Hand Function in a Population-Based Sample of Young Children with Unilateral or Bilateral Cerebral Palsy

Aim: To describe aspects of hand function in a population-based sample of young children with clinical signs of unilateral or bilateral cerebral palsy (CP). Method: A cross-sectional study with data from national CP registers in Norway. Manual ability was classified with the Manual Ability Classification System (MACS) or Mini-MACS. Hand use in bimanual activities was measured with the Assisting Hand Assessment (AHA) for unilateral CP or the newly developed Both Hands Assessment (BoHA) for bilateral CP. Results: From 202 children, 128 (57 females) were included (Mini-MACS/MACS levels I–V, mean age 30.4 months; SD = 12.1). Manual abilities were distributed across levels I–III in unilateral CP and levels I–V in bilateral CP. Variations in AHA and BoHA units were large. One-way ANOVA revealed associations between higher AHA or BoHA units and Mini-MACS/MACS levels of higher ability (p < 0.01) and higher age (p < 0.04). Conclusions: Compared with young children with unilateral CP, children with bilateral CP showed greater variation in Mini-MACS/MACS levels, and both sub-groups showed large variations in AHA or BoHA units. The classifications and assessments used in this study are useful to differentiate young children's ability levels. Such information is important to tailor upper limb interventions to the specific needs of children with CP.     

神经肌肉电刺激结合肌力训练对痉挛型脑性瘫痪患儿运动功能的影响

目的 探讨神经肌肉电刺激(NMES)结合肌力训练对痉挛型脑性瘫痪(脑瘫)患儿运动功能的影响.方法 脑瘫患儿86例.年龄4.0～5.8岁.通过计算机分层后随机分为研究组(44例)和对照组(42例).二组患儿均接受以Bobath技术为主的神经发育学疗法.研究组患儿在此基础上增加NMES结合肌力练,NMES采用电刺激仪,4个表面电极放置于患侧足背伸肌群肌腹处给予电刺激,20 min/次;肌力训练根据脑瘫患儿的运动功能状况,结合运动学理论、运动学习理论和神经发育学理论等进行针对性训练;1次/d,5次/周,连续6周.之后指导家长实施家庭康复治疗.治疗前,治疗6、12周随访时进行以下评定:(1)综合痉挛量表(CSS);(2)粗大运动功能量表(GMFM)中的D和E二项;(3)步行速度.结果 二组患儿的性别、年龄、粗大运动功能分级水平、痉挛型偏瘫和双瘫的患儿例数差异均无统计学意义(Pa＞0.05).治疗前,二组患儿的CSS评分、GMFM评分及步行速度比较差异均无统计学意义(Pa＞0.05);治疗6、12周CSS评分、GMFM评分及步行速度,与治疗前比较,差异均有统计学意义(Pa＜0.01).治疗6、12周,二组患儿CSS评分、GMFM评分及步行速度组间比较,差异均有统计学意义(Pa＜0.05).结论 NMES结合肌力训练能更好地提高痉挛型脑瘫患儿的运动功能.     

躯干肌强化训练对脑性瘫痪患儿平衡功能的影响

目的探索不同的躯干肌训练方法对脑性瘫痪(CP)患儿平衡功能的影响。方法CP患儿80例,分为常规组(34例)和躯干肌训练组(46例),常规组采用我科常规平衡训练方法,躯干肌训练组则在常规平衡训练方法的基础上增加对躯干肌的训练,两组其他康复治疗相同。由专人采用社会适应性行为评定ADL量表和GMFM运动疗效评定量表中平衡项目量表对患儿的平衡功能进行评定。结果常规组和躯干肌训练组治疗后ADL评分和GMFM平衡评分与治疗前相比有显著变化(P<0.05或P<0.01),评分普遍增高,且躯干肌训练组高于常规组,差异均具有非常显著性意义(P<0.01)。结论选择性强化对部分躯干肌的训练,即在加强前屈和后伸肌群训练的同时,增加躯干旋转肌群的训练,可更加有效地提高对CP患儿平衡功能障碍的训练效果。     

Effect of Hippotherapy on Motor Proficiency and Function in Children with Cerebral Palsy Who Walk

Aims: To evaluate the effects of hippotherapy on physical capacities of children with cerebral palsy. Methods: Thirteen children (4–12 years old) with cerebral palsy classified in Gross Motor Function Classification System Level I or II were included in this prospective quasi-experimental ABA design study. Participants received 10 weeks of hippotherapy (30 min per week). Gross motor function and proficiency were measured with the Bruininks–Oseretski Motor Proficiency short form [BOT2-SF]) and the Gross Motor Function Measure-88 [GMFM-88] (Dimension D and E) twice before the program (T1 and T1′), immediately after (T2), and 10 weeks following the end of the program (T3). Results: Mean scores for dimensions D and E of the GMFM-88 Dimension scores (p = .005) and three out of the eight items of the BOT2-SF (fine motor precision (p = .013), balance (p = .025), and strength (p = .012) improved between baseline and immediately after intervention; mean scores immediately following and 10 weeks following intervention did not differ. Conclusions: Hippotherapy provided by a trained therapist who applies an intense and graded session for 10 weeks can improve body functions and performance of gross motor and fine motor activities in children with cerebral palsy.     

