Effectiveness of unilateral versus bilateral intensive training in children with cerebral palsy: a randomized controlled study
Date Issued
2016
Date
2016
Author(s)
Huang, Chen-Wei
Abstract
Upper limb dysfunction is a common and disabling consequence of children with cerebral palsy (CP). They usually experience difficulties in daily living routines. Recently, a new contemporary training concept “intensive training” were emerged with evidence. Recent evidence suggests that unilateral intensive training (UIT) and bilateral intensive training (BIT) are two of the most effective intensive techniques to improve the use of the affected hand in children with CP. UIT approach focuses on training a child’s more affected hand with intensive, repetitive practice while restraining the less affected hand. BIT, on the contrary, was developed with the limitations of UIT that emphasizing on spontaneous use the more affected hand in bilateral daily activities. The purpose of this study was to investigate the effectiveness differences between individualized UIT and BIT in a home-based context on motor outcomes and emotional status. We recruited 20 participants. Participants were randomized to either UIT or BIT group, and received individualized training with 4.5 h/wk, lasts for 8 weeks (totaling 36 hours). Outcome measures were conducted at baseline, and after the entire training. Primary assessments included Melbourne Assessment-2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), ABILHAND-kids, Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Test of Playfulness (ToP) and a self-developed questionnaire: Engagement Questionnaire (EQ). The secondary outcomes included the proximal and distal part of the MA-2, a self-developed questionnaire: Satisfaction Questionnaires (SQ), and Parental Stress Index-short form (PSI-SF). Two-way ANOVA was used to investigate the treatment effects between the two groups for each outcome variable. The values of the effect size (Cohen’s d, η2 ) were also calculated for each outcome variable to present the magnitude of group differences. Results showed that the UIT made more improvements after the entire training than the BIT. For the primary outcomes, the time x training interaction occurred at the MA-2 (ROM, effect size: 0.014; Accuracy, effect size: 0.069; Fluency, effect size: 0.030), PMAL-R: amount of use (effect size: 0.241), PMAL-R: quality of movement (effect size: 0.114), ABILHAND-kids (effect size: 0.021), BOT-2: unilateral (effect size: 0.027), BOT-2:bilateral (effect size: 0.053), ToP (effect size: 0.029) and EQ (children, effect size: 0.031). The UIT made a better gain on the ROM and fluency sub-skills of the MA-2, the usage and quality of movements (as measured by the PMAL-R), the bilateral performance during the daily living environments (as measured by the ABILHAND-kids), and the both unilateral and bilateral performance of BOT-2. The BIT group revealed better improvements on the movement accuracy (as measured by the MA-2) playfulness (as measured by the ToP). In addition, participants in the BIT demonstrated a stable emotional status while the UIT group revealed a relatively low emotional level at the initial stage. As for the secondary outcomes, the time x training interaction occurred at the proximal part of the MA-2 (effect size: 0.088), the distal part of the MA-2 (effect size: 0.039), and PSI-SF (effect size: 0.018). The UIT appeared more gains on the proximal and distal upper limbs movements (as measured by the MA-2). In addition, both of the training did not made participants caregivers more stressful. Results showed the UIT made more gains on the motor function outcomes. While considering the psychosocial issues, the BIT demonstrated a better situation during the training session. In addition, we proved that with 4.5 hours per week training, children received the UIT made their improvements after the training session. However, the BIT might need more training dosage to reach improvement. This study provided a further consideration for applying the UIT and BIT on children with CP to clinical therapists.
Subjects
constraint induced therapy
intensive training
pediatric neurorehabilitation
rehabilitation
children
Type
thesis
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