[논문]Effects of Family-Centered Training on Functional Balance and Activities of Daily Living in Children with Cerebral Palsy

Kwon, Hae Yeon; Kim, Byeong Jo

doi:10.20540/jiaptr.2018.9.2.1475

Effects of Family-Centered Training on Functional Balance and Activities of Daily Living in Children with Cerebral Palsy 원문보기

Journal of international academy of physical therapy research, v.9 no.2, 2018년, pp.1475 - 1485

Kwon, Hae Yeon (Dong-Eui University) , Kim, Byeong Jo (Dong-Eui University)

Abstract ▼ AI-Helper

This study was conducted to examine the effects of the application of family-centered training over the 12-week period by the pediatric physiotherapist on functional balance and activities of daily living in children with cerebral palsy. Among the 26 children with cerebral palsy as the subjects were allocated to the experimental and control group. Both groups were subjected to neurodevelopmental treatment by the pediatric physiotherapist. The experimental group, participated in family-centered training program 3 times a week over a period of 12 weeks for the total of 36 sessions, functional balance and activities of daily living were verified through intergroup comparison. There was no significant difference between the outcomes prior to training and after 6 weeks of training, (p>.05) Pediatric Berg's Balance Scale(PBS) and Functional Independence Measure for children(Wee-FIM) increased significantly from those measures after 6 weeks to those after 12 weeks of training (p<.05). Therefore, these results suggest that on family-centered training on children with cerebral palsy has beneficial effects on functional movements and physical activities.

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문제 정의

In addition, in order for disabled children to grow ideally within the local community background, participation and support of all the constituent members of the family are necessary. Therefore, this study was conducted to examine the effects of application of family-centered training on children with cerebral palsy over 12-week period by pediatric physiotherapist, by acknowledging the families of disabled children as experts and maintaining mutually cooperative relationship throughout the entire processes of rehabilitation, on functional balance and activities of daily living in children with cerebral palsy. Furthermore, it was implemented to provide basic data for the provision of family-centered training for children with cerebral palsy as an efficient and reliable clinical intervention program for development of functional movements and physical activities of children with cerebral palsy.
This study was conducted on children diagnosed with cerebral palsy by specialists in neurosurgery and rehabilitation medicine as the subjects. Detailed selection criteria for subjects included the following: first, pre-school children of spastic diplegia who participated in the pediatric physical therapy launched by the “B brain lesion welfare center” in Busan; second, children corresponding to stages II~III under the Gross Motor Function Classification System (GMFCs); and last, children capable of executing simple tasks and communication in daily life with the assistance and supervision of researcher.
This study was conducted to examine the effects of application of 12 weeks of family-centered training on the functional balance and activities of daily living in children with cerebral palsy by pediatric physiotherapist by acknowledging the family of disabled children as experts and maintaining cooperative relationship in all the processes of rehabilitation. Although accurate comparison with the preceding studies would be difficult since the method and duration of application of family-centered training, including physical characteristics, clinical appearances and functional level of subjects of this study are not the same, considerations were made by associating the similarities mainly of the training method and measurement results.
This study was executed to examine the effects of 12 weeks of family-centered training on functional balance and activities of daily living applied to children with cerebral palsy and to provide basic data in provision of family-centered training on children with cerebral palsy as efficient and reliable clinical intervention program for development of functional movements and physical activities of said children in the future. As the results of family-centered training program on children with cerebral palsy was performed 3 times a week over a period of 12 weeks for the total of 36 sessions, there was no significant difference between the outcomes prior to training and after 6 weeks of training, functional balance and activities of daily living increased significantly from those measures after 6 weeks to those after 12 weeks of training.

