腦性麻痺孩童觸覺知覺測驗之發展

Abstract

前言：腦性麻痺孩童常伴隨上肢功能缺損，上肢功能缺損又以感覺及動作功能缺損最為常見。過去文獻顯示，約20~90%的腦性麻痺孩童有觸覺功能缺損之情形，過去文獻亦顯示觸覺知覺功能為預測腦性麻痺孩童上肢動作功能的重要因子，然而，目前應用於腦性麻痺孩童的觸覺知覺評估工具有些許限制，此外，亦無任何評估工具全面性地評估腦性麻痺孩童觸覺知覺功能，因此，本研究目的為發展一個標準化功能性觸覺知覺評估工具，並初步驗證本工具應用於腦性麻痺孩童之心理計量特性(包含內部一致性信度、再測信度、收斂效度、已知族群效度以及天花板/地板效應)。 方法：藉由文獻回顧與團隊會議討論，本團隊設計出一套包含物品、形狀、粗細、軟硬、重量等五個面向的觸覺知覺測驗。另外，為了驗證本工具於腦性麻痺孩童之心理計量特性，本研究招募4至13歲的腦性麻痺孩童與典型發展孩童。治療師於兩周內重複施測本測驗於同一名腦性麻痺孩童，此外，治療師亦施測外在校標(西門－韋恩斯坦單絲測驗、靜態/動態兩點區辨、修訂版諾丁漢感覺評估量表、墨爾本評估第二版)，以檢測本測驗於腦性麻痺孩童之心理計量特性，典型發展孩童則僅需接受一次施測。 結果：物品與形狀分測驗擁有良好至可接受的內部一致性信度，且本工具的五項分測驗於腦性麻痺孩童非慣用手(患側手)的測驗分數擁有良好的再測信度。本工具亦於腦性麻痺孩童非慣用手(患側手)呈現良好的收斂效度與已知族群效度，而物品、形狀、粗細、軟硬等四項分測驗呈現顯著的天花板效應。 討論：本工具於腦性麻痺孩童非慣用手(患側手)上具有良好的信效度，期待後續研究改良本工具並驗證其反應性，並推廣至臨床實務應用。 關鍵字：腦性麻痺孩童、觸覺功能、評估工具、信效度

Introduction: Children with cerebral palsy (CP) often have problems in upper-limb motor and sensory functions. According to previous studies, about 20–90% of children with CP have tactile deficits. In addition, tactile perception functions have been reported to be potential predictors of upper limb motor function in children with CP. Despite their importance, the existing tactile perception assessment tools have some critical limitations. Also, no comprehensive standardized tactile perception test is currently available for children with CP. Thus, the purpose of this study was to develop a new standardized functional tactile perception test, the Observatory Test of Tactile Perception (OTTP). Furthermore, the psychometric properties of the OTTP, including internal consistency, test–retest reliability, convergent validity, known-group validity and ceiling/floor effects, were also examined in children with CP. Method: The OTTP, including five subtests (i.e., object, shape, roughness, hardness and heaviness perception), was developed with standardized procedures. Children with CP and typically developing children aged 4 to 13 years were recruited to examine the psychometric properties of the OTTP. Each child with CP completed two assessment sessions within intervals of about 2 weeks. The typically developing children were tested only once. The OTTP, Semmes–Weinstein Monofilaments, Two-Point Discrimination, Revised Nottingham Sensory Assessment, Melbourne Assessment 2, and Manual Ability Classification System were administrated. Result: The object and shape perception subtests had acceptable internal consistency reliability with alpha or KR-20 values greater than 0.8. The OTTD had good test–retest reliability in the non-dominant (more-affected) hand (ICC > 0.8), but moderate test–retest reliability in the dominant (less-affected) hand among three out of the five subtests. The OTTD presented good convergent reliability and known-group validity in the non-dominant (more-affected) hand of children with CP. Four subtests of the OTTD showed notable ceiling effects in both hands. Discussion: The OTTP is a reliable and valid measure of tactile perception in children with CP. The OTTP comprehensively measures five domains of tactile perception functions to help therapists capture the scope of children’s tactile perception performances. The OTTP is recommended for use in the non-dominant (more-affected) hand of children with CP in clinical practice. Further refinement and examination of other psychometric properties are needed in the future. Keywords: Cerebral Palsy, Tactile Perception, Assessment, Reliability, Validity