行為改變技術在發展障礙兒量行走訓練中之運用：病例報告

物理治療過程中常需要病患與治療師間有良好互動，以獲得較佳的治療效果。然而在小兒物理治療中，由於患童的動機和合作度不易控制，常使治療的工作事倍功半。本文之個案是一位9歲7個月的重度智能不足兒童，此個案曾分別在2歲和5歲時，因不會爬行、不能站立而接受各2到3個月時間之物理治療，但都因個案不肯合作，治療工作受影響而半途放棄。本次訓練，我們運用行為改變技術配合傳統物理治療，誘發其學習行走的意願，以一個月時間，成功地訓練病童使用助行器獨立行走，成效良好，鑑於國內尚無此類病例報告，特此提出並回顧文獻加以討論，以供參考。

關鍵字

行走訓練；行為改變技術；物理治療；小兒科

並列摘要

That patients have good motivation and cooperation during training process of physical therapy is very important for getting efficient effect of treatment. Unfortunately, it is difficult to well control the motivation and cooperation of patients during training process. For this reason, behavior modification has been used frequently in the training process of pediatric physical therapy in states for years. But it is not popular in Taiwan. To introduce the concept, principles and methods of behavior modification in pediatric physical therapy, the authors review the related articles and present a case report on one child with severely mental retardation. He was a nine-year-and-seven-month-old boy, coming for ambulation training. He had been brought to department of physical therapy for ambulation training twice before, but that didn't work due to his poor motivation and cooperation during training process. He could shuffle on bottom and walk with the support by two hands, But most of time, he just sat still and asked someone else to bring things what he wanted to him. He was not willing to move at all and unable to crawl and stand up with furniture and cruise. After treatment with behavior modification (including positive reinforcement and behavior shaping) and functional training, this patient was willing to walk and could walk independently with walker in one month. For some children with purely mental retardation, to facilitate the motivation to learn is the key point in the training of motor function. And that is the reason, behavior modification could motivale the child and make independently walking possible. Besides, to combine behavior modification in the training process of physical therapy for other pediatric patients-such as cerebral palsy, spinal bifida, mutiple handicapped children and children with chronic pain-to get greater effect was mentioned by other authors. Our experience indicates that well-applied behavior modification combined with physical therapy may be better in pediatric clinic than the traditional physical therapy, but it needs further study.

並列關鍵字

Ambulation training ； Behavin modification ； Physical therapy ； pediatrics

國際替代計量

行為改變技術在發展障礙兒量行走訓練中之運用：病例報告

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