제안 방법

Detailed selection criteria for subjects included the following: first, pre-school children of spastic diplegia who participated in the pediatric physical therapy launched by the “B brain lesion welfare center” in Busan; second, children corresponding to stages II~III under the Gross Motor Function Classification System (GMFCs); and last, children capable of executing simple tasks and communication in daily life with the assistance and supervision of researcher.
First, pediatric physiotherapist examined the current status of daily life, desires and preferences of the child and family after having had preliminary interview with the subjects and guardian (legal representative).
Meanwhile, in this study, 40 minutes of neurodevelopmental treatment was applied both the experimental and the control groups with only the experimental group subjected to additional family-centered training at the rate of 3 times per week. In addition, it is thought that the preceding study was able to obtain further improved results in daily living activities in comparison to this study, which applied family-centered training to children with cerebral palsy, since it selected children with delay in the development of gross motor and minor motor skills at the baseline that has performances appropriate for the age in the development domain by excluding children diagnosed with disorders in neuromuscular skeletal system. Accordingly, it is deemed that application of familycentered training program planned by focusing on functional ability, that is task-oriented, or activities irrespective of the diseases of disabled children would have overall affirmative effects on daily life processes.
After having confirmed the normality of measurement variables of the subjects through Shapiro-Wilk test, parametric test method was used. Repeated measure ANOVA was implemented to examine the changes in accordance with the passage of time of the measurement times (prior to, and after 6 and 12 weeks of training) for functional balance and activities of daily living in the experimental and control groups. If there was interactive effect between the two groups, the differences in the changes between prior to and after 6 weeks of training, and after 6 and 12 weeks of training were analyzed by means of independent sample t-test.
Experimental and control groups were subjected to neurodevelopmental treatment by pediatric physiotherapist. The experimental group, participated familiy-centered training program for 3 times a week over a period of 12 weeks for the total of 36 sessions. Functional balance and activities of daily living were verified through intergroup comparison.
This study was executed with two group, before-after measurement quasi-experimental study design in order to examine the effects family-centered training on functional balance and activities of daily living in children with cerebral palsy. Experimental and control groups were subjected to neurodevelopmental treatment by pediatric physiotherapist.

대상 데이터

Such difference was due to the difference in the criteria for selection although the ages of the subjects of preceding studies and this study were similar. While the subjects of this study were composed of children with II~III stage cerebral palsy under GMFCs, those of the preceding study were composed of children including 10 children with traumatic brain damage within 1 years of the damage, which is more than half of the subjects. In particular, the control group, with children capable of maintaining standing posture for more than 5 seconds and perform sit-ups independently without falling, was not subjected to any therapeutic intervention.

데이터처리

Repeated measure ANOVA was implemented to examine the changes in accordance with the passage of time of the measurement times (prior to, and after 6 and 12 weeks of training) for functional balance and activities of daily living in the experimental and control groups. If there was interactive effect between the two groups, the differences in the changes between prior to and after 6 weeks of training, and after 6 and 12 weeks of training were analyzed by means of independent sample t-test.

이론/모형

05. After having confirmed the normality of measurement variables of the subjects through Shapiro-Wilk test, parametric test method was used. Repeated measure ANOVA was implemented to examine the changes in accordance with the passage of time of the measurement times (prior to, and after 6 and 12 weeks of training) for functional balance and activities of daily living in the experimental and control groups.
Functional balance in children with cerebral palsy was measured by using Pediatric Berg’s balance Scale(PBS), while Functional Independence Measure for children (Wee-FIM), which is a modified version of Functional Independence Measure (FIM), was used for daily living activities.

