Bain Kathryn, Bombria Suzanne Davis, Chapparo Christine Janet, Donelly Michelle, Heard Robert, Treacy Sue
Southern Cross University, East Lismore, New South Wales, Australia.
The University of Sydney, Camperdown, New South Wales, Australia.
Child Care Health Dev. 2023 Nov;49(6):1066-1075. doi: 10.1111/cch.13117. Epub 2023 Mar 28.
We aimed to determine if there was a significant difference in the functional performance of family requested daily tasks by a heterogeneous group of children with cerebral palsy following a programme of neuro-developmental treatment and in comparison to a randomly control group.
There are considerable challenges in conducting research into the functional performance of children with cerebral palsy. These include the highly heterogeneous nature of the population group, poor ecological and treatment fidelity, floor and ceiling effects in assessments, and insensitivity to the diverse functional needs and goals of children and families. Therapists and families identified functional goals and specified all aspects of performance details for each goal on five point goal attainment scales. Children with cerebral palsy were assigned randomly to treatment and alternate treatment groups. Children were video recorded attempting to perform targeted functional skills at pre-test, post-pest and follow-up. Videos were recorded and rated by expert clinicians blind to experimental condition.
After the first round of target intervention and alternate treatment had been completed, a significant difference in the goal attainment was noted between the control group and the treatment group at the post test, indicating that intervention was associated with a higher level of goal attainment than that attained by the control group (p = 0.0321) with a large effect size.
The study provided evidence of an effective way to investigate and to enhance the available motor capacity of children with moderate to severe cerebral palsy during participation in requested daily task performance, as reflected in goal attainment. Goal attainment scales were a reliable measure that was able to be used to detect changes in functional goals among a highly heterogeneous population group with individualized goals that were meaningful to each child and family.
我们旨在确定，在接受神经发育治疗方案后，一组异质性脑瘫儿童在完成家庭要求的日常任务时的功能表现，与随机对照组相比是否存在显著差异。
对脑瘫儿童的功能表现进行研究存在诸多挑战。这些挑战包括人群的高度异质性、较差的生态效度和治疗依从性、评估中的地板效应和天花板效应，以及对儿童及其家庭多样化功能需求和目标的不敏感性。治疗师和家长确定功能目标，并在五点目标达成量表上为每个目标详细规定表现的各个方面。脑瘫儿童被随机分配到治疗组和交替治疗组。在预测试、后测试和随访时，对儿童尝试执行目标功能技能的过程进行录像。录像由对实验条件不知情的专家临床医生进行评分。
在第一轮目标干预和交替治疗完成后，后测试时对照组和治疗组在目标达成方面存在显著差异，表明干预组的目标达成水平高于对照组（p = 0.0321），效应量较大。
该研究提供了证据，证明在参与要求的日常任务表现过程中，有一种有效的方法可用于调查和提高中重度脑瘫儿童的现有运动能力，这一点在目标达成方面得到了体现。目标达成量表是一种可靠的测量方法，能够用于检测一个高度异质性人群组中功能目标的变化，这些目标是针对每个儿童及其家庭设定的，具有实际意义。
