신경발달치료원리에 기초한 일상생활활동 훈련이 뇌성마비 아동의 분리된 움직임과 앉은 자세 균형에 미치는 효과 = The Effects of Activities of Daily Living Training based on Neurodevelopmental Treatment Principles for the Segmental Movement and Sitting Balance of Children with Cerebral Palsy : Single-Subject Research Design

다국어 초록 (Multilingual Abstract)

The purpose of this study is to verify the effects ADL training based on Neurodevelopmental treatment(NDT) principles on segmental movement and sitting balance of children with cerebral palsy. The subject is a 4 years and 6 months old girl with spastic diplegia and lives in P city. An AB design for a single-subject research was used for this study. The procedures consisted of 6 times of baseline phase(A), 13 times of treatment phase(B). The baseline phase involved no ADL training, but during treatment phase ADL training was conducted. The measurement criteria of segmental movement and sitting balance was designed to reflect individualized therapy goals that is included removal T-shirt and ankle-foot orthosis(AFO).
According to this study, the majority of segmental movement and sitting balance was improved above 2 standard deviation in treatment phase compared with in baseline phase. Therefore, this study supported the effectiveness of ADL training based on NDT principles by dealing with segmental movement and sitting balance of children with cerebral palsy. The study is integrated ADL training with NDT principles that are widespread for CP and measured outcomes based on individualized therapy goals. Consequently the study is suggested the meaning of quality effectiveness of NDT.

국문 초록 (Abstract)

본 연구는 신경발달치료원리에 기초한 일상생활 활동 훈련을 통해 뇌성마비 아동의 분리된 움직임 및 앉은 자세 균형의 효과를 알아보고자 하였다. 연구대상은 P시에 거주하는 만 4세 6개월 된 여아로, 경직성 양하지 마비로 진단받았다. 본 연구는 개별 실험 연구 중 AB설계를 사용하였다. 실험과정은 기초선 기간(A) 6회, 중재 기간(B) 13회로 진행되었다. 기초선 기간에는 일상생활활동 훈련을 하지 않았으며, 중재기간에는 신경발달치료 원리에 기초한 일상생활활동 훈련을 실시하였다. 분리된 움직임과 앉은 자세 균형은 아동의 개별화된 중재목표에 따라 긴팔 티셔츠 벗기와 발목보조기 벗기 활동 시 설정한 측정기준에 따라 평가하였다.
본 연구의 결과는 다음과 같다. 아동의 분리된 움직임과 앉은 자세 균형은 기초선 기간과 비교하여 중재기간에 대부분 2 표준편차이상으로 향상되었다. 따라서 신경발달치료원리에 기초한 일상생활 활동 훈련이 뇌성마비 아동의 분리된 움직임과 앉은 자세균형 향상에 효과적이었다. 본 연구는 뇌성마비 아동에게 널리 사용되고 있는 신경발달 치료원리를 일상생활 활동 훈련에 접목시켜 사용하였으며, 개별화된 중재목표에 따라 그 결과를 측정함으로써, 신경발달치료의 질적인 효과를 제시한데 의의가 있다.

참고문헌 (Reference)

1 조미애, "위험인자를 지닌 신생아에서 뇌성마비 발생빈도" 21 : 1068-1075, 1997

2 박창일, "뇌성마비의 조기진단을 위한 이학적 평가항목의 개발" 21 (21): 679-688, 1997

3 김세주, "뇌성마비아 부모의 욕구조사" 24 (24): 1070-1078, 2000

4 Kong,E., "Very early treatment of cerebral palsy" 8 : 198-202, 1966

5 Royeen,C., "Use of neurodevelopmental treatment as an intervention : annotated listing of studies 1980-1990" 75 : 175-194, 1992

6 Gormey,M.E., "Treatment of neuromuscular and musculoskeletal problems in cerebral palsy" 4 : 5-16, 2001

7 DeGangi,G.L., "Toward a methology of the short-term effects of neurodevelopmental treatment" 37 : 479-484, 1983

8 Bobath, K., "The facilitation of normal postural reactions and movements in the treatment of cerebral palsy" 50 : 3-19, 1964

9 Palmer, F. S., "The effects of physical therapy on cerebral palsy : a controlled trial in infants with spastic diplegia" 318 (318): 803-808, 1988

10 Fetters,L., "The effects of neurodevelopmental treatment versus practice on the reaching of children with spastic cerebral palsy" 76 : 346-358, 1996

