Taylor Emma, Greaves Susan, Hoare Brian
Cerebral Palsy Group, 74 Faraday Street, Carlton, VIC 3053, Australia.
School of Allied Health, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC 3065, Australia.
J Clin Med. 2025 Jan 30;14(3):924. doi: 10.3390/jcm14030924.
: There is high-level research evidence supporting task-focused upper limb therapy models for children with unilateral cerebral palsy (CP). However, a knowledge gap exists in understanding how to effectively implement distributed practice approaches in clinical practice and the effect on the development of bimanual performance. This study aims to evaluate clinical outcomes, examine key considerations for implementation outcomes, and propose a Model of Care for children with unilateral CP. : A mixed-methods approach was applied, including a retrospective case series with an observational descriptive design. A convenience sample of nine children (<5 years of age) with unilateral CP who received multiple blocks of distributed, evidence-based upper limb therapy approaches between 2014 and 2020 were included. Outcomes were evaluated using the Assisting Hand Assessment family of assessments. A Model of Care framework was informed by the Updated Consolidated Framework for Implementation Research and the Conceptual Model for Implementation Research. : A total of 59 blocks of upper limb therapy (10 mCIMT and 49 bimanual therapy) were delivered, ranging from two to nine blocks (mean = 6.6) for each child. All children demonstrated improved outcomes in bimanual performance with an average change of 14 AHA units (range 1-22). Barriers to implementation included complexity and cost. Facilitators included the evidence base and adaptability of the approaches that allowed clinicians to respond to an individual child and family's needs. Informed by evidence-based protocols and visual analysis of data, and in consideration of the barriers and/or facilitators to implementation from this study, a Model of Care for implementation of upper limb distributed practice approaches for children with unilateral CP in clinical practice is proposed. : Implementing repeated, distributed blocks of evidence-based upper limb therapy in a clinical setting for children with unilateral CP led to incremental improvements in bimanual performance. There are a range of barriers and facilitators to the implementation of distributed practice approaches in clinical practice. The Model of Care outlines best practice care and service delivery for children with unilateral CP and their families and aims to support clinical practice and the future examination of implementation-effectiveness in practice.
有高级别研究证据支持针对单侧脑瘫（CP）儿童的以任务为重点的上肢治疗模式。然而，在如何在临床实践中有效实施分散练习方法以及其对双手操作能力发展的影响方面，存在知识空白。本研究旨在评估临床结果，审视实施结果的关键考量因素，并为单侧CP儿童提出一种照护模式。：采用了混合方法，包括具有观察性描述设计的回顾性病例系列研究。纳入了一个便利样本，其中有9名年龄小于5岁的单侧CP儿童，他们在2014年至2020年期间接受了多个阶段的基于证据的分散式上肢治疗方法。使用辅助手评估系列评估来评估结果。照护模式框架以实施研究的更新后综合框架和实施研究概念模型为依据。：总共提供了59个阶段的上肢治疗（10个改良强制性诱导运动疗法和49个双手疗法），每个儿童接受的阶段数从2个到9个不等（平均 = 6.6）。所有儿童在双手操作能力方面均表现出改善，平均变化为14个辅助手评估单位（范围为1 - 22）。实施的障碍包括复杂性和成本。促进因素包括方法的证据基础和适应性，这使得临床医生能够满足个别儿童和家庭的需求。基于循证方案和数据的视觉分析，并考虑到本研究中实施的障碍和/或促进因素，提出了一种在临床实践中为单侧CP儿童实施上肢分散练习方法的照护模式。：在临床环境中为单侧CP儿童实施重复的、分散的基于证据的上肢治疗，导致双手操作能力逐步改善。在临床实践中实施分散练习方法存在一系列障碍和促进因素。该照护模式概述了为单侧CP儿童及其家庭提供最佳实践照护和服务的方式，旨在支持临床实践以及未来对实践中实施效果的检验。
