- 期刊
修正侷限誘發動作療法應用於痙攣型腦性麻痺之追蹤分析：先驅研究
Modified Constraint-Induced Movement Therapy in Spastic Cerebral Palsy: A Pilot Study
摘要
痙攣型腦性麻痺兒童普遍伴隨著肢體動作障礙，使得在執行日常生活活動時受到限制。近年來有研究支持侷限誘發動作療法(constraint-induced movement therapy, CIMT)的應用可提升此族群孩童劣勢側上肢的動作功能。本篇研究結合運動學分析系統配合臨床評估，來探討較一般侷限時間減少的減量修正侷限誘發動作療法，對於痙攣型腦性麻痺兒童上肢功能之立即與一個月後成效。本研究共有4位痙攣型腦性麻痺兒童參與，介入時間爲3週，參與個案以手套限制優勢手活動，加強劣勢側上肢的訓練，並在治療介入前後及停止治療後一個月各接受一次評估。 結果顯示，在臨床評估方面：個案在劣勢手之使用頻率、日常活動動作相關品質、抓握型態、雙手協調等方面，皆有所改善，且改善情形在接受治療結束一個月之後仍能維持；而優勢手的表現在介入後，並不受侷限的影響使得表現退步。運動學分析上在效能運用上達到統計上顯著的差異。兩者結果皆呈現高度效應值。 減量的修正侷限誘發動作療法，可改善痙攣型腦性麻痺兒童劣勢側上肢的動作及雙手協調等，且療效可持續一段時間；此外，也可改善執行動作的效能。此結果在臨床運用上的價值在於：減量治療較易實施，兒童接受度可能較高，而家長和照護者方面的配合度也可能因此提高。未來相關研究可增加個案參與人數與控制組，配合臨床抓握型態評估及運動學分析系統更進一步證實本研究結果。
並列摘要
Children with spastic cerebral palsy (CP) usually exhibit motor deficits and limited daily activities. Studies in recent years indicated that constraint-induced movement therapy (CIMT) might improve motor performance in CP patients. Combining kinematic analysis with clinical assessments, this study investigated the effect of modified CIMT (mCIMT) in four children with spastic CP immediately and one month after treatment. During the 3-week intervention, subjects underwent task-related training using the affected hand with restraint of the unaffected hand. The experimental results revealed significant improvements of the affected hand in use frequency, movement quality, grasping pattern, and bimanual coordination, both immediately and one month after mCIMT. The performance of the less-affected hand was unaffected by the constraint. The mCIMT significant enhanced energy efficiency according to clinical and kinematic movement analysis. The mCIMT therapy improved movement performance of the affected hand, bimanual coordination, and energy efficiency immediately and one month after therapy. The clinical implications are that, in comparison with CIMT, mCIMT is easier to be implemented and may improve compliance in children with CP as well as parents or caregivers. To extend the findings of this study, future research may examine a larger sample size and enroll a control group, as well as analyze grasping patterns.
延伸閱讀
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