11 Goodman,G., "The effects of a short thumb opponens splint on hand function in cerebral palsy : a single-subject study" 45 (45): 726-731, 1991

12 Backman,S.L., "Single subject research in rehabilitation : a review of studies using AB, withdrawal, multiple baseline, and alternating treatments designs" 78 : 1145-1156, 1997

13 Karlsson,B., "Results of physical treatment in cerebral palsy" 2 : 278-285, 1960

14 Montgomery,P.C., "Quantitative evaluation of upper extremity activity in patients with cerebral palsy" 52 : 170-175, 1972

15 Kluzik,J., "Quantification of control : a preliminary study of effects of neurodevelopmental treatment on reaching in children with spastic cerebral palsy" 70 : 65-78, 1990

16 Westcott, S. L., "Postural control in children : implications for pediatric practice" 24 (24): 5-55, 2004

17 Wright,T., "Physiotherapy for the spastic child : an evaluation" 15 : 146-163, 1973

18 Catherine, C., "Pervalence of cerebral palsy among ten-year-old children in Metropolitian Atlanta, 1985 through 1987" 123 : S13-S20, 1993

19 Steultjens, E. M. J., "Occupational therapy for children with cerebral palsy : a systematic review" 18 : 1-14, 2004

20 Mullen,S.L., "Neurodevelopmental Treatment Techniques and Dorsiflexor Activity in a Child With Spastic Diplegia" Boston University Master’s thesis 1981

21 Footh,W.K., "Measuring the effectiveness of physical in the treatment of cerebral palsy" 43 : 867-873, 1963

22 Lilly,L.A., "Measuring effects of neurodevelopmental treatment on the daily living skills of 2 children with cerebral palsy" 44 : 139-145, 1990

23 Campbell,S.K., "Measurement in developmental therapy : past, present, and future in : Developing Norm-Referenced Standardized Tests" Haworth Press 1-13, 1989

24 Bobath, K., "Management of the Motor Disorders of Children with Cerebral Palsy" JB Lippincott 6-18, 1984

25 Koman,L.A., "Impact of cerebral palsy. Accessed 5 March 2001" Frome www.ucpa.org/ucp-generaldoc.cfm/123/4/24/24-6607/106 2002

26 Gudjonsdottir,B., "Hip and spine in children with cerebral palsy musculoskeletal development and clinical implication" 9 : 179-185, 1997

27 Clinical Rehabilitation, "Exercise Training Program in Children and Adolescents With Cerebral Palsy" 161 (161): 1075-1081, 2007

28 Knox,V., "Evaluation of the functional effects of a course of Bobath therapy in children with cerebral palsy : a preliminary study" 44 : 447-460, 2002

29 Martin,J.E., "Evaluating treatment effectiveness in cerebral palsy : single-subject designs" 56 : 285-294, 1976

30 Ottenbacher,K., "Evaluating clinical change : strategies for occupational and physical therapists" Williams & Wilkins 1986

31 Paneth,N., "Etiologic factors in cerebral palsy" 15 : 191-201, 1986

32 Laskas, C. A., "Enhancement of two motor functions of the lower extremity in a child with spastic quadriplegia" 65 : 11-16, 1985

33 Butler, C., "Effects of neurodevelopmental treatment (NDT) for cerebral palsy : an AACPMD evidence report" 43 : 778-790, 2001

34 Harris,S.R., "Effects of neurodevelopmental therapy on motor performance of infants with Dawn’s syndrome" 23 : 477-483, 1981

35 Bower, E., "Effect of increased exposure to physiotherapy on skill acquisition of children with cerebral palsy" 34 : 25-39, 1992

36 Scherzer,A.L., "Early Diagnosis and Therapy in Cerebral palsy : A Primer on Infant Development Problems" 1982

37 Carlsen,P.N., "Comparison of two occupational therapy approaches for treating young cerebral palsied child" 29 : 267-272, 1975

38 Bar-Haim,S., "Comparison of efficacy of Adeli suit and neurodevelopmental treatment in children with cerebral palsy" 48 : 325-330, 2006

39 Weindling, A. M., "Additional therapy for young children with spastic cerebral palsy : a randomized controlled trial" 11 (11): 1-71, 2007

40 Parette, H. P., "A review or therapeutic intervention research on gross and fine motor progress in young children with cerebral palsy" 38 : 462-468, 1984

41 Bower, E., "A rando mized controlled trial of different intensities of physiotherapy and different goal-setting procedures in 44 children with cerebral palsy" 38 : 226-237, 1996