Upper extremities habilitation programs in children with unilateral cerebral palsy

U ovom preglednom radu predstavljene su najčešće istraživane i najučinkovitije metode koje se koriste u (re)habilitaciji gornjih udova djece s unilateralnom cerebralnom paralizom – terapija prisilno induciranog motoričkog pokreta i intenzivna bimanualna terapija. Djeca s unilateralnom cerebralnom paralizom imaju teškoće u korištenju gornjih udova zbog oštećenja mozga koje se dogodilo rano u razvoju. Često zanemaruju svoju (više) zahvaćenu ruku tijekom igre i aktivnosti svakodnevnog života zbog spasticiteta, mišićne slabosti i senzoričke disfunkcije. Iako je cerebralna paraliza nepromjenjivo stanje koje pojedinca prati kroz cijeli život, većina istraživanja i terapijskih pristupa odnose se na djecu. Postignut je veliki napredak u prevenciji i ublažavanju simptoma te povećanju funkcionalnosti djece s unilateralnom cerebralnom paralizom, ali još uvijek postoje velike razlike u učinkovitosti pojedinačnih metoda rehabilitacije kada se primjenjuju u heterogenoj grupi djece s istom dijagnozom. Kako bi se odredilo najbolje vrijeme početka, trajanje i intenzitet učinkovite terapije, potrebno je razumjeti neurološku pozadinu ovog poremećaja. Povezivanjem funkcije gornjih udova i motoričke kore s integritetom kortikospinalnog puta mogu se stvarati i razvijati učinkoviti pristupi terapiji gornjih udova kod djece s unilateralnom cerebralnom paralizom. Dostupnost znanstveno utemeljenih metoda važna je kako bi se izabrao najprikladniji pristup prema potrebama djeteta i mogućnostima obitelji. Izbor primjerenog tretmana povećava mogućnost da dijete dosegne svoj maksimalni funkcionalni potencijal uz ograničenja nametnuta strukturalnom ozljedom mozga.This review presents the most researched and most effective methods used in (re) habilitation of the upper limbs of children with unilateral cerebral palsy – Constraint-Induced Movement Therapy and Bimanual Intensive Therapy. Children with unilateral cerebral palsy experience difficulties using their hands together secondary to disturbances that occur in the developing fetal or infant brain. The (more) affected hand is often disregarded during play and activities of daily living due to spasticity, muscle weakness, and sensory dysfunction. Although cerebral palsy is uncahnging condition that lasts throughout life, most studies and therapeutic approaches apply to children. Great progress has been made in preventinon and reduction of symptoms and increasing the functionality of children with unilateral cerebral palsy, but there are still large differences in the effectiveness of specific rehabilitation method when applied in a heterogeneous group of children with the same diagnosis. In order to determine the offset, duration and intensity of effective therapy, it is necessary to understand the neurological basis of this disorder. Effective approaches to upper limb therapy in children with unilateral cerebral palsy can be created and developed by linking the function of upper extremities and motor cortex with corticospinal tract integrity. In order to select the most appropriate approach according to the needs of the child and the capabilities of the family, the availability of evidence-based methods is important. Choosing the appropriate treatment approach increases the child's ability to reach his or her maximum functional potential with the restrictions imposed by structural brain injury