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夏令營模式之複合治療方案於半側偏癱腦性麻痺孩童之應用

Application of Camp-Based Hybrid Intervention in Children With Unilateral Cerebral Palsy

摘要


研究背景與目的:上肢功能損傷為半側偏癱腦性麻痺孩童常見的問題。侷限誘發療法(constraint-induced therapy)及雙側上肢密集訓練(bimanual intensive training)為現行用於改善其上肢功能,最具實證基礎的治療方式。考量侷限誘發療法及雙側上肢密集訓練各有其特色與優點,本研究目的為探討採夏令營模式的複合治療方案應用於半側偏癱腦性麻痺孩童的可行性。方法:6位年齡介於5至12歲且任一上肢關節Modified Ashworth Scale不大於2之半側偏癱腦性麻痺孩童接受為期六天,平均每天6小時,共36小時的複合治療方案,並在介入前後進行評估。動作層面評估包含墨爾本單側上肢功能評量第二版(Melbourne Assessment 2, MA2)和布魯茵克斯-歐西瑞斯基動作能力測驗第二版(Brunininks-Oseretsky Test of Motor Proficiency-2, BOT-2)分測驗三:手部靈巧度測驗。心理社會層面評估包含參與度問卷、家長意見回饋表和聯絡簿上的回饋。本研究採用魏克生符號檢定(Wilcoxon signed-rank test)來分析動作層面的前後測分數,並以r值代表效應值,心理社會層面則使用描述性統計和質性描述表示。結果:經過36小時的介入後,在動作層面評估中,MA2具有大的效應值(r= 0.55-0.91),BOT-2分測驗三具有中等的效應值(r = 0.41)。在心理社會層面評估中,孩童每日的平均參與度為4.79分(滿分5分),家長的平均接受度為4.82分(滿分5分)。家長亦於聯絡簿中提及介入後孩童的動作品質和自信心提升,且過程中也提供同儕互動的機會。結論:由本研究的結果顯示36小時的複合治療方案對半側偏癱腦性麻痺孩童的動作表現具有初步的成效,且家長和孩童的參與度及接受度高,可行性良好。未來可增加樣本數及進行追蹤評估,以提供更好的實證結果。

並列摘要


Purpose: Upper limb dysfunction is a typical impairment in children with unilateral cerebral palsy (UCP). Constraint-induced therapy (CIT) and bimanual intensive training (BIT) are two of the most frequently used approaches with solid evidence to support their effectiveness. Considering each approach has its unique advantages, this study aimed to investigate the preliminary effectiveness of a day-camp hybrid model that combined both CIT and BIT approaches for children with UCP. Method: Six children with UCP, aged 5-12 years, with muscle tone no more than 2 in the Modified Ashworth Scale were recruited to receive a day-camp hybrid model for six days (36 hours in total). All children were assessed at pre- and post-treatment. The motor outcomes included the Melbourne Assessment 2 (MA2) and subtest 3 of the Brunininks-Oseretsky Test of Motor Proficiency-2 (BOT-2). The psychosocial outcomes included the Engagement Questionnaire, Parents' Feedback Chart, and daily dialog notes. Wilcoxon signed-rank test was used to analyze motor outcomes, and r was reported as effect sizes. Descriptive statistics and qualitative descriptions were used for psychosocial outcomes. Results: In terms of motor outcomes, the effect sizes were large in MA2 (r = 0.55-0.91) and moderate for subtest 3 of BOT-2 (r =0.41). For psychosocial outcomes, the Engagement Questionnaire and the Parents' Feedback Chart mean scores were 4.79 and 4.82, respectively. According to the daily dialog notes, the parents recognized that this camp offered opportunities for their children to interact with peers. In addition, the parents mentioned notable improvements in manual function and self-confidence after the camp. Conclusions: The preliminary study indicated that the hybrid day-camp model is a feasible and promising intervention with high engagement and acceptability for children with UCP and their parents. To provide stronger evidence, larger sample sizes and follow-up evaluations are recommended in future research.

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