Hippotherapy on Gross Motor Function in a Child with Hypotonic Quadriplegic Cerebral Palsy: A 1-year Follow-up

馬術治療雖已廣泛用於改善腦性麻痺兒童的粗動作功能，但尚未有文獻長期追蹤並探討其在低張型腦性麻痺兒童的成效以及了解不同馬背上治療姿勢的影響。本病例爲一位6歲四肢低張型腦性麻痺女童，治療前其四肢及軀幹呈現嚴重低張與整體發展遲緩。在12個月的馬術治療後，個案持續呈現粗動作功能的改善。我們採行兩種馬背上的治療姿勢，前3個月採行馬背上「倒坐」的姿勢，接下來的9個月療程則更改爲「橫趴肘撐」的姿勢，每次治療時間爲15分鐘，每星期2次，爲期一年。患童的粗動作功能使用「粗動作功能評估量表」、「粗動作功能分類系統」及「馬背上粗動作功能評估量表」來量化評估。在起初3個月的馬背上「倒坐」姿勢治療，患童的粗動作功能進步有限；然而，在改採「橫趴肘撐」姿勢治療後，粗動作功能呈現持續、明顯的改善。患童之「粗動作功能評估量表」向度A 的百分比由31.37%進步到82.35%，向度B由0%進步到25%；而「粗動作功能分類系統」由第五級進步到第四級；「馬背上粗動作功能評估量表」之百分比總分亦由29.17%進步到81.25%。顯示對該名低張腦性麻痺患童而言，馬背上「橫趴肘撐」姿勢的治療成效明顯較「倒坐」姿勢的治療成效爲佳。因此，馬術治療可以用於改善低張型腦性麻痺患童的粗動作功能及功能性表現，唯在選擇馬背上的治療姿勢時，需仔細評估患童能力，選擇切合患童能力的姿勢進行治療。

關鍵字

腦性麻痺；低肌張力；馬術治療；橫趴肘撐；粗動作功能

並列摘要

Hippotherapy is used to improve gross motor function in children with cerebral palsy (CP). However, the therapeutic effects of hippotherapy using specific position and its longitudinal improvements in children of hypotonic CP have not been thoroughly examined. A 6-year-old girl with hypotonic quadriplegic CP was noted to have generalized hypotonia and global delay in development before intervention. There was sustained improvement in gross motor function after 12-month hippotherapy. She received a 15-minute intervention twice a week for one year with two treatment positions being used, sitting backwards for the first 3 months and prone propped position for the next 9 months. Gross motor function was measured using Gross Motor Function Measure (GMFM-88), Gross Motor Function Classification System (GMFCS), and selected GMFM-88 items assessed on horseback (GMFM-h). The improvement was limited after initial 3-month hippotherapy with sitting backward; however, marked improvement was noted after replacing the sitting backwards program by prone propped position in the following courses. GMFM scores increased from 31.37% to 82.35% and from 0 to 25% in dimension A and B, respectively. GMFCS improved from Level V to Level IV and GMFM-h total scores also increased from 29.17% to 81.25% after the prone propped treatment. We suggested that hippotherapy might enhance gross motor performance and functional ability in hypotonic CP with appropriate treatment position.

並列關鍵字

cerebral palsy ； hypotonia ； hippotherapy ； prone propped ； gross motor function

國際替代計量

Hippotherapy on Gross Motor Function in a Child with Hypotonic Quadriplegic Cerebral Palsy: A 1-year Follow-up

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