Rosenberg Lori, Zecharia Shira, Gilboa Yafit, Golos Anat
Can J Occup Ther. 2025 Jun;92(2):85-93. doi: 10.1177/00084174241274743. Epub 2024 Sep 5.
To evaluate effectiveness of The Greenhouse for autonomy and independence to prepare adults with severe cerebral palsy (CP) for the transition from assisted to independent living. The intervention combines weekly individual sessions using Pathways and Resources for Engagement and Participation together with weekly group sessions. Seven adults with severe CP ages 23-45 years (M = 35; SD = 10) participated in the 20-week program. An Interrupted Time Series quasi-experimental design was used, assessing the intervention effect over time. The Canadian Occupational Performance Measure was administered bi-weekly from baseline to post-intervention to assess activity performance. Functional Independence Measure (FIM), Wheelchair use Confidence scale (WheelCon) and Impact on Participation and Autonomy (IPA) were administered baseline (4 weeks pre-intervention), mid and post-intervention, using Freidman test. Interviews were conducted four weeks after intervention. All participants' activity performance improved over time with significant clinical improvement in 95% of COPM goals. Significant improvement was seen in FIM (χ= 8.07, p = .018) and WheelCon (χ= 7.18, p = .028) though not in IPA. Participants described being better prepared, however more aware of challenges. The findings suggest the program may be effective to help adults with severe CP attain goals related to independent living and enhance function.
评估“温室计划”在帮助重度脑瘫(CP)成年人从依赖生活过渡到独立生活方面,对自主性和独立性的影响。该干预措施包括每周一次使用“参与和融入途径与资源”的个人辅导课程以及每周一次的小组辅导课程。7名年龄在23 - 45岁之间(平均年龄M = 35岁;标准差SD = 10岁)的重度脑瘫成年人参与了为期20周的项目。采用中断时间序列准实验设计,评估随时间推移的干预效果。从基线期到干预后,每两周进行一次加拿大职业表现测量,以评估活动表现。使用弗里德曼检验,在干预前4周(基线期)、干预中期和干预后,分别进行功能独立性测量(FIM)、轮椅使用信心量表(WheelCon)和参与与自主性影响量表(IPA)评估。干预四周后进行访谈。随着时间推移,所有参与者的活动表现均有所改善,95%的加拿大职业表现测量目标取得了显著的临床改善。功能独立性测量(χ = 8.07,p = 0.018)和轮椅使用信心量表(χ = 7.18,p = 0.028)有显著改善,尽管参与与自主性影响量表未出现显著改善。参与者表示自己为独立生活做了更好的准备,但也更加意识到面临的挑战。研究结果表明,该项目可能有效地帮助重度脑瘫成年人实现与独立生活相关的目标并增强功能。