Changes in Muscle Activation Following Ankle Strength Training in Children with Spastic Cerebral Palsy: An Electromyography Feasibility Case Report

ABSTRACT

Children with cerebral palsy (CP) are likely to experience decreased participation in activities and less competence in activities of daily living. Studies of children with spastic CP have shown that strengthening programs produce positive results in strength, gait, and functional outcomes (measured by the Gross Motor Function Measure). No investigations have analyzed electromyography (EMG) activity before and after strength training to determine whether any changes occur in the GMFM. This feasibility case report quantified dorsiflexor and plantarflexor muscle activation changes during performance of 3–5 selected GMFM items following a plantarflexor strength training in two children with cerebral palsy. Increased plantarflexor strength and increased ability to selectively activate muscles were found. Little carryover to performance on GMFM items was observed. It is feasible to use EMG during performance on selected GMFM items to evaluate motor control changes following strength training in children with CP.     

痉挛型偏瘫脑性瘫痪患儿表面肌电特征

目的 探讨痉挛型偏瘫脑性瘫痪(脑瘫)患儿肱二头肌、股四头肌在最大自主等长收缩( MIVC)过程中的表面肌电图(sEMG)的特征变化.方法 采用患、健侧自身对照试验方法设计.选择2008年9月-2010年7月在广州市康复训练中心进行康复的痉挛型偏瘫脑瘫患儿11例.其中男5例,女6例;年龄(10.09±2.47)岁.采用FexComp型表面肌电仪及Ag/Agcl表面电极,在康复训练前对受试者进行测试,采样时令所有受试者保持相同姿势.将EMG的表面电极固定于其双侧肱二头肌、股四头肌体表上,在进行肘关节屈肌、膝关节伸肌MIVC时,同步记录其健、患侧肱二头肌、股四头肌的表面肌电信号,并进行频域特征量化分析,包括中位频率(MF)及平均功率频率(MPF).结果采用SPSS 13.0软件进行统计学处理.结果 在MIVC状态下,痉挛型偏瘫脑瘫患儿健侧肱二头肌、股四头肌MPF值均明显大于患侧(P ＜0.01,0.05),健、患侧肱二头肌、股四头肌的MF值比较,差异均无统计学意义(Pa＞0.05).患儿健侧功率谱sEMG信号明显强于患侧.结论 痉挛型偏瘫脑瘫患儿肱二头肌、股四头肌存在sEMG信号异常,提示表面肌电仪对神经肌肉系统功能状态的评价具有实用价值.     

按摩疗法对痉挛型脑性瘫痪患儿运动功能动态变化的影响

目的探讨按摩疗法对痉挛型脑性瘫痪(CP)患儿运动功能和肌张力动态变化的影响。方法随机选择本院符合痉挛型CP诊断的54例住院患儿(男31例,女23例;平均年龄5.18岁),对其进行24周40 min.d-1的按摩疗法治疗,治疗过程未予药物及其他治疗。分析其运动功能的动态变化。采用SPSS11.01软件进行统计学分析。结果痉挛性CP患儿在24周的按摩过程中,基本粗大运动能力呈逐步提高趋势,治疗前后比较差异有统计学意义(P<0.01);按摩8周时,患儿臂近端的肌张力有轻-中度降低(P<0.05),而在14周时出现明显升高,与治疗8周时比较差异有统计学意义(P<0.05),但在18周时再次下降。同时在上、下肢的远端评价,下肢的近端评价中也出现类似情况;按摩4周时,患儿肌力有轻-中度降低,但按摩10周后均出现明显提高(P<0.05),按摩14周后,患儿颈、上肢近端和下肢近端的肌力也显著提高(P<0.05)。结论按摩疗法治疗可提高痉挛型CP患儿基本粗大运动能力,相应提高其生活能力。     

The Effect of Bimanual Training with or Without Constraint on Hand Functions in Children with Unilateral Cerebral Palsy: A Non-Randomized Clinical Trial

