children at MACS level III had improved performance in unilateral abilities in the less-affected side following intervention.
研究手动能力水平是否会改变对一种强化训练方案的反应，该方案结合了改良的强制性运动疗法和双手训练，用于治疗单侧脑瘫（UCP）儿童的手臂功能。
34名年龄在6至11岁之间、手动能力分类系统（MACS）水平为I - III级（I级：8名，II级：15名，III级：11名）的儿童参加了为期2周的训练方案，该方案每天将1小时的改良强制性运动疗法与5小时的双手练习相结合。在干预前、干预后及干预后3个月进行辅助手评估（AHA）和杰布森 - 泰勒手功能测试（JTTHF）。
AHA对数单位得分随时间增加（F2;50 = 5，p = 0.01）。MACS各水平之间的AHA对数单位变化得分无显著差异（F4;56 = 1.4，p = 0.22）。尽管在受影响较小的一侧发现了时间和MACS水平的显著交互作用（F4;58 = 6.5，p < 0.01），但受影响手和受影响较小手的JTTHF得分均未改变。与MACS III级的儿童相比，MACS I级和II级的儿童改善程度相似，MACS III级的儿童随时间推移表现出显著更大的变化。
虽然在所有MACS水平的儿童双手能力方面都发现了类似的改善趋势，但只有MACS III级的儿童在干预后受影响较小一侧的单侧能力表现有所改善。
