腦性麻痺兒童適應體育教學之成效研究

The Effect of Adapted Physical Education Program on the Outcome of School-aged Children with Cerebral Palsy

用依Sher rill(1997)之PAP-TE-CA模式所改編成之適應體育教學模式，並進行學齡腦性麻痺兒童適應體育教學成效研究；研究方法採取單一受試研究法之跨受試多基準線設計，研究對象為某國小之三名腦性麻痺學童；學童成效之分析包括學童整體動作功能之變化、學童在融合情境當中的參與度及活動表現、個別動作學習目標之效果、及家長與教師對適應體育教學教導成效之評估。本研究之研究結果如下：一、適應體育教學對學齡腦性麻痺兒童學習成效之影響(一)學齡腦性麻痺兒童整體動作功能之改變參與研究之三名腦性麻痺學童在整體動作功能方面均有成長：三名學童在「關節活動度」、「Peabody動作發展量表」、「粗動作功能量表」及「兒童動作評估表問卷」方面均有進步之情形；在「肌肉力量」與「Bruininks-Oseretsky動作精熟度測驗」方面，以動作功能較佳之學童甲與學童乙進步較明顯。(二)學齡腦性麻痺兒童在融合情境中的參與度及活動表現之改變參與研究之三名學童，在「融合情境當中的參與度」進步之情形以學童甲和學童乙較明顯；而在「與體能活動相關的學校表現」中，三名學童均有明顯進步之情形。(三)學齡腦性麻痺兒童個別動作學習目標之效果在適應體育教學對三名學齡腦性麻痺兒童的個別動作學習目標效果方面，學童甲、乙在「肩下滾球」、「肩下擲球」、「肩上擲球」之個別學習目標均通過，且於追蹤期顯示維持效果；而學童丙在「肩下滾球」、「肩下擲球」之個別學習目標均通過，但「肩上擲球」之個別學習目標則無通過。由此可知，適應體育教學對三名學童個別動作學習目標均有正向效果。(四)家長及教師對適應體育教學法之評估家長及大部份的教師認為適應體育教學方案對腦性麻痺學童在動作功能、心理社會能力及社會融合度方面有所助益。二、學齡腦性麻痺兒童適應體育教學方案之成效經為期一年學齡腦性麻痺兒童適應體育教學之計畫、成立、進行教學與研究，從參與研究學童之整體動作能力發展、個別化動作學習目標之達成、學校功能之進步，以及家長和教師的評價意見中，可發現適應體育教學為學齡腦性麻痺兒童適應體育教學有效之可行模式。而以PAP-TE-CA(Sher rill， 1997)所提出之適應體育教學要素檢視此方案，亦驗證適應體育教學法對學齡腦性麻痺學童為一有效之教學方案。本研究除對研究結果詳加討論之外，依據上述結果，並分別提出對學齡腦性麻痺兒童適應體育教學，及未來研究之建議，俾供身心障礙兒童適應體育推廣實施之參考。

program developed from PAP-TE-CA model on en hancing outcome of school-aged children with cerebral palsy. A single-subject research design with multiple baseline across subjects design was experimented to three school-aged children with cerebral palsy at some elementary school. Data were presented by graphic method and further analyzed by using visual analysis method. Besides muscle strength and range of joint motions， five instrument， the Bruininks- Oseretsky Test of Motor Proficiency (BOTMP)， Peabody Developmental Motor Scale-II (PDMS-II)， Movement Assessment Battery for children Checklist (MABC checklist)， Gross Motor Function Measure (GMFM) and School Function Assessment (SFA) were used to compare the effect of pre- and post- experimental treatment. In addition， open-ended questionnaire and semi-structured interviews were used for parents and teachers to evaluate the effects of physical education program. The result of this study indicated that: 1. The pre- and post measurement of range of joint motions， PDMS-II， GMFM and MABC indicated that the three subjects' overall motor performance during intervention was better than the overall motor performance at the time intervention began. Subject A and B had better performance on the measure of muscle strength and BOTMP. 2. All the three subjects had significant progresses on the ＂Physical Tasks Activity Performance＂ of SFA; subject A and B had better performance on ＂Participation＂ of SFA. 3. Except for one subject (subject C) who didn't accomplish one target behavior in overhand throwing， all other subjects accomplished their targeted behaviors， and showed maintenance effects during follow-up sessions. The visual analysis of graphic data to the multiple baseline across subjects design demonstrated the effects of the physical education program， especially the effect of individualized motor teaching. 4. Pa rents and teachers showed positive feedback towa rd the effect of physical education program on subjects in terms of their motor function， socio-emotional functions and social inclusion. The teachers indicated that the program benefited both the children with or without cerebral palsy. 5 The effectiveness of physical education program for school-aged children with cerebral palsy was demonstrated using the essential components of PAP-TE-CA proposed by Sherrill (Sherrill， 1997). Further discussion was made based on the above results. Recommendations to physical education program for school-aged children with cerebral palsy， and suggestions for future study were provided as well.