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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
書刊名：臺灣職能治療研究與實務雜誌
作者：林軒如／林克忠／吳菁宜／許瑋丹
作者(外文)：Lin, Hsuan-ju／Lin, Keh-chung／Wu, Ching-yi／Hsu, Woei-dan
出版日期：2007
卷期：3:1
頁次：頁19-29
主題關鍵詞：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
原始連結：連回原系統網址new window
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  • 點閱點閱:16
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。
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.
期刊論文
1.Fedrizzi, E.、Pagliano, E.、Andreucci, E.、Oleari, G.(2003)。Hand function in children with hemiplegic cerebral palsy: Prospective follow up and functional outcome in adolescence。Developmental Medicine and Child Neurology，45(2)，85-91。  new window
2.Taub, E.、Ramey, S. L.、DeLuca, S.、Echols, K.(2004)。Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment。Pediatrics，113(2)，305-312。  new window
3.Volman, M. J.、Wijnorks, A.、Vermeer, A.(2002)。Effect of task context on reaching performance in children with spastic hemiparesis。Clinical Rehabilitation，16(6)，684-692。  new window
4.Boyd, R. N.、Morris, M. E.、Graham, H. K.(2001)。Management of upper limb dysfunction in children with cerebral palsy: a systematic review。European Journal of Neurology，8(Suppl. 5)，150-166。  new window
5.Chang, J. J.、Wu, T. I.、Wu, W. L.、Su, F. C.(2005)。Kinematical measure for spastic reaching in children with cerebral palsy。Clinical Biomechanics，20(3)，381-388。  new window
6.Charles, J.、Lavinder, G.、Gordon, A. M.(2001)。Effects of constraint-induced therapy on hand function in children with hemiplegic cerebral palsy。Pediatric Physical Therapy，13(2)，68-76。  new window
7.DeLuca, S. C.、Echols, K.、Ramey, S. L.、Taub, E.(2003)。Pediatric constraint-induced movement therapy for a young child with cerebral palsy: two episodes of care。Physical Therapy，53(11)，1003-1013。  new window
8.Eliasson, A. C.、Krumlinde-Sundholm, L.、Shaw, K.、Wang, C.(2005)。Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: An adapted model。Developmental Medicine and Child Neurology，47(4)，266-275。  new window
9.Fetters, L.、Kluzik, J.(1996)。The effects of neurodevelopmental treatment versus practice on the reaching of children with spastic cerebral palsy。Physical Therapy，76(4)，346-358。  new window
10.Gordon, A. M.、Charles, J.、Wolf, S. L.(2005)。Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy:Development of a child-friendly intervention for improving upper-extremity function。Archives of Physical Medicine and Rehabilitation，86(4)，837-844。  new window
11.Karman, N.、Maryles, J.、Baker, R. W.、Simpser, E.、Berfer-Gross, P.(2003)。Constraint-induced movement therapy for hemiplegic children with acquired brain injuries。Journal of Head Trauma Rehabilitation，18(3)，259-267。  new window
12.Kluzik, I.、Fetters, L.、Coryell, J.(1990)。Quantification of control: A preliminary study of effects of neurodevelopmental treatment on reaching of children with spastic cerebral palsy。Physical Therapy，70，65-78。  new window
13.Ma, H, I.、Trombly, C. A.、Tickle-Degnen, L.、Wagenaar, R. C.(2004)。Effect of one single auditory cue on movement kinematics in patients with parkinson's disease。American Journal of Physical Medicine and Rehabilitation，83，530-536。  new window
14.Siegert, R. J.、Lord, S.、Porter, K.(2004)。Constraint-induced movement therapy: Time for a little restraint。Clinical Rehabilitation，18(1)，110-114。  new window
15.Steenbergen, B.、van Thiel, E.、Hulstijn, W.、Meulenbroek, R. G.(2000)。The coordination of reaching and grasping in spastic hemiparesis。Human Movement Science，19，75-105。  new window
16.van der Heide, J. C.、Fock, J. M.、Otten, B.、Stremmelaar, E.、Hadders-Algra, M.(2005)。Kinematic characteristics of reaching movements in preterm children with cerebral palsy。Pediatric Research，57(6)，883-889。  new window
17.van der Lee, J. H.(2003)。Constraint-induced movement therapy: Some thoughts about theories and evidence。Journal of Rehabilitation Medicine，Suppl 41，41-45。  new window
18.Willis, J. K.、Morello, A.、Davie, A.、Rice, J. C.、Bennett, J. T.(2002)。Forced use treatment of childhood hemiparesis。Pediatrics，110(1)，94-96。  new window
19.Wu, C. Y.、Trombly, C. A.、Lin, K. C.、Tickle-Degnen, L.(2000)。A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability。Archives of Physical Medicine and Rehabilitation，81，95-101。  new window
20.Hadders-Algra, M.、van der Fits, I.、Stremmelaar, E. F.、Touwen, B. C.(1999)。Development of postural adjustments during reaching in infants with cerebral palsy。Developmental Medicine and Child Neurology，41(11)，766-776。  new window
21.McCrea, P. H.、Eng, J. J.、Hodgson, A. J.(2002)。Biomechanics of reaching: clinical implications for individuals with acquired brain injury。Disability and Rehabilitation，24(10)，534-541。  new window
圖書
1.Shumway-Cook, A.、Woollacott, M. H.(1995)。Motor Control: Theory and Practical Applications。Lippincott Williams & Wilkins。  new window
圖書論文
1.Brooks, V. B.、Cooke, J. D.、Thomas, J. S.(1973)。The continuity of movent。Control of Posture and locomotion。New York：Plenum。  new window
 
 
 
 
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