Chen Yu-Lun, Chen Hao-Ling, Shieh Jeng-Yi, Wang Tien-Ni
a School of Occupational Therapy, College of Medicine, National Taiwan University , Taipei , Taiwan.
b Department of Physical Medicine and Rehabilitation , National Taiwan University Hospital , Taipei , Taiwan.
Phys Occup Ther Pediatr. 2019;39(2):139-150. doi: 10.1080/01942638.2018.1484407. Epub 2018 Jun 18.
Constraint-induced therapy (CIT) is effective, but concerns have been repeatedly raised regarding the generalizability, feasibility, and potentially intrusive nature of restraining a child's unimpaired upper limb. We examined the feasibility and efficacy of friendly-CIT, which uses home-based model, a caregiver-determined schedule, and gentle restraint, in children with cerebral palsy.
In a one-group pre-post intervention trial, 15 children (median of age = 8 years, 4 months) participated in 8 weeks of friendly-CIT (36 hours). Motor and psychosocial outcomes were investigated.
Participants showed significant improvement on the manual dexterity subtest of the Bruininks-Oseretsky Test of Motor Proficiency (p = 0.004); the how often (p = 0.01) and how well (p = 0.02) scales of the Revised Pediatric Motor Activity Log; and the functional skills score on the Chinese version of the Pediatric Evaluation of Disability Inventory (p = 0.002). For psychosocial outcomes, children with CP consistently demonstrated high engagement and increased playfulness (p < 0.0001) during the 8-week intervention. Parents showed no change in stress status and high satisfaction with friendly-CIT.
Friendly-CIT is feasible and promising for improving a child's motor and psychosocial outcomes without increasing parental stress.
强制性诱导疗法(CIT)是有效的,但对于限制儿童未受损上肢的可推广性、可行性以及潜在的侵入性,人们一直反复表示担忧。我们研究了友好型CIT(采用家庭模式、由照料者确定日程安排并进行轻柔限制)对脑瘫儿童的可行性和疗效。
在一项单组干预前后对照试验中,15名儿童(年龄中位数为8岁4个月)参与了为期8周的友好型CIT(36小时)。对运动和心理社会结果进行了调查。
参与者在布吕尼inks-奥塞列茨基运动能力测试的手动灵巧性子测试中表现出显著改善(p = 0.004);在修订版儿童运动活动日志的频率(p = 0.01)和程度(p = 0.02)量表上;以及在中文版儿童残疾评估量表的功能技能得分方面(p = 0.002)。对于心理社会结果,在为期8周的干预期间,脑瘫儿童始终表现出高度参与和更高的趣味性(p < 0.0001)。家长的压力状况没有变化,对友好型CIT的满意度较高。
友好型CIT对于改善儿童的运动和心理社会结果是可行且有前景的,同时不会增加家长的压力。