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강직성 양하지마비 아동의 자세조절과 운동성을 위한 물리치료의 중재 내용 분석: 단면연구

A Content Analysis of Physical Therapy for Postural Control and Mobility in Children with Spastic Diplegia: A Cross-sectional Study

  • 유성호 (대전웰니스병원) ;
  • 오덕원 (청주대학교 보건의료대학 물리치료학과)
  • Yoo, Sung-Ho (Dept. of Physical Therapy, Daejeon Wellness Hospital) ;
  • Oh, Duck-Won (Dept. of Physical Therapy, College of Health Science Cheongju University)
  • 투고 : 2018.03.27
  • 심사 : 2018.04.24
  • 발행 : 2018.05.31

초록

PURPOSE: The purpose of this study was to describe and analyze the components of physical therapy interventions to enhance postural control and mobility in children with spastic diplegia. METHODS: Thirsty-eight physical therapists working in rehabilitation settings volunteered to record the components of physical therapy interventions used during 894 treatment sessions for 179 children with spastic diplegia presenting with difficulties in postural control and mobility. Descriptive statistics were used to analyze the general characteristics of the therapists, the patients, and the frequency of the interventions. A one-way analysis of variance (ANOVA) and chi-square test were used to describe the components of the interventions and the goals of treatment. RESULTS: In clinical practice, physical therapists primarily used methods including "Hands-on: facilitation" (n=1990, 36.47%) and "Hands-off: practice" (n=1355, 24.83 %). Only 13.96% (n=762) of the interventions allowed patients to be independent or active outside of the treatment sessions. Interventions reflecting the therapeutic aims were performed for sitting (17.53%), standing (18.25%), and walking (27.39%). CONCLUSION: Physical therapists mostly used "therapistled" interventions to treat impaired postural control and mobility in children with spastic diplegia. Interventions to facilitate independent activity or practice outside the treatment sessions are infrequently used. These types of interventions were used regardless of the aims of treatment.

