Author/Editor		Korelc, Simona; Groleger Sršen, Katja
Title		Kakšne cilje si v programu delovne terapije postavljajo otroci s cerebralno paralizo?
Translated title		What are the goals that are set in occupational therapy programs by children with cerebral palsy?
Type		članek
Vol. and No.		Letnik 18, št. 1
Publication year		2019
Volume		str. 16-24
ISSN		1580-9315 - Rehabilitacija
Language		slv
Abstract		Izhodišče: Cilji rehabilitacije so lahko usmerjeni v izboljšanje ali povrnitev telesnih zgradb in funkcije, izboljšanje funkcioniranja ali izvedbe dejavnosti ter izboljšanje sodelovanja. Na sodelovanje otrok s telesnimi okvarami vpliva več dejavnikov. Model optimalnega sodelovanja vključuje dinamično medsebojno vplivanje med posameznimi značilnostmi sodelovanja (sposobnosti otroka, družine in okolja) in dimenzijami sodelovanja (fizična, socialna in osebnostna dimenzija). Zanimalo nas je, kakšne cilje si v programu delovne terapije postavljajo otroci s cerebralno paralizo (CP), ki so vključeni v programe rehabilitacije in s katero od značilnosti in dimenzij modela sodelovanja so ti cilji povezani. Zanimalo nas je tudi, ali je napredek pri doseganju izvedbe in zadovoljstva z izvedbo posameznih izbranih aktivnosti povezan z zmožnostmi grobega gibanja otrok s CP in njihovo funkcijo rok. Metode: V analizo smo vključili podatke o naključno izbranih 40 otrocih s cerebralno paralizo, ki so bili vključeni v bolnišnično obravnavo. Zbrali smo podatke o spolu, starosti, stopnji grobih gibalnih zmožnosti, stopnji zmožnosti funkcije rok ter ciljih, ki so si jih izbrali v programu delovne terapije. Otroci so v okviru prve ure s pomočjo Kanadskega testa za ocenjevanje izvedbe dejavnosti (COPM) izpostavili težave pri izvedbi različnih aktivnosti in nato s pomočjo staršev in delovne terapevtke izbrali do pet ciljev. Na vidni analogni lestvici (ocene od 1 do 10) ocenili, kako izvedejo posamezno aktivnost ter kako so z izvedbo zadovoljni. Oceno s COPM smo ponovili še ob zaključku terapevtskega programa. Rezultati: V analizo smo vključili podatke 16 dečkov in 24 deklic (povprečna starost 9,9 let; SO 3,1). Bili so dokaj enakomerno razporejeni glede na stopnje sistema za razvrščanje otrok s CP glede na grobe zmožnosti gibanja (GMFCS) in funkcijo rok (MACS). Otroci so si izbrali v povprečju 3,6 ciljev, oziroma 51 različnih ciljev. Večji del izbranih ciljev je bil s področja osnovnih, manj pa s področja razširjenih dnevnih aktivnosti, mobilnosti, športnih in šolskih aktivnosti. Analiza ocen s COPM je pokazala pomembno izboljšanje izvedbe in zadovoljstva z izvedbo tako pri vseh otrocih skupaj kot pri posameznih stopnjah GMFCS. Opazili smo statistično značilne razlike med otroci v GMFCS stopnji I. in II. ter ostalimi otroki. Najbolj so glede na oceno izvedbe izbranih aktivnosti napredovali otroci v III. stopnji GMFCS (absolutna razlika povprečij je znašala 4,1 točke). Pri isti skupini otrok smo ugotovili tudi največjo razliko v zadovoljstvu z izvedbo aktivnosti (absolutna razlika povprečij je znašala 4,8 točke). Zaključek: Analiza postavljenih ciljev je pokazala, da si otroci s cerebralno paralizo, s starši in delovnimi terapevti, večinoma postavljajo cilje iz nabora osnovnih vsakodnevnih aktivnosti, precej redkeje pa si želijo izboljšati bolj zahtevne veščine s področja vsakodnevnih aktivnosti, športa ali šole. V cilje usmerjen program delovne terapije je uspešen, kar je potrdilo izboljšanje ocen izvedbe in zadovoljstva z izvedbo aktivnosti ob zaključku programa. Izboljšanje izvedbe in zadovoljstva z izvedbo pri otrocih s cerebralno paralizo je odvisno od grobih gibalnih zmožnosti in funkcije rok.Background: The goals of rehabilitation can be directed towards improving or restoring body structures and functions, functioning or participation. The latter is influenced by several factors in children with physical disabilities. The model of optimal participation includes a dynamic interaction between the individual characteristics of participation (child, family and environment) and dimensions of participation (physical, social and personality dimensions). We wanted to know which were the goals within occupational therapy of the children with cerebral palsy (CP) who had been involved in rehabilitation programs, and to which of the characteristics and dimensions of the cooperation model are these goals related. We were also wanted to find out whether the progress in achieving performance and satisfaction with the implementation of selected activities is linked to the capabilities of the gross movement of children with CP and their hand function. Methods: We analysed the data from randomly selected 40 children with cerebral palsy who were included in the inpatient rehabilitation program. We collected data on sex, age, degree of gross mobility, the level of hand function and the goals they have chosen in the occupational therapy program. Within the first hour, the children underlined difficulties in carrying out various activities by means of the Canadian Occupational Performance Measure (COPM), and then selected up to five goals with the help of parents and therapists. They used a visual analogue scale (grades 1 to 10) to assess how they perform an individual activity and how satisfied they are with the performance. The COPM evaluation was repeated at the end of the therapeutic program. Results: We included 16 boys and 24 girls (average age 9.9 years, SO 3.1). They were fairly evenly distributed according to the levels of the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). The children selected an average of 3.6 goals, or 51 different goals. Most of the selected goals were from the domain of basic, and less from the domain of extended daily activities, mobility, sports and school activities. The analysis of COPM scores showed a significant improvement in performance and satisfaction with the performance of all children combined as well as within individual GMFCS levels. We observed statistically significant differences between children in GMFCS levels I and II and other children. The children in level III advanced the most according to the COPM assessment of (the mean difference was 4.1 points). In the same group of children, we also found the largest difference in satisfaction with the implementation of the activity (the mean difference was 4.8 points). Conclusion: The analysis of the set goals showed that children with cerebral palsy, their parents and occupational therapists mostly choose goals from a set of basic daily-life activities, while they they are much less interested to improve more demanding skills in everyday activities, sports or school. The goal-oriented occupational therapy program is successful, which was confirmed by the improvement of performance and satisfaction ratings at the completion of the program. Improving performance and satisfaction with performance in children with cerebral palsy depends on the gross motor function and the manual function.
Descriptors		Cerebral palsy Child rehabilitation
Keywords		child goal setting cerebral palsy rehabilitation otrok postavljanje ciljev cerebralna paraliza rehabilitacija