Palomo-Carrión Rocío, Romay-Barrero Helena, Lirio-Romero Cristina, Arroyo-Fernádez Rubén, M-Guijarro-Herraiz Marta, Ferri-Morales Asunción
Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy, University of Castilla-La Mancha, Toledo, Spain.
Group of research in Physiotherapy, Faculty of Physiotherapy and Nursing, Toledo, Spain.
Dev Neurorehabil. 2023 Jan;26(1):63-70. doi: 10.1080/17518423.2022.2099993. Epub 2022 Jul 14.
To examine the feasibility of a home-based hybrid Bimanual-Intensive-Therapy combined with modified Constraint-Induced-Movement-Therapy (h-BITmCI) in children with spastic unilateral cerebral palsy (SUCP) with low and very low bimanual functional level.
A single-group of 10 children aged 5-8 years old, performed the hybrid home Bimanual-Intensive-Therapy (BIT, 80 hours) combined with modified Constraint-Induced-Movement-Therapy (mCIMT, 20 hours): h-BITmCI. Thus, Bimanual Functional Performance (BFP), Quality of Life (QoL) and expectations from families were measured through the Assisting Hand Assessment, (AHA), Pediatric Quality of Life Inventory, for Cerebral Palsy, (PedsQL v. 3.0, CP) and a specific questionnaire for families for baseline period (week 0), during the treatment phase (week 4 and week 8) and after the intervention (week 10). Repeated measures ANOVA analysis (with post hoc test correction) was used for the BFP and QoL, with a confidence interval (CI) of 95% and with value <.008 considered statistically significant.
Ten children completed the study with an average of 77-hours-BIT and 17-hours-mCIMT. None of the participants dropped out of the study during the follow-up process, and the parents' expectations were fulfilled, indicating high caregiver compliance. During the first 80 hours of BIT, a mean increase of 3.7 AHA units was obtained for the BFP (p = 1.00) and 1.64 points in the QoL (p = 1.00). Clinically relevant changes were observed in the last two weeks (20 hours mCIMT) with a mean increase of 10.6 AHA units in BFP and 6.29 points in QoL (p < .001).
h-BITmCI protocol is feasible to be performed at home with the family's involvement, obtaining the greatest improvements after 100 hours of both therapies. Thus, mCIMT would be a relevant condition to increase the affected upper limb functionality, rather than the dosage used to obtain clinically relevant changes.
探讨家庭式混合双手强化疗法联合改良强制性运动疗法（h-BITmCI）用于双手功能水平较低和极低的痉挛型单侧脑瘫（SUCP）患儿的可行性。
选取10名5-8岁儿童组成单组，进行混合家庭双手强化疗法（BIT，80小时）联合改良强制性运动疗法（mCIMT，20小时）：h-BITmCI。通过辅助手评估（AHA）、脑瘫儿童生活质量量表（PedsQL v.3.0，CP）以及一份针对家庭的特定问卷，在基线期（第0周）、治疗阶段（第4周和第8周）以及干预后（第10周）测量双手功能表现（BFP）、生活质量（QoL）和家庭期望。对BFP和QoL采用重复测量方差分析（经事后检验校正），置信区间（CI）为95%，P值<.008被认为具有统计学意义。
10名儿童完成了研究，平均接受了77小时的BIT和17小时的mCIMT。在随访过程中，没有参与者退出研究，且家长的期望得到了满足，表明照护者依从性较高。在BIT的前80小时，BFP平均增加3.7个AHA单位（P = 1.00），QoL增加1.64分（P = 1.00）。在最后两周（20小时mCIMT）观察到临床相关变化，BFP平均增加10.6个AHA单位，QoL增加6.29分（P <.001）。
h-BITmCI方案在家庭参与下在家中实施是可行的，两种疗法共100小时后可取得最大改善。因此，mCIMT对于提高患侧上肢功能是一个相关条件，而非用于获得临床相关变化的剂量。