키워드

참고문헌

  1. Barbeau H, Fung J. The role of rehabilitation in the recovery of walking in the neurological population. Curr Opin Neurol. 2001;14(6):735-40. https://doi.org/10.1097/00019052-200112000-00009
  2. Butler C, Darrah J. Effects of neurodevelopmental treatment (NDT) for cerebral palsy: an AACPDM evidence report. Dev Med Child Neurol. 2001;43(11):778-90. https://doi.org/10.1017/S0012162201001414
  3. Carr JH, Shepherd RB. Neurological rehabilitation: Optimizing motor performance. Oxford. Butterworth-Heinemann. 2003.
  4. Damiano D. Activity, activity, activity: Rethinking our physical therapy approach to cerebral palsy. Phys Ther. 2006; 86(11):1534-40. https://doi.org/10.2522/ptj.20050397
  5. Flores-Mateo G, Argimon JM. Evidence based practice in postgraduate healthcare education: A systematic review. BMC Health Services Research. 2007;7(1): 119. https://doi.org/10.1186/1472-6963-7-119
  6. Helders PJM, Engelbert RHH, Gulmans VAM, et al. Paediatric rehabilitation. Disabil Rehabil. 2001;23(11):497-500. https://doi.org/10.1080/09638280010029840
  7. Lennon S, Ashburn A. The Bobath concept in stroke rehabilitation: A focus group study of the experienced physiotherapists’ perspective. Disabil Rehabil. 2000; 22(15):665-74. https://doi.org/10.1080/096382800445461
  8. Lennon S. Gait re-education based on the Bobath concept in two patients with hemiplegia following stroke. Phys Ther. 2001;81(3):924-35.
  9. Leroux A, Pinet H, Nadeau S, et al. Task-oriented intervention in chronic stroke: Changes in clinical and laboratory measures of balance and mobility. Am J Phys Med Rehabil. 2006;85(10):820-30. https://doi.org/10.1097/01.phm.0000233179.64769.8c
  10. Ma HI, Trombly GA, Robinson-Podolski C, et al. The effect of context on skill acquisition and transfer. AJOT. 1999;53(2):138-44. https://doi.org/10.5014/ajot.53.2.138
  11. Marsden J, Greenwood R. Physiotherapy after stroke; define, divide and conquer. J Neurol Neurosurg Psychiatry. 2005;76(4):465-6 https://doi.org/10.1136/jnnp.2004.053827
  12. McMichael G, Bainbridge MN, Haan E, et al. Whole-exome sequencing points to considerable genetic heterogeneity of cerebral palsy. Mol Psychiatry. 2015;20(2):176-82 https://doi.org/10.1038/mp.2014.189
  13. Novak I, Cusick A, Lannin N, et al. Occupational therapy home programs for cerebral palsy: Double-blind, randomized, controlled trial. Pediatrics. 2009;124(4): 606-14. https://doi.org/10.1542/peds.2009-0288
  14. Novak I, Mcintyre S, Morgan C, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol. 2013; 55(10):885-910. https://doi.org/10.1111/dmcn.12246
  15. Novak I. Evidence-based diagnosis, health care, and rehabilitation for children with cerebral palsy. J Child Neurol. 2014;29(8):1141-56. https://doi.org/10.1177/0883073814535503
  16. Oskoui M, Coutinho F, Dykeman J, et al. An update on the prevalence of cerebral palsy: A systematic review and meta-analysis. Dev Med Child Neurol. 2013; 55(6):509-19. https://doi.org/10.1111/dmcn.12080
  17. Peurala SH, Titianova EB, Mateev P, et al. Gait characteristics after gait-oriented rehabilitation in chronic stroke. Restor Neurol Neurosci. 2005;23(2):57-65.
  18. Pina-Garza JE. Fenichel's clinical pediatric neurology: A signs and symptoms approach (7th ed). WB Saunders Co. 2013.
  19. Polatajko HJ, Cantin N. Exploring the effectiveness of occupational therapy interventions, other than the sensory integration approach, with children and adolescents experiencing difficulty processing and integrating sensory information. AJOT. 2010;64(3): 415-29. https://doi.org/10.5014/ajot.2010.09072
  20. Pomeroy V, Tallis R. Neurological rehabilitation: A science struggling to come of age. Physiother Res Int. 2002; 7(2):76-89. https://doi.org/10.1002/pri.244
  21. Rodger S, Brown GT, Brown A, et al. Profile of pediatric occupational therapy practice in Australia. Aust Occup Ther J. 2005;52(4):311-25. https://doi.org/10.1111/j.1440-1630.2005.00487.x
  22. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8-14.
  23. Saleh M, Korner-Bitensky N, Snider L, et al. Actual vs. best practices for young children with cerebral palsy: A survey of pediatric occupational therapists and physical therapists in Quebec, Canada. Developmental Neurorehabilitation. 2008;11(1):60-80. https://doi.org/10.1080/17518420701544230
  24. Schiariti V, Selb M, Cieza A, et al. International classification of functioning, disability and health core sets for children and youth with cerebral palsy: A consensus meeting. Dev Med Child Neurol. 2015;57(2):149-58. https://doi.org/10.1111/dmcn.12551
  25. Schmidt RA, Lee TD. Motor control and learning: A behavioral emphasis (3rd ed). Champaign. Human Kinetics. 2005.
  26. Shevell M, Majnemer A, Morin I, et al. Etiologic yield of cerebral palsy: A contemporary case series. Pediatr Neurol. 2003;28(5):352-9. https://doi.org/10.1016/S0887-8994(03)00006-7
  27. Smithers-Sheedy H, Mcintyre S, Gibson C, et al. A special supplement: findings from the Australian cerebral palsy resister, birth years 1993 to 2006. Dev Med Child Neurol. 2016;58(2):5-10. https://doi.org/10.1111/dmcn.13110
  28. Tyson S, Connell L, Lennon S, et al. What treatment packages do UK physiotherapists use to treat postural control and mobility problems after stroke? Disabil Rehabil. 2009;31(18):1494-500. https://doi.org/10.1080/09638280802627686
  29. Tyson S, Selley A. A content analysis of physiotherapy for postural control in people with stroke: An observational study. Disabil Rehabil. 2006;28(13-14): 865-72. https://doi.org/10.1080/09638280500535090
  30. Tyson S, Selley A. The development of the stroke physiotherapy intervention recording tool (SPIRIT). Disabil Rehabil. 2004;26(20):1184-8. https://doi.org/10.1080/09638280410001714781