치료적 중재방법에 따른 뇌성마비아동의 적응행동 효과
Effects of Alternative Therapies for Adaptive Behavior in Children with Cerebral Palsy
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본 연구는 뇌성마비아동의 치료를 위하여 국내에서 주로 사용하고 있는 치료적 중재방법 즉, 신경발달치료를 적용하거나 신경발달치료를 활동중심교육(CE) 또는 감각통합치료와 병행하여 적용한 후, 중증 뇌성마비아동의 적응행동 즉, 정서적 행동, 지각, 운동기능, 운동행동에 미치는 중재 효과를 알아보기 위해 S 특수학교 2곳의 13세 이하 뇌성마비 아동 103명(신경발달치료 군 32명, 신경발달치료와 활동중심교육 병행 군 36명, 신경발달치료와 감각통합치료 병행 군 35명)을 대상으로 12주간 주 2회 매회 40분씩 각각의 치료적 중재를 적용하였으며 그 주요 결과에 따른 결론은 다음과 같다. 첫째, 적응행동검사에서는 신경발달치료 군, 신경발달치료와 활동중심교육 병행 군, 신경발달치료와 감각통합치료 병행 군에서 모두 중재 전보다 중재 후에 유의하게 증가하였다. 둘째, 적응행동의 하위영역인 정서적 행동과 대근육기능은 군 간 유의한 차이를 보여, 신경발달치료와 활동중심교육을 함께 적용하는 것이 더 효과적인 것으로 나타났다. 셋째, 대근육기능 분류체계 Ⅲ단계, Ⅳ단계, Ⅴ단계 아동 모두 신경발달치료와 활동중심교육 병행 군이 가장 많은 향상을 보였고, 특히 Ⅴ단계의 중증(severe) 장애를 가진 뇌성마비아동일수록 신경발달치료와 활동중심교육을 함께 적용할 경우 적응행동 향상에 효과적인 것으로 나타났다. 넷째, 적응행동의 하위영역인 시지각 기능과 소근육 발달 영역은 Ⅴ단계의 중증(severe) 장애를 가진 뇌성마비아동일수록 신경발달치료와 활동중심교육을 함께 적용할 경우 더 효과적인 것으로 나타났다. 다섯째, 적응행동의 하위영역인 전정감각 영역은 Ⅲ단계의 중등도(moderate)의 장애를 가진 뇌성마비아동일수록 신경발달치료를 집중적으로 적용하였을 경우 전정감각 향상에 더 효과적인 것으로 나타났다. 뇌성마비아동과 같이 중증ㆍ중복화로 일반교육과정의 적용이 어려울 경우 활동중심교육(CE) 프로그램을 학교 교육과정과 연계하여 적용하면 특수교육의 효과는 더욱 증가될 것으로 생각된다.
Abstract
The purpose of this study was to evaluate and compare the effectiveness of alternative therapies for adaptive behavior in children with severe cerebral palsy(CP). One hundred three children with cerebral palsy were included. Each group had a structured training program by a physical therapists for 40 minutes, four times a week for twelve-weeks period. Measurements of adaptive behavior checklist were evaluated at initial presentation(pretest) and after completion of the training program(posttest). The results of this study were presented as follows: Firstly, adaptive behavior was significantly increased in three groups after the completion of the exercising programs. Secondly, the improvement in sub items as emotional response, gross motor function was significantly increased after intervention in NDT plus CE group than other groups. Thirdly, sub items as visual perception, fine motor function in GMFCS Level Ⅴ of NDT plus CE group was meaningfully higher than that in other groups. Lastly, sub items as vestibular system in GMFCS Level Ⅲ of NDT group was meaningfully higher than that in other groups. In conclusion, there was no difference among those three treatment groups in adaptive behavior, however, in sub items as emotional response, gross motor function of NDT plus CE group was more effective on children with severe cerebral palsy. And this study suggests that effectiveness of CE program, further studies employed by longer and deeper experiments were strongly recommended.
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