Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
Eur J Phys Rehabil Med. 2023 Oct;59(5):554-563. doi: 10.23736/S1973-9087.23.07945-5. Epub 2023 Jul 18.
The effects of unilateral cerebral palsy (UCP) are largely observed in the upper limb (UL), which represents the main focus of rehabilitation for this disorder. Thanks to an increment in home training and progress in technology innovative systems have been created. The Tele-UPCAT (Tele-monitored UPper Limb Children Action Observation Training) platform is dedicated to the delivery at home of a program for UL rehabilitation, based on action observation therapy (AOT).
This study aimed to investigate the immediate effectiveness of Tele-UPCAT for promoting UL skills in children with UCP and to determine if immediate effects were retained in the medium and long term.
Tele-UPCAT was conducted on an intention-to-treat basis and was proposed as a randomized, allocation concealed (waitlist controlled) and evaluator-blinded clinical trial with two investigative arms: intensive in-home AOT program and standard care (SC).
This is a home-based AOT program delivered with a customized ICT platform.
Thirty children (mean age 11.61±3.55 years) with confirmed diagnosis of spastic UCP with predominant UL involvement and cognitive level within or at normal limits were enrolled in this study. Orthopedic surgery or an intramuscular botulinum toxin A injection in the UL within 6 months prior to enrolment represented an exclusion criteria.
Participants were randomized using concealed random allocation. They were assessed according to the study design with the Assisting Hand Assessment (AHA), the Box and Block Test (BBT) and the Melbourne Assessment 2 (MA2). Linear mixed models were used for statistical analysis.
A significant difference between the AOT and SC groups was identified immediately after the training on the AHA (6.406 [2.73] P=0.021) with an effect size (ES) of 1.99, and for the BBT of the less affected hand (9.826 [4.535] P=0.032) with an ES of 1.44. These effects were sustained at medium and long term.
This study supports the effectiveness of AOT home training in promoting UL skills in children with UCP, with immediate effects lasting for 6 months.
This should encourage the use of technology for rehabilitative purposes and further applications of the AOT paradigm.
单侧脑瘫（UCP）的影响主要表现在上肢（UL），这是该疾病康复的主要关注点。由于家庭训练的增加和技术创新系统的进步，已经创建了一些系统。Tele-UPCAT（远程监控上肢儿童动作观察训练）平台致力于在家中提供基于动作观察疗法（AOT）的 UL 康复计划。
本研究旨在探讨 Tele-UPCAT 即时促进 UCP 儿童 UL 技能的效果，并确定即时效果是否在中远期保留。
Tele-UPCAT 基于意向治疗进行，并提出了一项随机、分配隐藏（等待对照）和评估者盲法临床试验，有两个研究臂：强化家庭 AOT 计划和标准护理（SC）。
这是一个基于家庭的 AOT 计划，通过定制的信息通信技术平台提供。
30 名儿童（平均年龄 11.61±3.55 岁），经确诊为痉挛性 UCP，上肢受累为主，认知水平在正常范围内或正常范围内。在入组前 6 个月内接受上肢矫形手术或肌内注射肉毒毒素 A 者排除在外。
参与者使用隐藏随机分配进行随机分组。根据研究设计，他们使用辅助手评估（AHA）、方块和块测试（BBT）和墨尔本评估 2（MA2）进行评估。线性混合模型用于统计分析。
在训练后，AOT 组和 SC 组在 AHA 上的差异具有统计学意义（6.406[2.73]，P=0.021），效应量（ES）为 1.99，对于受影响较小的手的 BBT，差异也具有统计学意义（9.826[4.535]，P=0.032），ES 为 1.44。这些效果在中远期持续存在。
本研究支持家庭 AOT 训练在促进 UCP 儿童 UL 技能方面的有效性，即时效果持续 6 个月。
这应该鼓励使用技术进行康复目的，并进一步应用 AOT 范式。
