侷限誘發療法對半側偏癱腦性麻痺兒童的運用：病例報告

Constraint-Induced Movement Therapy for a Child with Hemiplegic Cerebral Palsy: A Case Report

吳紋綺(Wen-Chi Wu) ； 吳宜華(Yee-Hwa Wu) ； 張雪鳳(Hsueh-Feng Chang) ； 黃芝葦(Chih-Wei Huang) ； 洪禎雯(Jen-Wen Hung)

《台灣復健醫學雜誌》 34卷2期 (2006/06) Pp. 111-118

https://doi.org/10.6315/2006.34(2)07

摘要

患側手的廢用是半側偏癱腦性麻痺兒童常見的問題。本研究的目的是探討侷限誘發療法(constraint-induced movement therapy)是否能改善半側偏癱腦性麻痺兒童患側手的功能和使用率，及此治療方式對健側手是否會有不好的影響？這是一個病例研究，我們報告一位5歲的右側偏癱腦性麻痺男童接受八週的侷限誘發療法的效果。在八週的治療期間，個案的好手需穿戴副木限制其使用，每天至少八個小時。我們選擇Peabody Developmental Motor Scales第二版(PDMS-Ⅱ)來評估患側手的功能、Bruininks-Oseretsky Test of Motor Proficiency (BOTMP)來評估健側手功能變化狀況和15分鐘的遊戲錄影來記錄男童患側手的使用率。評估時間為治療前一週、治療第四、八週和治療結束後第八週。我們發現個案患側手的PDMS-Ⅱ標準分數在治療第四週後明顯進步，且這個進步一直持續到治療結束後第八週。15分鐘的遊戲錄影也發現患側上肢使用率持續進步。而BOTMP評估顯示此治療方式並不會減低健側上肢功能。從這個個案報告我們看到侷限誘發療法對半側偏癱腦性麻痺兒童的治療效果，且效果可持續到治療結束後八週。我們將擴大研究對象，以確定其療效可類化到其他半邊偏癱的腦性麻痺兒童身上。

關鍵字

半邊偏癱腦性麻痺兒童 ； 侷限誘發療法 ； 習得廢用症

並列摘要

Non-use of the affected hand is a common symptom of children with hemiplegic cerebral palsy (CP). This report describes the effects of constraint-induced movement therapy in a child with hemiplegic CP, focusing on function and use frequency of the affected hand. Additionally, possible harmful affect on the non-affected hand is also assessed. This study concerns a five-year-old male, with right hemiplegic CP, who received constraint-induced movement therapy for 8 weeks. Throughout the therapy period, the boy wore a splint for at least 8 hours per day to limit movement to the non-affected hand. Functional changes of the affected hand were assessed with the Peabody Developmental Motor Scales-2 (PDMS-2) and in the non-affected hand with Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) at 1 week prior to therapy and weeks 4 and 8 during therapy, and at week 8 post-therapy. At the time points, the child was videotaped while playing for 15 minutes. The boy's affected hand had a significant improved score of PDMS-2 at week 4 of therapy. This improvement remained at week 8 post-therapy. Analysis of the videotape data, we also indicated that the use frequency of the affected hand had increased. The BOTMP assessment demonstrated that therapy did not impact the non-affected hand. This report shows that constraint-induced movement therapy improved function and use frequency of this hemiplegic CP boy's affected hand. Additionally, improvement persisted for 8 weeks after therapy was finished. As this is only a single case, a further study will enroll more cases to determine whether these findings are applicable to other subjects with hemiplegic CP.

並列關鍵字

hemiplegic cerebral palsy ； constraint-induced movement therapy ； learned non-use