26 - Jpts 2013 255
26 - Jpts 2013 255
26 - Jpts 2013 255
Abstract. [Purpose] The purpose of the present study was to examine the effects of task-oriented approach on
motor function of the affected arm in children with spastic hemiplegia due to cerebral palsy. [Subjects] Twelve chil-
dren were recruited by convenience sampling from 2 local rehabilitation centers. The present study utilized a one-
group pretest-posttest design. All of children received task-oriented training for 6 weeks (40 min/day, 5 days/week)
and also underwent regular occupational therapy. Three clinical tests, Box and Block Test (BBT), Manual Ability
Measure (MAM-16), and Wee Functional Independence Measure (WeeFIM) were performed 1 day before and after
training to evaluate the effects of the training. [Results] Compared with the pretest scores, there was a significant
increase in the BBT, MAM-16, and WeeFIM scores of the children after the 6-week practice period. [Conclusion]
The results of this study suggest that a task-oriented approach to treatment of the affected arm improves functional
activities, such as manual dexterity and fine motor performance, as well as basic daily activities of patients with
spastic hemiplegia due to cerebral palsy.
Key words: Cerebral palsy, Hemipleiga, Task-oriented approach
(This article was submitted May 28, 2013, and was accepted Jul. 3, 2013)
cal procedures within the past 6 months. This study was test consists of moving, one by one, as many small wooden
approved by the human research ethics committees of the blocks as possible from one compartment of a box to anoth-
participating institutions, and all of the patents of the chil- er within 60 seconds7). The test-retest reliability of the BBT
dren agreed to their participation in the study and volun- was reported to be between 0.93 and 1.008). The MAM-16 is
tarily signed the consent forms. The general characteristics a task-oriented, patient-focused outcome measure and may
of the participants are listed in Table 1. For each child, the be best used as a screening tool or in conjunction with other
general characteristics included sex, age, hemiparetic side, hand-function assessments. This test uses self-reporting to
and ambulatory status. assess unimanual and bimanual function and consists of 16
This study utilized a one-group pretest-posttest design task items that cover a wide range of difficulty. Individuals
with task-oriented arm training that comprised 30 sessions are scored using a 5-point ordinal scale from 0 points (un-
over 6 weeks. All of the participants received conventional able to perform the movement) to 4 points (able to complete
occupational therapy that lasted 30 min for improving the the movement easily). Using Rasch analysis, the MAM-
functional activities of the affected arm. The conventional 16 was found to have good validity and reliability9). The
occupational therapy involved range of motion exercise WeeFIM is an 18-item observational instrument modeled
and stretching for the upper extremities. The task-oriented on the adult Functional Independence Measure; it measures
training consisted of activities similar to the daily tasks per- the severity of disability and changes in the functional abili-
formed by children, such as playing and basic ADL. Table ties of children over time and in rehabilitation settings. The
2 shows the protocol for the task-oriented training of the tool measures direct observations obtained from interviews
affected arm6). or from the guardian of the children, regarding exercise
The participants underwent the task-oriented arm train- and performance of cognitive tasks. The WeeFIM can be
ing (lasting 40 min/sessions) 5 times per week for 6 weeks. used for infants and children 6 months to 7 years. The 6
The first week of training focused on familiarizing partici- subscales, scored on a 7 points ordinal scale from 1 point
pants with the task-oriented arm training protocol involv- (total assistance) to 7 points (complete independence), focus
ing bilateral manipulation. Participants were then asked to on self-care, sphincter control, transfers, locomotion, and
follow the training protocol for the next 5 weeks. All par- cognition. The inter-rater reliability of the WeeFIM ranged
ticipants were examined prior to participation in the study from 0.82 to 0.9410).
