Bingol H, Kerem Gunel M
Department of Therapy and Rehabilitation, Vocational School of Health Services, Mus Alparslan University, Mus, Turkey.
Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Sıhhiye, Ankara, Turkey.
Rehabilitacion (Madr). 2023 Oct-Dec;57(4):100784. doi: 10.1016/j.rh.2023.100784. Epub 2023 Feb 3.
To investigate relationships between amount of use of the more affected upper extremity and functional motor and communication performance classification systems.
The study comprised 95 children with congenital hemiplegic cerebral palsy (CP) aged 6-15 years (52 males, 43 females; mean age 9.53, SD 3.1) and their parents/caregivers. The amount of use of the more affected upper extremity was assessed using Pediatric Motor Activity Log-Revised-How Often subscale (PMAL-R HO). Functional levels of the enrolled children were defined by the parents/caregivers using Manual Ability Classification System (MACS), Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R), and Communication Function Classification System (CFCS).
A strong and negative correlation was found between PMAL-R HO subscale score and MACS (r=-0.819), suggesting that children with lower MACS levels are more likely to use their more affected upper extremity spontaneously. Additionally, negative and moderate associations between PMAL-R HO subscale score and GMFCS and CFCS were revealed (r1=-0.549 and r2=-0.567).
The amount of use of the more affected upper extremity is more sensitive to MACS than GMFCS-E&R and CFCS. Children with a given MACS level had a wide range of PMAL-R HO subscale score. In addition to MACS, a score on the PMAL-R HO subscale related to the more affected upper extremity should be included as an inclusion criterion in clinical trials to avoid misleading effects of intervention approaches aimed at improving the amount of use of the more affected upper extremity in children with congenital hemiplegic CP.
探讨偏瘫更严重的上肢使用量与功能运动和沟通表现分类系统之间的关系。
本研究纳入了95名6至15岁的先天性偏瘫型脑瘫（CP）儿童（52名男性，43名女性；平均年龄9.53岁，标准差3.1岁）及其父母/照顾者。使用儿童运动活动日志修订版-使用频率分量表（PMAL-R HO）评估偏瘫更严重的上肢的使用量。入选儿童的功能水平由父母/照顾者使用手动能力分类系统（MACS）、粗大运动功能分类系统扩展和修订版（GMFCS-E&R）以及沟通功能分类系统（CFCS）进行定义。
发现PMAL-R HO分量表得分与MACS之间存在强负相关（r = -0.819），这表明MACS水平较低的儿童更有可能自发地使用偏瘫更严重的上肢。此外，还揭示了PMAL-R HO分量表得分与GMFCS和CFCS之间存在中度负相关（r1 = -0.549，r2 = -0.567）。
偏瘫更严重的上肢使用量对MACS的敏感性高于GMFCS-E&R和CFCS。具有特定MACS水平的儿童的PMAL-R HO分量表得分范围较广。除MACS外，与偏瘫更严重的上肢相关的PMAL-R HO分量表得分应作为临床试验的纳入标准，以避免旨在改善先天性偏瘫型CP儿童偏瘫更严重的上肢使用量的干预方法产生误导性影响。
