臺北市兩醫學機構腦性麻痺兒童復健相關資料之調查

Rehabilitation Services for Children with Cerebral Palsy in Two Medical Institutions in Taipei City

為了解台北地區腦性麻痺兒童障礙情形、復健相關狀況及其影響因素，本研究以台化市兩個醫學機構病歷調閱之方式，得過去12年來不同類別腦性麻痺兒童共948名之資料。結果顯示，腦性麻痺兒童中男性佔63%，女性佔37%；類型則以痙攣型兒童(80%)佔最多，其次是混合型(12%)。發展方面，有90%患童有粗動作發展遲緩，65%精細動作發展遲緩，62%智能發展遲緩。開始接受復健醫療之平均月齡是19 ± 20月（中位數12月），在兩機構開始復健醫療之平均月齡是33 ± 31月（中位數24月），結束之平均月齡則是45 ± 34月（中位數35月），平均接受復健治療（包括物理治療與職能治療）37 ± 43次（中位數26次），平均3次/月。影響復健醫療之因素包括年代、社會階層與智能。過去12年來隨著年代之增加，患童接受復健治療之次數有增加之趨勢；患童為低社會階層者，開始復健之年齡較晚，接受復健之次數也較少；智能發展輕度遲緩或正常者較智能中重度遲緩者接受復健之次數高；愈早接受復健治療者其粗動作發展較好。腦性麻痺之類型、性別則與復健情形並無顯著相關。對於處於不利發展環境之低社會階層腦性麻痺兒童，應優先主動提供早期復健介入服務。

The rehabilitation of children with cerebral palsy (CP) in Taiwan has not been studied. The purposes of this study were to understand rehabilitation programs and the influencing factors in rehabilitation services We reviewed 948 medical records covering the past 12 years from two medical institutions that are well known for their CP treatment. The results showed that 63% of children with CP were boys, and most children were the spastic type (80%). Ninety percent of children with CP showed delayed development in gross motor skills, 65% showed delays in fine motor skills and 62% had delayed cognitive function. The influencing factor in rehabilitation services included time period, father’s socioeconomic status and development of cognitive function. The number of rehabilitation services has increased in the past 12 years. The average age at rehabilitation was 19 ± 20 months. The number of treatment sessions in an average period of 12 months was 37 ± 43 times. The children associated with higher father’s socioeconomic status were found to receive more treatment sessions and to start their treatment earlier than those with lower father’s socioeconomic status. Children with less mental impairment received more treatment and earlier treatment. The children who received rehabilitation earlier had better gross motor development. The type of CP and sex did not relate to rehabilitation services. We should pay more attention to children with CP in the lower socioeconomic classes and actively provide rehabilitation services to them..