探險主題夏令營模式之侷限誘發療法於腦性麻痺孩童之療效研究：前驅試驗

Effectiveness of Adventure-themed Summer Camp Model of Constraint-induced Therapy on Motor and Psychosocial Outcomes in Taiwanese Children with Unilateral Cerebral Palsy: A Pilot Study

劉宜佳(Yi-Chia Liu)

指導教授 ： 王湉妮

國立臺灣大學/醫學院/職能治療研究所/碩士(2018年)

https://doi.org/10.6342/NTU201800209

摘要

腦性麻痺為造成兒童生理失能最常見的原因。侷限誘發療法為當今用以改善上肢動作功能與發展性忽略最有效的上肢介入方案之一。然而，過去在應用侷限誘發療法時時常面臨許多挑戰，包含：治療密集性導致治療師人力成本高、學齡孩童家庭難以配合、孩童對於侷限所產生之負面情緒反應、孩童缺乏動機等。本研究提出夏令營模式之侷限誘發療法以改善上述困境。本研究欲探討以探險主題夏令營模式之侷限誘發療法於腦性麻痺孩童之療效。
本研究為一單組前後測比較試驗。所有受試者須接受為期7天共36小時夏令營模式之侷限誘發療法。動作功能成效包含布魯茵克斯-歐西瑞斯基動作能力測驗(BOT-2)及墨爾本測驗(MA2)。社會心理測驗成效指標包含動機問卷(PMQ)、玩性測驗(ToP)、接受度問卷(AQ)、滿意度問卷(CSQ)及親職壓力量表(PSI)。本研究使用配對t檢定與重複量測單變量分析檢定孩童在治療期間動作功能與心理社會之變化。
本研究共納入13位半側偏癱腦麻孩童(平均年齡8歲4月±2歲4月)，夏令營介入後，受試者在動作功能(包含BOT-2及MA-2)測驗呈現顯著進步。社會心理適應部分，孩童玩性呈現進步的趨勢，且維持高度動機與接受度。家長部分則呈現高度滿意度並維持平穩的親職壓力。
此前驅試驗驗證了探險主題夏令營之侷限誘發療法於腦性麻痺孩童之療效。針對孩童上肢功能成效具初步驗證。針對社會心理適應部分，從質性與量性的結果皆顯示探險主題的夏令營相較於過去侷限誘發療法較能被孩童與其家庭接受。本介入方案能提升孩童的玩性、維持高度參與動機與接受度。在親職壓力部分顯示，孩童參與此高密集的治療方案，並不會增加照顧者的負擔或壓力。本研究結果支持此方案值得後續研究繼續探討。

關鍵字

半側偏癱 ； 團體治療 ； 上肢介入 ； 神經復健 ； 動機 ； 玩性 ； 接受度

並列摘要

Cerebral palsy (CP) is the most common motor disability in childhood. Recent evidence has suggested that constraint-induced therapy (CIT) is the one of the most effective technique to improve the use of the affected hand in children with CP. However, several challenges are identified. This study aims to use the adventure-themed summer camp CIT model to address the challenges of implementing CIT model for children with CP in Taiwan.
The current study is a single group pre-post intervention trial design. All participants received 36 hours CIT program in a 7 day adventure-themed summer camp. Motor outcomes include the Melbourne Assessment 2 (MA2) and Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). Psychosocial outcomes included motivation, playfulness, acceptability, satisfaction and parental stress which assessed by Pediatric Motivation Questionnaire (PMQ), Test of Playfulness (ToP), Acceptability Questionnaire (AQ), Clint Satisfaction Questionnaire (CSQ) and Parenting Stress Index-Short Form (PSI-SF), respectively. The paired t-test and one way repeated measure ANOVA was conducted to analyze the outcomes.
13 children (8y4 m ± 2y4m) with hemiplegic CP were recruited for this current study. Participants showed significant improvement on scores of the MA2 and BOT-2 with small to large effect. As for the psychosocial outcomes, a trend of significant improvement on child’s playfulness was found. The results demonstrate that children have high motivation while receiving the CIT programs and show well acceptance of the restraint materials. In addition, parents were satisfied with our program and shown stable parenting stress through the intervention period.
These results have confirmed that the proposed program is friendly for both children and their families. This preliminary study support the promising effectiveness of the adventure-themed camp CIT model for children with CP.

並列關鍵字

hemiplegia ； group therapy ； upper limb intervention ； neurorehabilitation ； motivation ； playfulness ； acceptance

參考文獻

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