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題名 | 修正式侷限-誘發動作療法應用於非對稱性動作障礙腦性麻痺兒童之療效:伸臂動作之運動學分析與臨床評估=Efficacy of Modified Constraint-Induced Movement Therapy for Children with Cerebral Palsy with Asymmetric Motor Impairments: Kinematic Analyses and Clinical Evaluation |
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作者 | 林軒如; 林克忠; 吳菁宜; 許瑋丹; | 書刊名 | 臺灣職能治療研究與實務雜誌 |
卷期 | 3:1 2007[民96] |
頁次 | 頁19-29 |
分類號 | 418.996 |
關鍵詞 | 侷限-誘發動作療法; 腦性麻痺; 運動學分析; Constraint-induced movement therapy; Cerebral palsy; Kinematic analysis; |
語文 | 中文(Chinese) |
中文摘要 | 侷限誘發療法為近年來對於半邊偏癱患者所提倡的一種復健治療模式,在成人中風患者上已顯示正向之復健療效,但對於有類似表現的非對稱性動作障礙腦性麻痺兒童,卻極少有臨床實證研究,且多屬於個案觀察報告。本篇研究主要以客觀的運動學分析(kinematic analysis)系統,配合臨床評估:動作活動日誌(Motor Activity Log, MAL)及布氏動作能力測驗(Bruininks-Oseretsky Test of Motor Proficiency, BOTMP)來探討修正式侷限-誘發動作療法(modified Constraint-Induced Movement Therapy, mCIMT)對於非對稱性動作障礙腦性麻痺兒童劣勢側上肢功能的療效,並觀察受侷限後個案優勢手的相關表現。 共有16位診斷為痙攣型腦性麻痺兒童參與本研究。平均年齡為5歲11個月,分為實驗組(接受mCIMT)及控制組(接受傳統復健療法),研究時間共3週。實驗組個案以手套限制健側手活動,使用操作制約技巧,加強患側上肢使用動機和手功能訓練,每天限制總時間至少三小時;控制組則以傳統復健方式,加強患側上肢動作、手功能訓練以及雙手協調練習。兩組個案在研究期間皆接受專業職能治療師治療,每週兩回,一回一小時。兩組皆在治療介入前後各接受一次評估。 在三星期的介入後,運動學分析結果發現兩組個案劣勢側在伸臂動作的表現,在統計上並無顯著差異。但在臨床評估則顯示,實驗組個案在劣勢側上肢的使用頻率及動作品質,改善幅度較控制組明顯。而實驗組個案優勢手的動作表現與治療前並無差異,沒有因為受侷限而出現暫時性失能(temporal dysfunction)的現象。 本篇為一初探性研究。結果顯示侷限誘發療法在減量的侷限與治療條件下,對於半身偏癱腦性麻痺兒童患側上肢的使用量及動作品質仍可有效提升。未來研究可探討該療法結合其他評估方式可行性,如腦部造影工具(functional MRI),以求進一步更詳細地評量侷限誘發療法對於半身偏癱腦性麻痺兒童的療效。 |
英文摘要 | Cerebral palsy (CP) often includes motor impairments. Recent evidence suggests that children with CP may improve motor performance when provided with constrain-induced movement therapy (CIMT). While previous studies employed clinical measures to evaluate the efficacy of CIMT, this study attempted to use kinematic analyses (the spatio-temporal analysis of movement) and clinical measure to investigate the effectiveness of modified CIMT (mCIMT) on reaching performance in children with CP. Sixteen children (mean age=71 months old) with spasticity associated with CP were randomly assigned to receive either mCIMT or conventional intervention. The mCIMT program involved constraint of the less-affected upper extremity for 3 hours/day and intensive training (using shaping) of the more-affected upper extremity for 2 hours/week during the 3 weeks. The conventional intervention involved bilateral and the more-affected upper extremity training for 2 hours/week for 3 weeks. The effect of the mCIMT in the spastic CP was measured by using kinematic analysis (spatio-temporal analysis of movement) and clinical assessments (MAL and BOTMP) just prior and after intervention. After 3 weeks intervention, there were no significant differences in kinematic variables. However, children receiving modified CIMT compared with those receiving conventional treatment showed better reaching performance (i.e., a greater percentage of reach where peak velocity), and acquired more significant improvements in clinical measure. The results also revealed no temporal dysfunction of the less-affected hand after 21 days constraint. This is a preliminary research. The results revealed positive efficacy of mCIMT for children with CP with asymmetric motor impairments. Future research should increase sample size, and combine the mCIMT with other medical treatments (i.e., BoTox) to determine the effectiveness of the mCIMT for spastic CP. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。