| Summary: | 碩士 === 國立陽明大學 === 醫學工程研究所 === 102 === Cerebral palsy (CP) is a permanent, non-progressive defect or lesion of the brain about at time of birthing. The injured brain cortex affects a central motor dysfunction, causes the physical disorders of abnormal muscle tone, movement disorder, walking difficulty, sensory and perception dysfunction, visual, auditory and speech impairment. Comprehensive management of cerebral palsy suggests surgical intervention, physical therapy and occupational therapy. In addition to the regular inland physical therapy, hydrotherapy has been used to improve the gross motor ability of CP children for many years. By applying the physical characteristics of hydrogen oxide which provides buoyancy and hydraulic pressure on the impaired limbs, the execution of joint movements can be assisted. Researches showed that CP children with receiving a six to twelve hydrotherapy program could improve the gross motor function of increasing the activity of daily living and decreasing the heart rate during the gait cycle. However, there are only few studies focused on the biomechanical evaluation of the efficacy.
The purpose of this study was on the instrumented assessment of the effect of hydrotherapy and duration of persistence in motor control ability and postural stability. Three spastic children (one boy and one girl hemiplegia with GMFCS-I, and one boy of Diplegia with GMFCS-II) and six age matched healthy children were recruited for this study. CP children received consecutive two weeks hydrotherapy, once every week 60 minutes then a week of on-land therapy, with total of 12 weeks period. The assessments performed in three tasks: Sit to Stance, Instrumented Time-Up and Go, crossing 20% leg length of obstacle gait. Force platform ( AMTI, USA), Plantar pressure platform (RsScan, Belgium), Inertia motion measurement unit ( APDM, USA) were used to record and analyze before and post the hydrotherapy. Measured variables were the CoP trajectory change of the base of support and weight bearing in a Sit to Stand task; the spatial-tempo gait parameter, trunk sway excursion angles, maximum shank swing angle of leading and trailing limb during crossing the obstacle.
The results showed that during the sit-to-stance the total COP trajectory and maximal COP displacement were decreased, particular after received the fourth therapy, some participant had a maximum of 50% reduction in CoP sway distance and 60% reduction of sway area. In the preparation period of Sit-to stand task, the medial-lateral excursion reduced up to 83%, the CoP speed reduced 78%; in T2 period, the M-L maximum excursion reduced 91% and at the T3 the A-P direction excursion reduced 83, the speed reduced 61%, M-L excursion reduced 21%; at the T4 period the A-P reduced 28% and speed reduced 53%. The weight bearing ratio closed to one, all these values indicted that the hydrotherapy was very effective in improving the postural stability and motor control. In addition, in the iTUG task, the M-L sway and gait parameters showed two hemiplegic subjects had the spatial-tempo gait parameters near to what the normal subject performed. The trunk mass sway reduced 30% in M-L, 37% in A-P, and 18% in axial directions. In the cross obstacle task, the ratio of maximum shank swing angle closed to symmetric in both leading and tailing legs.
In conclusion, the CP children performed poor motor control and postural stability particular in the sit to stance and cross obstacle gait. The hydrotherapy intervention can effectively improve CP children on the functional coordination, it shall be added to the regular on-land therapy in order to achive a better intervention outcome.
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