2011-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660301摘要：背景與問題：腦性麻痺是最常見且會造成孩童長期運動功能障礙的小兒病症，其動作控制困難與伴隨的障礙是影響孩童學校生活的參與之主要原因，文獻已證實腦性麻痺孩童學校參與較一般發展孩童參與少，也遭遇較多困難，亟需專業人員協助孩童自學齡前至國小的轉銜。腦性麻痺孩童學校參與的影響因子涵蓋「國際功能、失能與健康分類系統(International Classification of Functioning, Disability and Health, ICF)」中身體功能與構造、活動及參與，與情境因素各層面。然而，迄今卻尚未有長期追蹤的研究以ICF模式為架構，同時探討腦性麻痺孩童學齡前、轉銜初期(入學時)兩階段成功銜接整合的影響因子、在學齡前階段ICF各層面的因子如何影響孩童入學後的學校參與，以及轉銜後的發展歷程變化（developmental trajectory）及影響其變化的因子。若能瞭解前述的影響因子，則有助於臨床工作者、老師在學前階段將影響因子列為早期療育介入的目標，使早期療育介入能更有效地銜接入學後的學校生活，將早期療育習得的技巧與經驗延續至小學。此外，藉由長期追蹤研究以瞭解腦性麻痺孩童學校參與之發展歷程，將有助於臨床工作者、老師整合轉銜前、轉銜初期，與轉銜一年後之三階段的發展，使轉銜過程無接縫。目的：本3年期追蹤研究計畫之目的為依據ICF模式，探討腦性麻痺孩童於轉銜前、轉銜初期，與轉銜一年後時學校參與的預測因子，並建立初步的「台灣腦性麻痺兒童學校參與之模型」。方法：研究樣本為來自全台灣幼稚園、發展中心、復健門診、小兒科等單位轉介之5至7歲預計下一學年上小學之學齡前腦性痲痺孩童。考量長期追蹤研究流失率約為16％，期望在第3年有足夠的個案資料（約200名）作統計分析，因此第一年預計收案300名，第二年追蹤研究，預估因流失因素剩250名，第三年追蹤研究，預估因流失因素剩200名。研究方法為根據ICF模式，於腦性麻痺孩童就學前(即大班階段)、轉銜初期(小學一年級上學期)，與轉銜一年後(小學二年級上學期)三個時間點蒐集腦性麻痺孩童ICF模式中身體功能與構造、活動與參與及情境因素等變項之資料，以廣義估計方程式(Generalized Estimating Equations, GEE)來建構影響腦性麻痺孩童學校參與的迴歸模式以確認預測因子，並以結構方程模式(structural equation modeling)來建立「台灣腦性麻痺孩童學校參與之模型」。預期貢獻：本3年期追蹤研究成果之預期貢獻有以下五點：(1)學校參與之預測因子可作為臨床工作者評估與介入腦性麻痺孩童學校參與之參考；(2)「台灣腦性麻痺孩童學校參與之統計模型」可解釋ICF模式中各因子對於腦性麻痺孩童學校參與的影響；(3)作為醫療、教育、社會福利相關主管單位擬定預防政策之參考，以達早期發現，早期治療與預防之目的；(4) 有助於臨床工作者、老師瞭解腦性麻痺孩童學校參與之發展歷程，進而協助改善其學校參與；(5)本研究描述腦性麻痺孩童在ICF模式中各面向之特性，有助於建立腦性麻痺孩童的ICF核心組套編碼(ICF core set)，並應用於臨床實務與研究。<br> Abstract: Background: Cerebral palsy (CP), the most common cause of long-term disability in children, permanently impairs motor development and restricts school participation. Children with CP are known to have reduced school participation and encounter more difficulties as compared to typically developing children. The factors influencing school participation in children with CP encompass all dimensions of the International Classification of Functioning, Disability, and Health (ICF). However, no longitudinal study, to date, adopts the ICF framework to investigate the factors influencing transition from preschool to school for children with CP, and later school participation. Thus, a follow-up study investigating the developmental trajectory of school participation in children with CP before transition, the initial stage and a year after transition and its determinants is warranted. The results of the study help to ensure a smooth transition and help clinicians and educators to plan the best fit intervention and education program for children with CP.Purposes: This 3-year longitudinal study is aimed to (1) identify determinants of school participation in children with CP before transition, the initial stage and a year after transition according to the ICF framework, and (2) build up a “Taiwanese model of school participation in children with CP (TMSPCCP)”.Method: Children with CP who are going to enroll in Grade one of primary schools in the coming school year will be recruited from kindergartens, rehabilitation and pediatric clinics, and developmental centers in Taiwan. Considering 16% of drop-out rates in follow-up studies and in order to have enough sample size (N=200) for statistical analysis, sample size will be 300 in year one, 250 in year two, and 200 in year three. In order to investigate the determinants of school participation, variables related to body structures and functions, activity and participation, and context in the ICF framework will be collected in 3 time points, which are one year before transition (kindergarten), the initial stage of transition (Grade one of primary school) and a year after transition (Grade two of primary school). The generalized estimating equations and the structural equation modeling will be used respectively to identify the determinants of school participation and build up the TSMSPCCP.Anticipated results and contributions: Pediatric clinicians, special educators, and researchers all will have the following benefits: (1) The determinants of school participation can serve as the evaluation or the intervention goals for children with CP ; (2) The TSMSPCCP can describe how the determinants in the ICF framework impact on the school participation of children with CP; (3) The determinants could serve as references for policy makers when making policy for prevention, early identification and intervention to improve school participation in children with CP; (4) Knowledge of developmental trajectory of school participation in children with CP can help professionals identify children with reduced school participation; (5) The results of the study investigating determinants of school participation using the ICF framework can provide empirical evidence for establishing the ICF core set of children with CP and help application of core set to clinical and research fields.腦性麻痺學校參與長期追蹤ICFcerebral palsyschool participationlongitudinal follow-upICF