Background

Children with unilateral spastic cerebral palsy (USCP) exhibit impaired bimanual coordination, gait control, and whole body movement control. Intensive upper extremity training has been found to be effective for improving upper extremity function. However, the effectiveness of the intensive upper extremity training on whole body movement control is not known.

Research question

The present study aimed to evaluate the effects of Constraint Induced Movement Therapy (CIMT) and Hand Arm Bimanual Intensive Therapy (HABIT) on bimanual coordination and gait control during a complex whole body task.

Methods

Sixteen children with congenital hemiplegia (age 6–12 years; GMFCS: I-II, MACS: I-II) were randomly assigned to either CIMT or HABIT for 6 h per day training for 15 days. Children were asked to perform two whole body tasks (walking with and without a tray carrying) while 3-D kinematic analysis was performed before and after training.

Results

After training, the HABIT group increased the symmetry in height of their hands during tray carrying (more leveled tray). Both CIMT and HABIT groups decreased the lateral motion of the tray. The CIMT group increased speed and stride length after training in both the walking and tray carrying tasks. Both groups also increased their minimum toe clearance (all p < 0.05).

Significance

Two types of intensive upper extremity training have provided significant improvements to whole body movement control for children with USCP. Adhering to the specificity of practice concept, HABIT improved bimanual coordination after training during the whole body tray carrying tasks. Given extensive interactions between the upper and lower extremities in real-world activities, future studies should focus on the effects of such combined training.

中文翻译：

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强化上肢训练改善了单侧痉挛性脑瘫儿童的全身运动控制能力。

背景

患有单侧痉挛性脑瘫 (USCP) 的儿童表现出双手协调性、步态控制和全身运动控制受损。研究发现，强化上肢训练对于改善上肢功能是有效的。然而，强化上肢训练对全身运动控制的有效性尚不清楚。

研究问题

本研究旨在评估约束诱导运动疗法（CIMT）和手臂双手强化疗法（HABIT）对复杂全身任务期间双手协调和步态控制的影响。

方法

16 名先天性偏瘫儿童（年龄 6-12 岁；GMFCS：I-II，MACS：I-II）被随机分配到 CIMT 或 HABIT 组，每天训练 6 小时，持续 15 天。孩子们被要求执行两项全身任务（携带托盘行走和不携带托盘行走），同时在训练前后进行 3D 运动学分析。

结果

训练后，HABIT组在搬运托盘时提高了双手高度的对称性（托盘更加平整）。CIMT 和 HABIT 组均减少了托盘的横向运动。CIMT 组在步行和搬运托盘任务训练后增加了速度和步幅。两组还增加了最小脚趾间隙（所有p < 0.05）。

意义

两种类型的强化上肢训练显着改善了 USCP 儿童的全身运动控制能力。秉承练习理念的特殊性，HABIT在全身托盘搬运任务中训练后提高了双手的协调性。鉴于现实世界活动中上肢和下肢之间的广泛相互作用，未来的研究应重点关注这种联合训练的效果。