Stuyvenberg Corri L, Brown Shaaron E, Inamdar Ketaki, Evans Megan, Hsu Lin-Ya, Rolin Olivier, Harbourne Regina T, Westcott McCoy Sarah, Lobo Michele A, Koziol Natalie A, Dusing Stacey C
Rehabilitation Science Graduate Program, University of Minnesota Medical School, MMC 388, 420 Delaware St. SE, Minneapolis, MN 55455, USA.
Department of Physical Therapy, Virginia Commonwealth University Health System, 1300 East Marshall Street, PO Box 980419, Richmond, VA 23298, USA.
J Pers Med. 2021 Feb 27;11(3):163. doi: 10.3390/jpm11030163.
Therapies for children with cerebral palsy (CP) often fail to address essential components of early rehabilitation: intensity, child initiation, and an embodied approach. Sitting Together And Reaching To Play (START-Play) addresses these issues while incorporating intensive family involvement to maximize therapeutic dosage. While START-Play was developed and tested on children aged 7-16 months with motor delays, the theoretical construct can be applied to intervention in children of broader ages and skills levels. This study quantifies the impact of a broader START-Play intervention combined with Botulinum toxin-A (BoNT-A) and phenol on the developmental trajectory of a 24 month-old child with bilateral spastic CP. In this AB +1 study, A consisted of multiple baseline assessments with the Gross Motor Function Measure-66 and the Assessment of Problem Solving in Play. The research participant demonstrated a stable baseline during A and changes in response to the combination of BoNT-A/phenol and 12 START-Play sessions during B, surpassing the minimal clinically important difference on the Gross Motor Function Measure-66. The follow-up data point (+1) was completed after a second round of BoNT-A/phenol injections. While the findings suggest the participant improved his gross motor skills with BoNT-A/phenol and START-Play, further research is needed to generalize these findings.
针对脑瘫（CP）儿童的治疗往往未能解决早期康复的关键要素：强度、儿童主动性和一种具身化方法。“一起坐并伸手玩耍”（START-Play）在纳入家庭深度参与以最大化治疗剂量的同时解决了这些问题。虽然START-Play是针对7至16个月大运动发育迟缓儿童开发并进行测试的，但其理论架构可应用于更广泛年龄和技能水平儿童的干预。本研究量化了更广泛的START-Play干预联合肉毒杆菌毒素A（BoNT-A）和苯酚对一名24个月大双侧痉挛性脑瘫患儿发育轨迹的影响。在这项AB +1研究中，A阶段包括使用粗大运动功能测量-66和游戏中问题解决能力评估进行多次基线评估。研究参与者在A阶段表现出稳定的基线，在B阶段对BoNT-A/苯酚联合12次START-Play治疗有反应变化，在粗大运动功能测量-66上超过了最小临床重要差异。随访数据点（+1）在第二轮BoNT-A/苯酚注射后完成。虽然研究结果表明参与者通过BoNT-A/苯酚和START-Play改善了粗大运动技能，但需要进一步研究以推广这些发现。
