兒童物理治療臨床實習教育中發展治療師訓練課程之個案報告

The Case Report of Developmental Therapist's Training Program in the Clinical Education of Pediatric Physical Therapy

梁淑敏(Sok-Man Leong) ； 廖華芳(Hua-Fang Liao)

《中華民國物理治療學會雜誌》 24卷3期 (1999/05) Pp. 192-205

https://doi.org/10.29616/JPTAROC.199905.0004

摘要

在醫療體系中，兒童物理治療現今已趨向以「系統模式」作為評估及介入之方式，強調功能性取向與各系統整體評估與介入。美國1975年通過的第94-142條「公眾法案」以及國內最近修正公佈之「兒童福利法」、「特殊教育法」及「身心障礙者保護法」皆明文規定對身心障礙兒童應擬定個別化服務計劃或個別化教育方案（individualized education plan，簡稱IEP）。而腦性痲痺兒童或年齡較小之發展障礙兒童，因其發展障礙以知覺動作為主，所以物理治療師常為主要誘發者。在此環境下，物理治療師就應具備嬰幼兒發展治療師或個案管理員之概念，以促進兒童之整體發展。因此台大醫院復健部兒童物理治療部門於1997年6月開始，要求實習生對年齡較小或特殊障礙兒童實施類似IEP之個別化服務計劃（individualizd planned program，簡稱IPP），每位實習生必須完成一份IPP之擬定與評量，以促進兒童之整體發展，並訓練實習生具備永本發展治療師之能力。本文所報告之個案便是實施者之一，個案為一名接受IPP之4歲的男孩，其診斷為中度雙邊痙孿型腦性痳痺，物理治療師根據評估結果及觀察，同時與幼稚園老師、職能治療師及家長討論所得結果，為個案撰寫了一份為期一年之IPP。經過一年之訓練後，IPP成果良好，所有目標均完成75%以上，而社會性發展目標更高達l00%，明顯看到個案之整體進步。IPP完成後，個案再接受評估，個案在粗動作及精細動作方面均有進步。而實習生在訓練課程中藉由對發展障礙兒童實施IPP，不但可增加實習生之發展治療師概念，而且對個案之整體發展有一定之效果，確實有其推行之價值。然而此訓練課程之效益如何，仍有待進一步探討。

關鍵字

物理治療 ； 障礙兒童 ； 專業執業 ； 臨床教育

並列摘要

In pediatric physical therapy the system model emphasizes on the evaluation and intervention in the systems of the child as a whole and on the functional goal approach. According to the American Public Law 94-142 and the recently amended laws in Taiwan, government is obligated to provide early multi-disciplinary intervention and individualized education programs (IEP) for disabled children. Pediatric physical therapist (PT) are the main facilitator for children with cerebral palsy or developmental delays. In such situation, a pediatric PT needs to play the role of a developmental therapist. Since June 1997, the pediatric physical therapy department of National Taiwan University Hospital started to request each senior student to design an individualized planned program (IPP) for disabled children. The aims of such training program were to train the basic ability of each senior student to be a developmental therapist and to provide an integrated intervention program for the disabled children. In this case study a 4 years old boy with moderate spastic diplegic cerebral palsy is reported. Based on results of the evaluation and discussion with parents, teachers and occupational therapists, the pediatric PT designed an one-year IPP for the child. After one year of training, 75% of the goals of the IPP were met. Improvements in various domains of the child were prominent and the ability of the students in developmental therapy also improved. The IPP and the developmental therapy training program seem worth promoting as part of the clinical education. The benefits of such training program deserve further investigation.

並列關鍵字

Physical therapy ； Children with disability ； Professional practice ； Clinical education