Aim: To compare the effect of bimanual training with or without constraint on manual functions in children with unilateral cerebral palsy (UCP). Methods: Seventeen children aged 6–11 years with UCP participated in one of two intensive therapeutic camps: bimanual (n = 9) incorporating one hour of constraint (“Hybrid”) or Bimanual (n = 8). Each camp met for 2 weeks, 5 days per week for 6 hours each day. The Assisting Hand Assessment (AHA) and the Jebsen Taylor Test of Hand Function (JTTHF) examined bimanual and unimanual functions pre, post- and 3-months post-intervention. Results: A significant improvement was noted in AHA scores for both groups between the pre-, post- and three months post-intervention [Hybrid (F2; 16 = 85.5, p < 0.01); Bimanual (F2; 16 = 15.4, p < 0.01)] with no significant differences between groups over time (F2; 30 = 0.74, p = 0.48). For the JTTHF, a significant improvement was noted in the affected hand following the Hybrid program (F2; 30 = 7.45, p = 0.01), while following the Bimanual program a significant difference was noted only in the less-affected hand (F2; 16 = 6.02, p < 0.01]. Conclusion: Both interventions Hybrid and Bimanual were similarly effective for improving use of the affected hand in bimanual tasks. The unique contribution of each intervention, the Hybrid program on the affected and the Bimanual on the less-affected side, warrants further examination.     

位点加穴位药物注射与功能训练治疗脑性瘫痪的对比研究

目的　研究位点加穴位药物注射与功能训练治疗脑性瘫痪 (脑瘫 )的疗效对比。方法　设研究组 1 4 4例 ,对照组 76例 ,两组年龄均为 6个月～ 7岁 ,病残程度为中、重度。研究组应用小量VitB1 、VitB1 2 ,按照脑解剖及神经生理功能在头部的投射区 (位点 ) ,结合临床表现选择部位 ,四肢按照局部肌肉功能选择注射位点。下肢瘫痪较重患儿 ,可加选L4 、L5椎间隙 ,轻度刺激神经根。对照组应用功能训练。两组均为 4个疗程 ,每疗程 2 3d。结果　两组经 1 8个月的随访观察 ,研究组总有效率96 .52 % ,对照组总有效率 73 .63 %。结论　药物注射疗法疗效好 ,见效快 ,无不良反应。     

Haptic Exploratory Procedures of Children and Youth with and without Cerebral Palsy

Aims: Compare haptic exploratory procedures (EPs) and exploratory movements (EMs) of children. This study also tested the interrater reliability of a novel digital recording method. Methods: Participants were 31 children with typical development (TD) (aged 6 years 1 month to 15 years 9 months; 14 male) and 23 children with spastic unilateral cerebral palsy (CP) (aged 6 years to 15 years 5 months; 13 males; right hemiplegia, n = 12). Results: There were no statistically significant differences between groups for expected EP (p = .15), additional EPs (p = .78), or EMs (p = .69) but there was for mean duration of exploration (p < .001) and accuracy (p < .001). This suggests that although children with CP performed similar haptic EPs for each object as children with TD, they took more time and were less accurate in their identification. There was substantial agreement between the two raters' observations of expected EP, κ = .64, p < .0005. Conclusion: Children with CP performed similar haptic EPs as their TD peers. However, despite similarities, the results indicate that for children with CP manual ability was not the primary determinant of accuracy or speed of identification. This study provides evidence for a reliable method of recording haptic EPs.     

Relationships Between Lower Limb Muscle Strength and Locomotor Capacity in Children and Adolescents with Cerebral Palsy Who Walk Independently

ABSTRACT

This study aimed to quantify relationships between lower limb muscle strength and locomotor capacity for children and adolescents with cerebral palsy (CP) to identify key muscle groups for strength training. Fifty 6- to 16-year-olds with CP (Gross Motor Function Classification System level I or II) participated. Isometric muscle strength of hip flexor and abductor, knee flexor and extensor, and ankle dorsiflexor muscles was measured using hand-held dynamometry. Ankle plantar flexor concentric muscle strength was assessed as the maximal number of unilateral heel rises. Locomotor capacity was evaluated by the 6-min walk test (6MWT), 10-meter Shuttle Run Test (10mSRT), and Timed Up and Down Stairs Test (TUDS). With control for age, sex, and height, hip flexor and ankle plantar flexor strength explained 47.8% of the variance in the 6MWT and 32.9% of variance in the TUDS and hip abductor isometric strength explained 43.5% of the variance in the 10mSRT. Avenues for future research include randomized controlled trials that specifically target hip flexor muscles, as this has not previously been done, and determining factors other than strength that are likely related to locomotor capacity of children and adolescents with CP.     

