Fahr Annina, Keller Jeffrey W, van Hedel Hubertus J A
Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.
Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Front Neurol. 2020 Dec 4;11:572038. doi: 10.3389/fneur.2020.572038. eCollection 2020.
Impaired selective voluntary motor control is defined as "the reduced ability to isolate the activation of muscles in response to demands of a voluntary posture or movement." It is a negative motor sign of an upper motor neuron lesion. This paper reviews interventions that may improve selective motor control in children and youths with spastic cerebral palsy. The aim was to systematically evaluate the methodological quality and formulate the level of evidence from controlled studies. Six databases (Scopus, Web of Science, PubMed, Embase, MEDLINE, and CINAHL) were searched with predefined search terms for population, interventions, and outcomes. Two reviewers independently completed study selection and ratings of methodological quality and risk of bias. Evidence was summarized in a best evidence synthesis. Twenty-three studies from initially 2,634 papers were included. The interventions showed a wide variety of approaches, such as constraint-induced movement therapy (CIMT), electrical stimulation, robot-assisted therapy, and functional training. The evidence synthesis revealed conflicting evidence for CIMT, robot-assisted rehabilitation and mirror therapy for the upper extremities in children with cerebral palsy. Final recommendations are difficult due to heterogeneity of the reviewed studies. Studies that include both an intervention and an outcome that specifically focus on selective voluntary motor control are needed to determine the most effective therapy.
选择性随意运动控制受损被定义为“根据随意姿势或运动的需求，隔离肌肉激活的能力降低”。它是上运动神经元损伤的一种负面运动体征。本文综述了可能改善痉挛性脑瘫儿童和青少年选择性运动控制的干预措施。目的是系统评价方法学质量，并从对照研究中确定证据水平。使用预定义的搜索词在六个数据库（Scopus、科学网、PubMed、Embase、MEDLINE和CINAHL）中搜索人群、干预措施和结果。两名评价者独立完成研究选择以及方法学质量和偏倚风险的评级。证据在最佳证据综合中进行总结。最初的2634篇论文中有23项研究被纳入。干预措施呈现出多种方法，如强制性运动疗法（CIMT）、电刺激、机器人辅助疗法和功能训练。证据综合显示，对于脑瘫儿童上肢的CIMT、机器人辅助康复和镜像疗法，证据相互矛盾。由于所综述研究的异质性，最终建议难以给出。需要开展既包括干预措施又包括专门针对选择性随意运动控制的结果的研究，以确定最有效的治疗方法。
