Article

The goal of this study was to contribute evidence towards the effectiveness
of task-oriented training with and without restriction of trunk movement (trunk
restraint) on the quality of upper limb movement in children with cerebral palsy
(CP). METHOD: We used a prospective, single-subject research design in 12
children (three males, nine females; aged 6-11 y; median 9 y) with di-, hemi-, or
quadriplegia. Movements of the most affected arm were assessed five times: three
times before training, immediately after training, and 3 months after training.
The main outcome measures were the Melbourne Assessment of Unilateral Upper Limb
Function (Melbourne) and upper limb movement kinematics during a functional
reaching task. Children were randomly allocated to one of two groups:
task-oriented training with or without trunk restraint. Treatment consisted of
three 1-hour sessions per week for 5 weeks (total training duration 15 h).
Treatment effects were determined using single-subject research design
analysis--regression through baseline data and standard mean differences.
RESULTS: Although the Melbourne scores were largely unchanged after training,
some children in each group improved arm trajectory smoothness (effect size
0.55-1.87), and most children improved elbow extension range (effect size
0.55-4.79). However, more children in the trunk restraint group than in the no
restraint group demonstrated reduced trunk displacement (effect size 0.94-2.25)
and longer-term improvements in elbow extension and trunk use. Among the group
who underwent training without trunk restraint, trunk displacement was unchanged
or increased, and fewer carry-over effects were apparent at follow-up.
INTERPRETATION: This proof-of-principle study showed that greater improvement in
the quality of upper limb movement in children with CP, including less
compensatory trunk use and better carry-over effects, was achieved by training
with trunk restraint.
CI - (c) The Authors. Journal compilation (c) Mac Keith Press 2010.

Langue : ANGLAIS

Tiré à part : OUI