新規理学療法ジャーナル

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Effect of Manipulating Object Shape, Size and Weight Combined with Hand- Arm Bimanual Intensive Training (HABIT) in Improving Upper Extremity Function in Children with Hemiplegic Cerebral Palsy-A Randomized Controlled Trial

Chandan Kumar, Rucha Mahendra Palshikar and Vaibhav Choubey

Background: Hand Arm Bimanual Intensive Training (HABIT) has proven to improve upper extremity performance and co-ordination in children with hemiplegia. Children with unilateral spastic cerebral palsy display deficits in motor planning and execution that impact the timing and co-ordination of joint movements, orientation of the hand to object size, shape, weight and use, and calibration of fingertip forces. Bilateral impaired modulation of aperture, decreased bilateral ability to orient the hand prior to object contact based on forthcoming actions with the object was also reported.

Objective: To study the effect of Manipulating object shape, size and weight combined with Hand-arm bimanual intensive training(HABIT) in improving actual use of the more affected arm for completing activities commonly carried out in daily life, child's ability to handle objects and reducing spasticity in children with hemiplegic cerebral palsy.

Material and method: Thirty patients who fulfilled the inclusion criteria were randomly allocated into two groups. Group A-HABIT with Object Manipulation, Group B- HABIT without Object Manipulation with 15 patients in each group. All the patients were evaluated with Pediatric Motor Activity Log, Modified Ashworth Scale and Manual Ability Classification System at pre-and post-treatment level.

Results: There were significant decrease in spasticity MAS (p=0.001) & improvement in upper extremity function PMAL-R (p=0.001) & MACS (p=0.001) in both the groups post intervention. HABIT with object manipulation with different shape & size group had significant improvement on PMAL-R (p=0.002) & MACS (p=0.009) but no change in spasticity MAS (p=0.679) as compared to HABIT with object manipulation with similar shape & size group.

Conclusion: From finding of this study conclude that HABIT with Object Manipulation with different shape and size have positive effect in improving upper extremity function in children with hemiplegic cerebral palsy but not in spasticity reduction after 4 weeks of intervention.