單側侷限誘發與雙側密集訓練於偏癱腦性麻痺孩童之比較：文獻回顧

目的：單側偏癱腦性麻痺孩童常伴隨上肢功能缺失，可能影響孩童的獨立性、參與、生活品質及照顧者負擔，亟需有效的實證治療。侷限誘發療法(constraint inducedtherapy, CIT)及雙側訓練(bimanual/ bilateral intensive training, BT/ BIT)為近年備受關注的上肢介入方法。本文欲透過系統性的文獻回顧，彙整並分析比較CIT與BT的臨床對照試驗研究，探討兩種療法之成效差異，並分析過去研究趨勢及不足之處。方法：作者檢索Medline、CINAHL、Cochrane Library、Web of Science、OTSeeker等電子資料庫，收錄至2015年1月之相關論文。納入條件包含：(1)在單一試驗中比較等劑量的CIMT及BT；(2)受試者為0至18歲之腦性麻痺孩童及青少年；(3)以英語發表之全文文獻。所有收錄之文獻作者將分析其實證層級與研究設計之品質，並彙整比較研究結果。結果：本文共收錄10篇實證層級佳的文獻，其皆採用嚴謹的研究設計。整體而言兩種療法成效相近，僅在部分成效指標有些微差異。CIT於單側上肢動作功能與生活品質的立即成效較佳，然長期追蹤時兩種療法成效無顯著差異；BT組則於日常生活表現、個人目標達成及雙側協調等療效具優勢，長期效果仍待探討。結論：CIT與BT皆為單側偏癱腦性麻痺孩童有效的治療方案，兩者於不同成效的面向各具優勢，可適用於不同特質的孩童。建議未來研究可探討個案年齡、特質、治療劑量等影響療效之因素，並以影像學方法比較兩種療法對於腦部可塑性的成效差異。結合兩療法的混合療法亦為值得探究之主題。

關鍵字

上肢密集治療；腦性麻痺；上肢復健

並列摘要

Objective: Constraint induced therapy (CIT) and bimanual training (BT) are two of the current evidence-based upper limb interventions; however, differences of the effectiveness between these two interventions are still unclear. This systemic review aimed to synthesize the effectiveness of CIT and BT in children with cerebral palsy. Methods: Articles published before January 2015 were retrieved from electrical databases and manual search. The inclusion criteria were studies (1) compared matched dose of CIT and BT in a single trial; (2) recruited children with cerebral palsy between 0 to 18 years old; (3) were published in English. The included articles were analyzed and synthesized, and the evidence level and methodology quality were also measured. Results: 10 randomized control trials with high methodology quality were included. Generally, CIT and BT showed minimal difference in various outcomes. CIT yielded better outcomes in uni-manual upper limb function and quality of life immediately after the treatment (however, long term treatment effect of both interventions were similar), while BT showed better improvement in occupation performance, goal achievement and bilateral coordination. Conclusion: This review supported both CIT and BT are as effective UL intervention in children with cerebral palsy, and the two interventions show advantages in different outcomes. Future research about characteristics of participants and factors effecting outcome are needed. A hybrid model comprising both interventions is another valuable issue.

並列關鍵字

Intensive upper limb therapy ； Children ； Rehabilitation

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單側侷限誘發與雙側密集訓練於偏癱腦性麻痺孩童之比較：文獻回顧

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