家庭與孩童友善之居家雙側密集訓練於半側偏癱腦性麻痺孩童之應用：個案系列研究

Effectiveness of Family- and Child-friendly Home-based Bimanual Intensive Training in Children With Hemiplegic Cerebral Palsy: Case Series Study

梁凱傑(Kai-Jie Liang) ； 李冠儀(Kuan-Yi Lee) ； 黃晨維(Chen-Wei Huang) ； 張亭薇(Ting-Wei Chang) ； 陳顥齡(Hao-Ling Chen) ； 王湉妮(Tien-Ni Wang)

《職能治療學會雜誌》 38卷1期 (2020/06) Pp. 77-97

https://doi.org/10.6594/JTOTA.202006_38(1).0004

摘要

研究背景：上肢功能缺損為半側偏癱腦性麻痺兒童最常見之障礙。雙側密集訓練為近年來對於半側偏癱腦性麻痺孩童所提倡具實證基礎的復健治療模式之一。 本研究以三位臨床個案為例，採用對兒童與家庭來說較為友善之居家雙側密集訓練，探討其在半側偏癱腦性麻痺孩童的介入療效。方法：共有3位半側偏癱腦性麻痺孩童參與，所有孩童皆接受每週兩次（一次2小時、一次2.5小時），為期八周（共36小時）的居家雙側密集訓練，並在介入前後接受評估。療效評量包含墨爾本單側上肢功能評量（Melbourne Assessment 2, MA2）、布－歐氏動作精練度評量測驗第二版（Bruininks-Oseretsky Test of Motor Proficiency-2, BOT-2）分測驗三、雙手操作能力問卷兒童版（ABILHAND-kids）、兒童生活功能量表－中文版（Chinese Version of Pediatric Evaluation of Disability Inventory, PEDI-C）與參與度問卷。結果：經過36小時的介入後，所有個案在動作層級的評估（MA2與BOT-2）都有進步。在活動與參與層級的結果顯示，2位個案在日常生活表現有所進步（ABILHAND-kids與PEDI-C），參與度問卷結果顯示，孩童與家長在介入過程中都維持高的參與度。結論：根據本研究的結果，家庭與孩童友善之居家雙側密集訓練應用於半側偏癱腦性麻痺孩童是可行的，動作表現、日常生活參與表現皆有初步成效。此外，本研究提供雙側上肢密集訓練的臨床治療活動目標與範例，盼能提供臨床從業人員執行之參考。

關鍵字

神經復健 ； 半側偏癱 ； 腦性麻痺孩童 ； 上肢 ； 居家介入

並列摘要

Objective: Upper limb impairment is the most common disability in children with hemiplegic cerebral palsy (CP). Bimanual intensive training (BIT) is reported to be one of the best evidence-based neurorehabilitation programs for hemiplegic CP. The aim of this study was to examine the effectiveness of child- and family-friendly BIT program, modified from the original BIT program, in children with hemiplegic CP. Method: Three children with hemiplegic CP participated in this study. The BIT program was delivered with two times a week (2 hours and 2.5 hours respectively) for 8 weeks (36 hours in total). The outcome measure included Melbourne Assessment 2 (MA2), subtest 3 of Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), ABILHAND-kids, Chinese Version of Pediatric Evaluation of Disability Inventory (PEDI-C) and Engagement Questionnaire (EQ). Results: The results showed that all participants improved their upper limb performance on motor function (MA2 and BOT-2). Two participants showed improvement on daily function (ABILHAND-kids and PEDI-C). In addition, the parents responded high engagement to our program. Conclusions: The results of this study suggested that the child- and family-friendly BIT program is promising for improving motor and participation outcome. Moreover, guideline of the BIT is provided for clinical application, including principles of training, therapeutic goals, and recommended activities.

並列關鍵字

Neurorehabilitation ； Hemiparesis ； Cerebral Palsy ； Upper Limbs ； Home-based Intervention