University of Castilla-La Mancha, Toledo, Spain.
Universidad de Castilla-La Mancha, Facultad de Fisioterapia y Enfermería, Toledo, Castilla-La Mancha, Spain.
PM R. 2023 Dec;15(12):1536-1546. doi: 10.1002/pmrj.12990. Epub 2023 Jun 19.
Children with infantile hemiplegia with low or very low bimanual functional performance have great impediments to spontaneously use their affected upper limb, which affects their performance of day-to-day activities and their quality of life.
To determine whether the order of application and the dose of modified constraint-induced movement therapy within a combined (hybrid) protocol influences the results of bimanual functional performance of the affected upper limb and the quality of life of children with congenital hemiplegia (5 to 8 years old) with low/very low bimanual functional performance.
Single-blinded randomized controlled trial.
Twenty-one children with congenital hemiplegia (5 to 8 years old) were recruited from two public hospitals and an infantile hemiplegia association in Spain.
The experimental group (n = 11) received 100 hours of intensive therapies for the affected upper limb: 80 hours of modified constraint-induced movement therapy and 20 hours of bimanual intensive therapy. The control group (n = 10) received the same dose with 80 hours of bimanual intensive therapy and 20 hours of modified constraint-induced movement therapy. The protocol was provided 2 hours per day, 5 days per week, for 10 weeks.
The primary outcome was bimanual functional performance, measured with the Assisting Hand Assessment, and the second outcome was quality of life, measured with the Pediatric Quality of Life Inventory Cerebral-Palsy module (PedsQL v. 3.0, CP module). Four assessments were performed: Weeks 0, 4, 8, and 10.
The experimental group obtained an increase of 22 assisting hand assessment (AHA) units at week 8 with the application of modified constraint-induced movement, in contrast with the control group, which obtained an increase of 3.7 AHA units after bimanual intensive therapy. At week 10, the control group showed its greatest increase in bimanual functional performance, with 10.6 AHA units after modified constraint-induced movement therapy. Regarding quality of life, the greatest improvement occurred after modified constraint-induced movement, with 13.1 points in the experimental group (80 hours) and 6.3 points in the control group (20 hours). The protocol interaction was statistically significant for bimanual functional performance (p = .018) and quality of life (p = .09).
Modified constraint-induced movement therapy is more beneficial than bimanual intensive therapy for improving upper limb functioning and quality of life in children with congenital hemiplegia showing low/very low bimanual performance.
NCT03465046.
患有婴儿偏瘫且双手功能表现为低或极低的儿童，其受影响上肢的自主使用能力存在严重障碍，这会影响他们的日常活动表现和生活质量。
确定在联合（混合）方案中，改良强制性运动疗法的应用顺序和剂量是否会影响低/极低双手功能表现的先天性偏瘫儿童（5 至 8 岁）的受影响上肢的双手功能表现和生活质量。
单盲随机对照试验。
21 名患有先天性偏瘫的儿童（5 至 8 岁）从西班牙的两家公立医院和一家婴儿偏瘫协会招募。
实验组（n=11）接受 100 小时针对受影响上肢的强化治疗：80 小时改良强制性运动疗法和 20 小时双手强化治疗。对照组（n=10）接受相同剂量的治疗，80 小时双手强化治疗和 20 小时改良强制性运动疗法。该方案每天提供 2 小时，每周 5 天，持续 10 周。
主要结局指标为双手功能表现，使用辅助手评估（Assisting Hand Assessment）进行测量；次要结局指标为生活质量，使用小儿生活质量量表脑瘫模块（PedsQL v.3.0，CP 模块）进行测量。共进行了 4 次评估：第 0、4、8 和 10 周。
实验组在第 8 周进行改良强制性运动时上肢辅助手评估（AHA）增加了 22 分，而对照组在进行双手强化治疗后上肢辅助手评估增加了 3.7 分。在第 10 周，对照组在进行改良强制性运动治疗后表现出最大的双手功能表现改善，上肢辅助手评估增加了 10.6 分。关于生活质量，实验组（80 小时）在改良强制性运动后有最大的改善，增加了 13.1 分，而对照组（20 小时）增加了 6.3 分。改良强制性运动疗法与双手强化治疗的方案交互作用在双手功能表现（p=0.018）和生活质量（p=0.09）方面具有统计学意义。
与双手强化治疗相比，改良强制性运动疗法更有益于改善上肢功能和生活质量，对表现出低/极低双手功能表现的先天性偏瘫儿童。
NCT03465046。