성능/효과

However, in this study, scores for the PBS increased significantly after 6 and 12 weeks of training from that prior to training for both the control and the experimental groups. As the results of comparison of changes in the PBS between the two groups, although there was no significant difference in the increase from that prior to training to that after 6 weeks of training, there was significant difference in the increase from that after 6 weeks to that after 12 weeks of training between the two groups. These differences are due to the fact that this study was composed of children with II~III stage cerebral palsy under GMFCs while the 2 preceding studies were compose of children with I~II stage cerebral palsy under GMFCs.
This study was executed to examine the effects of 12 weeks of family-centered training on functional balance and activities of daily living applied to children with cerebral palsy and to provide basic data in provision of family-centered training on children with cerebral palsy as efficient and reliable clinical intervention program for development of functional movements and physical activities of said children in the future. As the results of family-centered training program on children with cerebral palsy was performed 3 times a week over a period of 12 weeks for the total of 36 sessions, there was no significant difference between the outcomes prior to training and after 6 weeks of training, functional balance and activities of daily living increased significantly from those measures after 6 weeks to those after 12 weeks of training. Based on these study results, it is deemed that family-centered training program can be an efficient alternative, both temporally and economically, if it were to be used as complementary intervention in clinical settings through associated activities with pediatric physiotherapist since it can provide affirmative assistance in improving the functional movements and physical activities of children with cerebral palsy.
As the results of family-centered training program on children with cerebral palsy was performed 3 times a week over a period of 12 weeks for the total of 36 sessions, there was no significant difference between the outcomes prior to training and after 6 weeks of training, functional balance and activities of daily living increased significantly from those measures after 6 weeks to those after 12 weeks of training. Based on these study results, it is deemed that family-centered training program can be an efficient alternative, both temporally and economically, if it were to be used as complementary intervention in clinical settings through associated activities with pediatric physiotherapist since it can provide affirmative assistance in improving the functional movements and physical activities of children with cerebral palsy.
Fifth, at the time of execution of interim evaluation 6 weeks after the execution of family-centered training, discussions were carried out on the extent of accomplishment of planned goals, and cooperation and problems of family in the course of execution of the program in order to change to new method or newly establish new goals.
¹⁰⁾ conducted study on the effects of home-based task-oriented exercise program on the ability to maintain balance by randomly allocating 20 children in the age range of 7~13 year with severe traumatic brain damage or cerebral palsy who are able to walk independently into control and experimental groups. First, the control group was instructed to complete regular daily life activities while the experimental group was instructed to achieve home based task-oriented exercises such as sit-ups and walking up and downstairs in addition to the daily life activities for 6 weeks. Although there was no change in the control group, the experimental group displayed reduction of 1.
77%) when compared to that prior to the execution. For each of the detailed areas, the increased was the lowest for the areas of walking, running and jumping with 0.58% while that for the areas of crawling on all limbs and standing on knees was 1.68% with greater increase in the experimental group in comparison to the control group. In addition, in terms of the motility of Wee-FIM, although the control group illustrated improvement by I stages in only one subject, the experimental group illustrated improvement by 1 stage in two subjects and by II stages in 1 subject.
All of comprehensive developmental inventory of children, toddlers test and pediatric evaluation of disability inventory displayed significant increase in the group for which systematic home-activity program was applied in addition to the institutional therapy. In this study, as the results of comparison of the changes in the Wee-FIM between the control and the experimental groups, although there was no significant difference from that prior to training to that after 6 weeks of training, there was significant difference from that after 6 weeks of training to that after 12 weeks of training between the two groups. Although both this study and preceding study are the same in that the intervention program was applied for 12 weeks, the preceding study implemented 45 minutes of institutional therapy once for the control group, and 30 minutes of institutional therapy and 15 minutes of home-activity program for the experimental group.
In this study, it was also found that functional balance and activities of daily living are improved when family-centered training is applied for 12 weeks on children with cerebral palsy by acknowledging the family members of the disabled children as experts and maintaining mutually cooperative relationship in all the processes of rehabilitation. Across the world, community and state organizations in mental health, social services, health care, and education are developing new frameworks to put families at the center of collaborative, strength-based, culturally responsive services.
In this study, the changes in the functional independence measure between prior to training and after 6 weeks of training was 1.42±1.68 and that between after 6 and 12 weeks of training was 1.62±0.50 for the control group, while that between prior to training and after 6 weeks of training was 2.15±1.21 and that between after 6 and 12 weeks of training was 4.15±3.36 for the experimental group, thereby illustrating significant increases in both groups.

참고문헌 (34)

Rosenbaum P, Paneth N, Leviton A, et al., A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl, 2007; 109, 8-14.

상세보기
Shumway-Cook A, Hutchinson S, Kartin D, et al., Effect of balance training on recovery of stability in children with cerebral palsy. Dev Med Child Neurol, 2003; 45(9), 591-602.

상세보기
Cans C. Surveillance of cerebral palsy in Europe:a collaboration of cerebral palsy surveys and registers. Surveillance of cerebral palsy in Europe(SCPE). Dev Med Child Neurol, 2000; 42(12), 816-24.
Himmelmann K, Hagberg G, Beckung E, et al., The changing panorama of cerebral palsy in sweden IX. Prevalance and origin in the birth year period 1995-1998. Acta paediatr, 2005; 94(3), 287-94.

상세보기
Novak I, Cusick A, Lowe KA. Pilot study on the impact of occupational therapy home programming for young children with cerebral palsy. Am J Occup Ther, 2007; 61(4), 463-8.

상세보기
King S. Teplicky R, King G, et al., Family-centered service for children with cerebral palsy and their families: a review of the literature. Semin Pediatr Neurol, 2004; 11(1), 78-86.

상세보기
King G. Chiarello L. Family-centered care for children with cerebral palsy: conceptual and practical considerations to advance care and practice. J Child Neurol. 2014; 29(8), 1046-54.

상세보기
Dodd KJ, Taylor NF, Graham HK. A randomized clinical trial of strength training in young people with cerebral palsy. Dev Med Child Neurol, 2003; 45(10), 652-7.

상세보기
Chen CL, Hong WH, Cheng HY, et al., Muscle strength enhancement following home-based virtual cycling training in ambulatory children with cerebral palsy. Res Dev Disabil, 2012; 33(4), 1087-94.

상세보기
Katz-Leurer M, Rotem H, Keren O, et al., The effects of a 'home-based' task-oriented exercise programme on motor and balance performance in children with spastic cerebral palsy and severe traumatic brain injury. Clin Rehabil, 2009; 23(8), 714-24.

