| Popis: |
Uvod: Cerebralna paraliza (CP) je neprogresivna, nevro-razvojna motnja, ki nastane zaradi nepravilnosti v razvoju možganov med nosečnostjo, porodom ali pa v zgodnjem otroštvu. Pojavnost CP v svetu je od 2 do 2,5 na 1000 živorojenih otrok. CP vpliva na razvoj gibanja in drže. Z motoričnimi spretnostmi roke (seganje, prijemanje in manipulacija) imajo največje težave otroci s hemiparetično obliko CP, zato velikokrat nehajo uporabljati prizadeti ud pri vsakodnevnih aktivnostih. Eden od terapevtskih pristopov za izboljšanje motoričnih spretnosti roke je terapija z omejevanjem (Constraint-induced movement therapy – CIMT). Namen: Iz pregleda literature ugotoviti, kakšni so dokazi za uporabo CIMT pri otrocih s CP in kakšno vlogo ima pri tem delovni terapevt. Metode dela: Narejen je bil pregled literature. Literatura je bila iskana v bibliografskih bazah Web of Science, CINAHL, PubMed in OTseeker. V končno analizo je bilo vključenih 12 člankov. Rezultati: Iz analize člankov smo oblikovali tri glavne teme: protokoli CIMT (podteme: časovno obdobje, okolje, aktivnosti v obravnavi in starost), učinkovitost CIMT (podtema: dolgoročni učinki CIMT) in vloga delovnega terapevta. Razprava in zaključek: V pregledu literature smo ugotovili, da je CIMT učinkovita intervencija za izboljšanje motoričnih spretnosti roke pri otrocih s CP. CIMT je pozitivno vplivala na spontano uporabo prizadetega uda pri vsakodnevnih aktivnostih, otroci so postali tudi bolj samostojni. Pregled literature kaže, da CIMT ni primerna intervencija za izboljšanje mišičnega tonusa, glede prijemanja pa so mnenja avtorjev različna. Raziskave kažejo na različne rezultate učinkov in trajanja. Pri nekaterih raziskavah je napredek obstal 6 mesecev, pri drugih pa je napredek upadel po končanih terapijah. Navajajo, da napredek ni odvisen od starosti. CIMT se najpogosteje izvaja v domačem okolju, saj je otrok v tem okolju najbolj sproščen in motiviran. Glavna vloga delovnega terapevta je, da pripravi načrt obravnav na podlagi otrokovih sposobnosti in rezultatov začetnih meritev. Upoštevati mora cilje otrok in staršev ter razpoložljivost okolja. Introduction: Cerebral palsy (CP) is a non-progressive, neurodevelopmental disorder that results from abnormalities in brain development during pregnancy, childbirth or early childhood. The worldwide incidence of CP is between 2 and 2.5 per 1000 live births. CP affects the development of movement and posture. The motor skills of the hand (reaching, grasping and manipulation) are most difficult for children with hemiparetic CP, who often stop using the affected limb in everyday activities. One therapeutic approach to improve hand motor skills is Constraint-induced movement therapy (CIMT). Aim: To review the literature to determine the evidence for the use of CIMT in children with CP and the role of the occupational therapist. Methods: The literature was searched in the bibliographic databases Web of Science, CINAHL, PubMed and OTseeker. Twelve articles were included in the final analysis. Results: Three main themes emerged from the analysis of the articles: CIMT protocols (subthemes: time period, setting, treatment activities and age), CIMT effectiveness (subthemes: progress and long-term effects of CIMT) and the role of the occupational therapist. Discussion and conclusion: In our literature review, we found that CIMT is an effective intervention to improve hand motor skills in children with CP. CIMT had a positive effect on the spontaneous use of the affected limb in activities of daily living, and the children became more independent. We also found that CIMT is not an appropriate intervention to improve muscle tone, and authors have different opinions regarding grasping function. In some studies, progress persisted for 6 months, while in others progress declined after the therapies were completed. CIMT can be performed in a variety of settings, but it is most often performed in the home environment, as this is where the child is most relaxed and motivated. The main role of the occupational therapist is to develop a treatment plan based on the child's abilities and the results of the initial measurements. It should take into account the goals of the child and the parents and the availability of the environment. |