(pretest) and at the end of the study (posttest) after 6 weeks The independent variable of the present study was the
by an examiner who was not the training therapist. task-oriented arm training, and the dependent variables
The following 3 clinical tools were used in this study: were the BBT scores. The general characteristics of the par-
the Box and Block Test (BBT), Manual Ability Measure ticipants were analyzed using descriptive statistics. Paired
(MAM-16), and Wee Functional Independence Measure t-test was used to examine the effects of the task-oriented
(WeeFIM). The BBT was originally developed to evaluate functional activities of the affected arm in children with CP.
the gross manual dexterity of adults with CP and is current- The collected data were analyzed sing PASW version 18.0
ly used to evaluate physically handicapped individuals. The for Windows (SPSS Inc., Chicago, IL, USA), and the sig-
799
Table 3. Scores of clinical tools for the affected arm in the participants (N=12)
nificance level was set at p<0.05. training that focused on functional activities that use lower
limb strength and reported that the task-specific exercise
RESULTS program resulted in improved functional performance that
was maintained over time in children with CP13). Ahl et al.
Table 3 presents the means and standard deviations of also reported significant improvements in the ability to per-
the pre- and post-test of outcome measures in participants, form daily activities in 14 children with CP after a 5-month
and level of significance of the change scores. The results functional training program14). However, these studies
indicate there were significant differences in the scores anayzed lower extremity functions or daily activities and
of the post-test compared to in the scores of the pre-test. not upper extremity functions of children with CP. Because
Over 6 weeks training period, a significant increase was upper extremity functions do not affect locomotion, reha-
observed in the BBT, MAM-16, and WeeFIM scores of the bilitation research and clinical settings have mainly focused
participants. on improving lower extremity functions for independent
walking in children with CP. Therefore, children with CP
DISCUSSION may have difficulty in social integration because of their
dependency in basic ADL, although they are capable of in-
The purpose of the present study was to evaluate the ef- dependent walking.
fect of task-oriented arm approach on functional activities The results of the present study shows the feasibility
of the affected arm in children with CP. The results of the of task-oriented arm training in improving functional ac-
present study support the efficacy of task-oriented train- tivities and basic ADL in children with CP. Task-oriented
ing for improving functional activities of the affected arm approach generally include daily activities and play activi-
in children with CP. After training, the improvements in ties, and these activities have been beneficial in motivating
the BBT, MAM, and WeeFIM scores indicate that task- children. The practice activities of the present study also
oriented arm training reduced dysfunction in the affected included repetitive practice of functional activities used in
arm as well as basic ADL in the study participants. The daily activities or play activities. The results indicate that
changes in the BBT scores indicate that manual dexterity task-oriented arm training significantly improved function-
improved after the task-oriented arm training. The statisti- al activities of the affected arm. The task-oriented training
cally significant change observed in the MAM-16 scores of also reduced the dysfunction in the affected arm. Clinical
the participants may be of clinical importance. Finally, the settings for CP treatment should be selected after consider-
changes in the WeeFIM scores of the participants indicate ing the effects of task-oriented training on children with CP.
that basic ADL improved after the task-oriented training. However, the present study not include control group for
These findings suggest that task-oriented arm training may comparison of the effects of task-oriented arm approach.
help children with CP to independently perform basic ADL, Generalizations of the results of the present study are lim-
whick is important for their successful social integration. ited by absence of adequate control or comparison groups.
Previous studies have been reported that the most impor- Future studies are need to compare the task-oriented arm
tant factor for motor skill recovery are muscle strengthen- approach with the effects of other therapeutic exercise for
ing and the amount of practice devoted to learning a partic- reducing the affected arm dysfunction of the affected arm
ular skill. Task-oriented approaches improve the skills and in children with CP. Furthermore, follow-up measures were
experience of the participants, select a context that enables not performed in the present study. Future study is therefore
performance, change aspects of the context to allow par- needed to determine the long term effects of a task-oriented
ticipants to perform tasks, and change the course of events training program and to examine the long-term retention
by predicting barriers to performance11). Recently, several and transfer of the training effects.
studies reported that functional activities significantly im-
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