상세보기
Dormans JP, Pellegrino L. Caring for Children with Cerebral Palsy: A Team Approach. Brookes publishing company, 1st edition, 1998.
Hinojosa J, Sproat CT, Mankhetwit S, et al., Shifts in parent-therapist partnerships: twelve years of change. Am J Occup Ther, 2002; 56(5), 556-63.

상세보기
Blundell SW, Shepherd RB, Dean CM, et al., Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4-8 years. Clin Rehabil, 2003; 17(1), 48-57.

상세보기
Al-Oraibi S, Eliasson AC. Implementation of constraint-induced movement therapy for young children with unilateral cerebral palsy in Jordan: a home-based model. Disabil Rehabi, 2011; 33(21-22), 2006-12.

상세보기
Hsin YJ, Chen FC, Lin KC, et al., Efficacy of constraint-induced therapy on functional performance and health-related quality of life for children with cerebral palsy: a randomized controlled trial. J Child Neurol, 2012; 27(8), 992-9.

상세보기
Lin KC, Wang TN, Wu CY, et al., Effects of home-based constraint-induced therapy versus dose-matched control intervention on functional outcomes and caregiver well-being in children with cerebral palsy. Res Dev Disabil, 2011; 32(5), 1483-91.

상세보기
Hinojosa J, Anderson J. Mother's perceptions of home treatment programs for their preschool children with cerebral palsy. Am J Occup Ther, 1991; 45(3), 273-9.

상세보기
Bartlett D, Birmingham T. Validity and reliability of a pediatric reach test. Pediatr Phys Ther, 2003; 15(2), 84-92.

상세보기
Franjoine MR, Gunther JS, Taylor MJ. Pediatric balance scale: A modified version of the berg balance scale for the school-age child with mild to moderate motor impairment. Pediatr Phys Ther, 2003; 15(2), 114-28.

상세보기
Franjoine MR, Darr N, Held SL, et al., The performance of children developing typically on the pediatric balance scale. Pediatr Phys Ther, 2010; 22(4), 350-9.

상세보기
Darr NS, Franjoine MR, Young B, et al., Pediatric Balance Scale performance in children who are developing typically and in Children with mild developmental delays. American Physical therapy association combined sections meeting. Las vagus, NV. Platform presentation, 2009.
Msall ME, DiGaudio KM, Duffy LC. Use of functional assessment in children with developmental disabilities. Phys Med Rehabil Clin N Am, 1993; 4(1), 517-27.

상세보기
Braun S, Granger CV. A practical approach to functional assessment in pediatrics. Occup Ther Pract, 1991; 2, 46-51.
Ries LG, Michaelsen SM, Soares PS, et al., Cross-cultural adaptation and reliability analysis of the Brazilian version of Pediatric Balance Scale (PBS). Rev Bras Fisioter. 2012; 16(3), 205-15.

상세보기
Rose J, Wolff DR, Jones VK, et al., Postural balance in children with cerebral palsy. Dev Med Child Neurol, 2002; 44(1), 58-63.

상세보기
Woollacott MH, Shumway-Cook A. Postural dysfunction during standing and walking in children with cerebral palsy: what are the underlying problems and what new therapies might improve balance? Neural Plast, 2005; 12(2-3), 211-9.

상세보기
Cherng RJ, Su FC, Chen JJ, et al., Performance of static standing balance in children with spastic diplegic cerebral palsy under altered sensory environments. Am J Phys Med Rehabil, 1999; 78(4), 336-43

상세보기
Kwon JM. A study on effect and factor of active participation on the home treatment of mothers with cerebral palsy. Master's Degree of SilLa University, 2006.
Gan SM, Tung LC, Tang YH, et al., Psychometric properties of functional balance assessment in children with cerebral palsy. Neurorehabil Neural Repair, 2008; 22(6), 745-53.

상세보기
Moon JW, Kim ES. Effects of home exercise program on the improvement of gross motor function in child with cerebral palsy. J Rehabil Psych, 2007; 13(1), 66-81.
Tang MH, Lin CK, Lin WH, et al., The effect of adding a home program to weekly institutionalbased therapy for children with undefined developmental delay: A pilot randomized clinical trial. J Chin Med Assoc, 2011; 74(6), 259-66.

상세보기
Novak I, Cusick A, Lannin N. Occupational therapy home programs for cerebral palsy: Doubleblind, Randomized, Controlled trial. Pediatrics, 2009; 124(4), e606-14.

상세보기
Janet WL, Carol D.M.C, Dorothea SG, et al., Special education for the early childhood years. Seoul, Special education, 1994.
Barlett DJ, Palisano RJ. A multivariate model of determinants of motor change for children with cerebral palsy. Phys Ther, 2000; 80(6); 598-614.

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