电刺激小脑顶核联合任务导向性训练对脑性瘫痪患儿运动功能的影响

目的 探讨电刺激小脑顶核(ESFN)联合任务导向性训练(TOT)对脑性瘫痪(脑瘫)患儿运动功能的影响.方法 前瞻性将60例脑瘫患儿按性别、年龄、分型及粗大运动功能量表(GMFM)-66项评分进行配对设计,分成观察组和对照组各30例.观察组采用ESFN结合TOT;对照组采用ESFN加Babath法.ESFN:电极正负极分别置于患儿双侧乳突处,脉宽50～100 US,频率80～100 Hz,强度5～15 mA,刺激时间5 s,休息时间10 s,20 min/次,1次/d.TOT及Babath训练,40 min/次,2次/d.2组疗程均为3个月.采用GMFM-66项,以盲法测评2组患儿治疗前、治疗后的粗大运动功能.结果 治疗前2组患儿性别、年龄、分型及GMFM-66项评分比较差异均无统计学意义(Pa >0.05).治疗后观察组GMFM-66项评分(55.24±11.68)较治疗前(39.81±13.17)明显提高(P=0);对照组治疗后的GMFM-66项评分(48.76±11.96)较治疗前(40.25±12.89)明显提高(P=0.0103);观察组的疗效明显优于对照组(P=0.038 0).结论 ESFN联合TOT能有效地提高脑瘫患儿的运动功能.     

Reproducibility of Task-Oriented Bimanual and Unimanual Strength Measurement in Children with Unilateral Cerebral Palsy

Aim: To examine reproducibility of the arm-hand strength measured while performing the bimanual crate task and the unimanual pitcher task. Methods: 105 children diagnosed with unilateral Cerebral Palsy, aged between 6 and 18?years, participated in this study. The test–retest reliability of the force generated during bimanual crate task and unimanual pitcher task of the Task-oriented Arm-hAnd Capacity instrument was investigated using intraclass correlation two-way random model with absolute agreement. The intraclass correlations were calculated for two age groups (6–12 and 13–18?years old). Results: The results showed good test–retest reliability for the crate and pitcher task with the non-affected hand for both age groups. The results of the pitcher task for the affected hand showed moderate test–retest reliability for both age groups. Conclusion: The Task-oriented Arm-hAnd Capacity instrument has moderate to good test–retest reliability. It is a simple and objective instrument to assess task-oriented strength in children with unilateral cerebral palsy.     

Muscle Force and Range of Motion as Predictors of Standing Balance in Children with Cerebral Palsy

SUMMARY

Children with cerebral palsy frequently receive therapeutic intervention to remediate standing balance deficits. Evaluation of the impairments associated with poor balance could facilitate more effective treatment programs. This study evaluated the relationship between lower extremity force production, range of motion and standing balance in thirty-five children between the ages of 6 and 14 years of age with spastic cerebral palsy. Standing balance was evaluated using the Pediatric Clinical Test of Sensory Interaction (P-CTSIB). Hand-held dynamometry was used to assess force production and goniometry was used to assess range of motion. The results indicated that force production and range of motion are highly related to standing balance. Blocked, hierarchical multiple regression analysis revealed that force production explained 41% of the variance in P-CTSIB scores in this sample, while range of motion explained an additional 13%. Therefore, the total variance explained by these variables was 54%. Results of this study suggest that impairment level testing may allow the development of more effective individualized intervention programs to remediate balance deficits. Clinical suggestions are provided.     

Therapeutic Effects of Horseback Riding Therapy on Gross Motor Function in Children with Cerebral Palsy: A Systematic Review

ABSTRACT

Purpose: This systematic review examined the efficacy of hippotherapy or therapeutic horseback riding (THR) on motor outcomes in children with cerebral palsy (CP). Methods: Databases were searched for clinical trials of hippotherapy or THR for children with CP. Results: Nine articles were included in this review. Although the current level of evidence is weak, our synthesis found that children with spastic CP, Gross Motor Function Classification System (GMFCS) levels I–III, aged 4 years and above are likely to have significant improvements on gross motor function as a result of hippotherapy and THR. Evidence indicates that 45-min sessions, once weekly for 8–10 weeks, result in significant effects. Conclusions: The current literature on hippotherapy and THR is limited. Large randomized controlled trials using specified protocols are needed to more conclusively determine the effects on children with CP. From the current evidence, it appears that hippotherapy and THR have positive effects on gross motor function in children with CP.