學院

醫學院

系所

職能治療學系

題名

到宅式修正侷限誘發運動療法應用於痙攣型腦性麻痺兒童之療效：先驅研究

作者

陳斐娟、吳菁宜、陳協慶、林克忠、鍾佳英、陳嘉玲*

期刊名稱

Taiwan Journal of Physical Medicine and Rehabilitation

發表日期

2011

著作性質

原著

語文

中文

關鍵字

修正式侷限誘發運動療法(modified constraint-induced movement therapy)，腦性麻痺(cerebral palsy)，動作功能(motor function)，運動學分析(kinematic analysis)，到宅服務(home-based services)

摘要

先前研究初步證實修正式侷限誘發運動療法可改善腦性麻痺兒童患側上肢的動作功能；然而，卻少有 文獻以運動學分析來驗證其動作改善之機制。為了改善此療法在臨床上可行性與兒童服從性，本研究主要 是結合臨床評估與運動學分析，探討到宅式修正侷限誘發運動療法應用於痙攣型腦性麻痺兒童之療效。 本研究採用隨機控制試驗，共選取十二位半側偏癱的痙攣型腦性麻痺兒童(六位男性、六女性)，經 隨機分成侷限誘發組與傳統治療組兩組。每組均接受四週的到宅服務介入(一週兩次、一次四個小時)。 兩組兒童介入的前後均進行臨床評估及運動學分析。臨床評估測量，包括：患側上肢的使用量與品質， 以及抓握與視動整合的進步能力；運動學分析，則包括：患側手伸臂取物之反應時間、動作時間、動作 單位數與最大瞬時速度。以療效指數(effectiveness index)做為分析。療效指數＝(後測分數－前測分數)/ 前測分數×100%。 結果顯示兩組受試者特徵皆無顯著差異。在臨床評估方面：經過治療後，侷限誘發組在精細的動作 功能上以及患側手使用量和動作品質等部份項度療效指數均較傳統復健組好(p<0.05)，但在視動整合部分 卻沒有顯著差異性(p>0.05)。在運動學評估方面：侷限誘發組在反應時間、動作單位數及動作時間療效指 數等表現皆顯著優於傳統復健組(p<0.05)，但在達最大瞬時速度(peak velocity)卻未達顯著差異。 修正式侷限誘發運動療法配合到宅服務，透過增加兒童動機與參與性，提升動作計劃、動作的流暢 度以及動作效率，進而改善患側手使用及動作品質。

Previous studies have shown beneficial effects of modified constraint-induced movement therapy (mCIMT) in improving motor functions of the upper extremities in children with spastic cerebral palsy (CP). However, there are few studies which have used kinematic analysis to validate the effectiveness and mechanisms underlying motor improvement after mCIMT. To promote clinical applicability and children’s compliance with mCIMT, this study attempted to investigate the effects of home-based mCIMT in children with spastic CP using integration of clinical measures and kinematic analysis. This study used a randomized controlled trial design. Twelve children with spastic CP (6 boys and 6 girls) were randomly assigned to mCIMT and traditional rehabilitation (TR) groups. Both groups received 4 weeks of home-based interventions with either mCIMT or TR (twice per week for 4 hours for each intervention). Clinical measures and kinematic parameters were analyzed in all children before and after the intervention. Clinical measures included the amount and quality of affected limb usage, and grasp and visual motor integration (VMI) functions. Kinematic parameters included reaction time (RT), movement time (MT), movement units (MU), and peak velocity (PV). The effectiveness index (EI) for clinical measures and kinematic parameters was calculated as follows:100% x (post-test score – pre-test score)/pre-test-score. Our results showed there were no significant differences in the baseline data and severity between the two groups. The EIs for the amount and quality of affected limb usage, and grasp functions were better in the mCIMT group than the TR group (p<0.05). The EIs for the RT, MT and MU in the mCIMT group were significantly better than in the TR group (p<0.05). However, the EIs for the VMI functions and PV showed no significant differences between groups. Our findings suggest that home-based mCIMT intervention can enhance motor planning, movement efficiency and smoothness to improve upper limb usage and motor function by increasing the motivation and participation of these children.