Ryalls Brigette O, Harbourne Regina, Kelly-Vance Lisa, Wickstrom Jordan, Stergiou Nick, Kyvelidou Anastasia
University of Nebraska at Omaha, Omaha NE, USA.
Duquesne University, Pittsburgh PA, USA.
Front Psychol. 2016 May 3;7:643. doi: 10.3389/fpsyg.2016.00643. eCollection 2016.
For children with moderate or severe cerebral palsy (CP), a foundational early goal is independent sitting. Sitting offers additional opportunities for object exploration, play and social engagement. The achievement of sitting coincides with important milestones in other developmental areas, such as social engagement with others, understanding of spatial relationships, and the use of both hands to explore objects. These milestones are essential skills necessary for play behavior. However, little is known about how sitting and play behavior might be affected by a physical therapy intervention in children with moderate or severe CP. Therefore, our overall purpose in this study was to determine if sitting skill could be advanced in children with moderate to severe CP using a perceptual motor intervention, and if play skills would change significantly as sitting advanced. Thirty children between the ages of 18 months and 6 years who were able to hold prop sitting for at least 10 s were recruited for this study. Outcome measures were the sitting subsection of the Gross Motor Function Measure (GMFM), and the Play Assessment of Children with Motor Impairment play assessment scale, which is a modified version of the Play in Early Childhood Evaluation System. Significant improvements in GMFM sitting scores (p < 0.001) and marginally significant improvement in play assessment scores (p = 0.067) were found from pre- to post-intervention. Sitting change explained a significant portion of the variance in play change for children over the age of 3 years, who were more severely affected by CP. The results of this study indicate that advances in sitting skill may be a factor in supporting improvements in functional play, along with age and severity of physical impairment.
对于中重度脑瘫（CP）患儿而言，早期的一个基本目标是能够独立坐立。坐立为物体探索、玩耍及社交互动提供了更多机会。实现坐立与其他发育领域的重要里程碑相契合，比如与他人的社交互动、对空间关系的理解以及用双手探索物体。这些里程碑是玩耍行为所需的基本技能。然而，对于中重度CP患儿的物理治疗干预如何影响坐立和玩耍行为，我们知之甚少。因此，本研究的总体目的是确定使用感知运动干预能否提高中重度CP患儿的坐立技能，以及随着坐立能力的提高，玩耍技能是否会发生显著变化。本研究招募了30名年龄在18个月至6岁之间、能够扶物坐立至少10秒的儿童。结果测量指标为粗大运动功能测量（GMFM）中的坐立子项，以及运动障碍儿童玩耍评估量表，该量表是幼儿期玩耍评估系统的修改版。干预前后，GMFM坐立分数有显著提高（p < 0.001），玩耍评估分数有边缘显著提高（p = 0.067）。对于3岁以上、受CP影响更严重的儿童，坐立变化解释了玩耍变化中很大一部分方差。本研究结果表明，坐立技能的提高可能是支持功能性玩耍改善的一个因素，同时还有年龄和身体损伤的严重程度。
