Bumin Gonca, Kavak Sermin Tukel
Hacettepe University School of Physical Therapy and Rehabilitation, Samanpazari Ankara, Turkey.
Disabil Rehabil. 2008;30(18):1374-85. doi: 10.1080/09638280701673609.
This study investigated the effects of sensory-perceptual-motor and cognitive functions on handwriting performance in primary-school children with left-hemiplegic cerebral palsy, compared with that of their healthy peers.
The study included 26 children aged 8-12 years with left-hemiplegic cerebral palsy and 32 typically developing children of similar age with dominant right hand. The Minnesota Handwriting Assessment was used to evaluate handwriting ability. The Bruininks- Oseretsky Test of Motor Proficiency was used to assess motor performance. Cognitive function was assessed by the Loewenstein Occupational Therapy Cognitive Assessment. The Ayres Southern California Sensory Integration Tests were used to assess visual perception, kinaesthesia, and graphesthesia.
Statistically significant differences were found between the two groups in sensory-perceptual-motor and cognitive function and in handwriting ability (p < 0.05). There were also significant correlations between handwriting parameters and upper-extremity speed and dexterity, proprioception, bilateral coordination, visual and spatial perception and, visual-motor organisation in children with cerebral palsy (p < 0.05).
The results showed that left-hemiplegic children with cerebral palsy whose right sides were dominant were significantly less competent at handwriting than their right-dominant, healthy peers. It was found that the impairment in proprioception seen in the non-hemiplegic side in children with cerebral palsy, and also the impairment in bilateral coordination, speed and dexterity of the upper extremities, visual and spatial perception, visual-motor organization, and tactile-sensory impairments negatively affected their handwriting skills. In the treatment approaches for children with hemiplegic cerebral palsy, comprehensive sensory-perceptual-motor assessments that involve both extremities must be performed in detail at the earliest possible stage, in order to minimize the existing problems with early-treatment policies. Developing the sensory-perceptual-motor and cognitive function of hemiplegic children would thus be possible, and they would be able to adapt to the same primary-school curriculum as their healthy peers.
本研究调查了左侧偏瘫型脑瘫小学生的感觉-知觉-运动和认知功能对其书写表现的影响，并与健康同龄人进行了比较。
该研究纳入了26名8至12岁的左侧偏瘫型脑瘫儿童以及32名年龄相仿、右利手的正常发育儿童。采用明尼苏达笔迹评估来评估书写能力。使用布吕宁克斯-奥塞雷茨基运动技能测试来评估运动表现。通过洛温斯坦职业治疗认知评估来评估认知功能。使用艾尔斯南加州感觉统合测试来评估视觉感知、动觉和图形觉。
两组在感觉-知觉-运动和认知功能以及书写能力方面存在统计学显著差异（p < 0.05）。脑瘫儿童的书写参数与上肢速度和灵活性、本体感觉、双侧协调、视觉和空间感知以及视觉-运动组织之间也存在显著相关性（p < 0.05）。
结果表明，右侧为主导的左侧偏瘫型脑瘫儿童在书写方面的能力明显低于其右利手的健康同龄人。研究发现，脑瘫儿童非偏瘫侧的本体感觉受损，以及上肢双侧协调、速度和灵活性、视觉和空间感知、视觉-运动组织受损，以及触觉-感觉障碍对他们的书写技能产生了负面影响。在偏瘫型脑瘫儿童的治疗方法中，必须尽早详细进行涉及双侧肢体的全面感觉-知觉-运动评估，以尽量减少早期治疗政策中存在的问题。这样就有可能发展偏瘫儿童的感觉-知觉-运动和认知功能，使他们能够适应与健康同龄人相同的小学课程。
