Article

High-intensity training aims to improve hand function in children
with unilateral spastic cerebral palsy (USCP). However, the extent to which skill
training is required is not known. Objectives.
To compare the effects of
intensive bimanual training with and without structured progression of skill
difficulty, on manual dexterity, bimanual hand use, daily functioning, and
functional goals in children with USCP. Method.
Twenty-two children were
randomized to structured practice group (SPG) or unstructured practice group
(UPG), and received 6 h/d training during 15 days. Children from the SPG were
engaged in fine and gross motor bimanual activities, with skill progression and
goal training. Children from UPG performed the same activities without skill
progression or goal training. Participants were evaluated before, immediately and
6 months after training by a physical therapist blinded to group allocation. The
primary outcomes were the Jebsen-Taylor Test of Hand Function (JTTHF) and
Assisting Hand Assessment (AHA). Secondary outcomes included the Canadian
Occupational Performance Measure (COPM), Pediatric Evaluation of Disability
Inventory (PEDI), and ABILHAND-Kids. Results. Both groups showed similar
improvements in the JTTHF, AHA, ABILHAND-Kids, COPM-satisfaction, and PEDI (P <
.05). A significant interaction in the COPM-performance scale
(P = .03) showed
superior improvements of the SPG immediately, but not 6 months, after the
intervention. Conclusions: Children from both groups demonstrated improvements in
dexterity and functional hand use. This suggests that for intensive bimanual
approaches, intensive training at such high doses may not require structured
practice to elicit improvements. However, there may be immediate added benefit of
including goal training.
CI - (c) The Author(s) 2013.

Langue : ANGLAIS