居家介入對動作發展遲緩兒童日常功能之影響

The Effects of Home Visit on the Daily Function of Children with Motor Developmental Delay

廖雅芳(Ya-Fang Liao)

指導教授 ： 王慧儀

高雄醫學大學/醫學院/神經學科研究所/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00071

摘要

背景與目的：「居家介入」(home visit)為專業人員至兒童的居家生活環境當中，評估環境之物理條件及觀察家庭成員間的動態關係，繼而提供適當衛教服務、親職支持及促進親子互動、確認問題並協助找出解決策略或提供兒童直接服務。居家介入是在提供發展遲緩兒童的療育處理當中常用的一種介入策略。在國外有相當豐富的研究資料報告有關家庭訪視療育介入的解說及其成效，而目前台灣的早療服務體制中，最常應用的資源為兒童及家長前往醫療院所接受以兒童為基礎(child-based)的治療服務。隨著近年療育人員重視世界衛生組織(WHO)所提倡的健康概念，強調應同時重視人們的生活參與層面及環境因素，因此本研究的目的為藉由居家介入，特別針對動作發展遲緩的兒童，探討對其日常生活功能之成效、相關因素、家長對介入之滿意度，及影響家長參與之相關因素。
方法：本研究使用準實驗、單盲設計(Quasi-Experimental design)，利用嬰幼兒綜合發展測驗之動作分測驗（CDIITMS）做為篩選條件，收錄40名0-7歲動作發展遲緩兒童，以隨機方式分成實驗組及對照組，二組皆需在4個月內接受二次物理治療師到宅的居家介入。由同一位物理治療師執行居家介入，針對實驗組的介入內容為1.依居家環境及兒童發展能力，給予居家活動建議，2.直接示範訓練技巧，3.給予輔具或環境改造建議，4.對家庭成員提供情緒支持，5.協助問題解決及6.教養態度的建議；對照組的介入內容為情緒支持及一般福利資訊提供。此外，由另一位研究人員採用兒童功能障礙評量表（PEDI）進行居家介入前、後及追蹤的測量，評量結果作為介入成效的指標，此人員未被告知各兒童所屬分組。使用獨立樣本T檢定、配對T檢定及變量變異數分析方法，進行研究資料的分析。
結果：二組個案基本資料為：實驗組的女、男各10名，平均年齡：3.78±1.15歲；對照組女、男分別為9及11名，平均年齡：4.28±1.03歲。PEDI的測量結果為實驗組在六個分項當中，組內的前-後測及前-追蹤比較皆有顯著的差異；對照組在功能性技巧及照顧者協助程度的移位領域在前-後測有達顯著差異、在功能性技巧的自我照顧及社會功能及照顧者協助程度的移位及社會功能領域在前-追蹤有達顯著差異；在二組的前-後測及前-追蹤的改變量，實驗組在PEDI的六個分項皆較對照組有顯著差異。在變量變異數分析中，功能性技巧和的自我照顧和移位領域皆有顯著的時間及時間乘以組別的交互作用。
結論：二組發展遲緩兒童隨著時間在發展領域上皆有某種程度的發展，二個月一次的專業居家介入能有效幫助動作發展遲緩兒童獲得自我照顧及移位的功能性技巧。

關鍵字

居家介入 ； 早期療育 ； 發展遲緩 ； 物理治療

並列摘要

Background:
Home visit is a common type of family based early intervention service which facilitates children’s development, parent-child interaction, confirm problem, problem solving, and direct service. In many countries, there already are plenty of researches and studies on information and effectiveness of home visit. Currently, the most common early intervention resources in Taiwan used have been child-based therapy provided by hospitals. Recently years, caregivers have focused their attention on the concept of health promoted by WHO. It emphasizes the importance of attention to both human participation and environmental influences.
Purposes:
The purposes of this research are to determine:
1. the effects of home visit on daily living function of children with developmentally motor delay.
2. the correlation between the effects of home visit and relative demographic factors.
3. the factors which relate with parent's satisfaction and their participation in home visit.
Methods:
This study uses a quasi-experimental single-blind design. Forty children aged younger than 7 years old were randomly assigned to experiment group (EG) and controlgroup (CG). The inclusion criterion of these children was that their test score was less than two standard deviation on a standardized screening test, the Comprehensive Developmental Inventory for Infants and Toddlers- Motor Subscale. A common assessment tool, the Pediatric Evaluation of Disability Inventory (PEDI) was used for assessing the daily living function of both groups’ children in two-month interval within 4 months; that was three assessments were conducted: pre-test (before home visit), post-test (just after home visit) and follow-up test (2 months after home visit). A physical therapist executed home visit programs for both groups twice in 4 months. The home visit programs consisted of direct training, task or environment modification, demonstrationof using assistance device and emotional support for the EG but only emotional support was given to the CG. Two sample t test, paired t test, and MANOVA were used for statistical analyses.
Result:
The mean (SD) age of the EG was 3.78(1.15) years old (yrs) and the CG was 4.28(1.03) yrs. There were 20children, 10 boys and 10 girls in the EG, and 11 boys and 9 girls in the CG. The scores on PEDI showed that the EG has significant differences between post-test and pre-test and also between follow-up-test and pre test in the six PEDI domains: domains of self care, mobility and social function in the PEDI Functional Skills Scale(FSS) and the domains of self care, mobility and social function in the PEDI Caregiver Assistance Scale(CAS). Besides, the CG has significant differences in scores between post-test and pre-test in the mobility domains of FSS and CAS, and also significant differences in scores between follow up-test and pre–test in the domains of self care and social function of FSS and the domains of mobility and social function of CAS. The improvements in scores on PEDI FSS and CAS of the EG were greater than those of the CG. In addition, there were significant time X group interaction for the scores on the domains of self care and mobility of FSS of the EG.
Discussion:
Both groups of developmentally delayed children have different levels of improvement in daily living function. Our home visit programs of once every two months was proved having positive effects for our preschool children with motor delay in their daily living domains of functional self care and mobility.

並列關鍵字

home visit ； early intervention ； developmental delay ； physical therapy

參考文獻

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