The effectsof intensive upper extremity training גלעד שורק 18-1

 The effectsof intensive upper extremitytraining on endurance and autonomic cardiac control system function

 in children with unilateral cerebral palsy: A clinical trial

Gilad Sorek, Marilyn Cohen-Holzer, Keren Ben Shitrit, Simon-Henri Schless, Michal Katz-Leurer

 
ABSTRACT

Aim: To assess the effects of an intensiveupper-extremity (UE) training program on UE functioning, walkingendurance and the autonomic cardiac control system in children with unilateral cerebral palsy (UCP).The selectedprogram combined bilateral and constraint-induced exercises and included a variety of modalities, among them fitness room and pooluse.

Methods: Ten children, ages 6–10 years, participated in the program for two weeks (10 days), six hours each day. Outcomes were evaluated using the Assisting Hand Assessment (AHA), Jebsen-Taylor Test of Hand Function (JTTHF), and the six-minute walk test (6MWT). Changes in the autonomic cardiac control system were measured with a Polar RS800CX device. The chosen parameters were the resting heart rate (HR) and resting heart rate variability (HRV); the latter was defined as the root mean squared of the successive differences (RMSSD). All data were collected before, immediately after, and three months post-intervention.

 
Results: A significant improvement was notedbetween the first and the third assessments in both un imanual as well as bimanual UE performance. The AHA score changed significantly, improving by9 logit units [range: 1-26]; the JTTHF improved by56 seconds [range: 217-(-55)] in the more affected hand, and by 9 seconds [range: 26-(-6)] in the less affected hand,. The 6MWT changed significantly,from a median of 438 meters [range: 294–558] at baseline to 466 [432–592] post intervention, and to 528 meters [425–609] after 3 months (p = .03). After the 3-month follow-up period,a significant change was found also in the autonomic cardiac control system, with a median decrease of 4 beats per minute in the resting HR values and a median increase of 8.5 milliseconds in the resting HRV values.

 
Conclusion: A significant carry-over improvement was achieved in both un imanual as well as bimanual UE performance following the intervention. The brief, intensive, and combined training of the UE with a variety of modalities improved not onlyUE function, but also walking endurance and regulation of the autonomic cardiac control system, in children with UCP. This approach can offer an effective therapeutic intervention for children with UCP.

Key words: Unilateral Cerebral Palsy, HABIT, CIMT, Heart rate, Heart rate variability, walking endurance.