مقايسۀ تأثير مداخلات تمريني بر هماهنگي چشم و دست كودكان فلج مغزي همي‌ پلژي اسپاستيك

The Effects of Exercise Interventions on Eye-Hand Coordination in Children with Spastic Hemiplegic Cerebral Palsy

زمينه و هدف: مداخلات‌ انجام‌ شده در زمينۀ بهبود هماهنگي چشم و دست به‌عنوان عنصر اساسي در فعاليت‌هاي روزمرهٔ كودكان فلج مغزي، بسيار محدود است؛ بنابراين اين مطالعه با هدف مقايسهٔ تأثير مداخلات تمريني بر هماهنگي چشم و دست كودكان فلج مغزي همي‌پلژي اسپاستيك انجام شد. روش‌ بررسي: اين پژوهش از نوع نيمه‌تجربي با طرح پيش‌آزمون و پس‌آزمون با گروه گواه بود. 20 كودك فلج مغزي همي‌پلژي اسپاستيك از مدرسهٔ استثنايي گلها در شيراز در سال 1398 به روش نمونه‌گيري دردسترس انتخاب شدند. سپس به‌صورت تصادفي در چهار گروه 5نفره، مداخلات فعاليت بدني، فيزيوتراپي و واقعيت مجازي را دريافت كردند و گروه گواه هيچ مداخلاتي دريافت نكرد. مداخلات به‌مدت هشت هفته و هر هفته سه جلسه و هر جلسه 30 دقيقه اجرا شد. آزمون يكپارچگي بينايي‌حركتي (بيري، 1989) به‌منظور ارزيابي هماهنگي چشم و دست به‌كار رفت؛ همچنين براي سنجش تأثير مداخلات در مراحل مختلف آزمون از آزمون تحليل واريانس با اندازه‌گيري مكرر و براي تعيين ماندگاري تأثير مداخلات از آزمون تعقيبي بونفروني استفاده شد. سطح معناداري 0٫05 در نظر گرفته شد. يافته‌ها: در سنجش تأثير مداخله، نتايج بيانگر تفاوت معنادار تأثير مداخلات بر هماهنگي چشم و دست در گروه‌هاي مختلف شامل فعاليت بدني (0٫001>p)، فيزيوتراپي (0٫008=p) و واقعيت مجازي (0٫001>p) بود. در سنجش ميزان ماندگاري مداخلات باتوجه به مراحل پس‌آزمون و پيگيري، در گروه واقعيت مجازي ميزان ماندگاري مداخله درمقايسه با دو گروه ديگر درخورتوجه بود (0٫108=p). نتيجه‌گيري: طراحي برنامه‌هاي تمريني با استفاده از محيط واقعيت مجازي درمقايسه با ساير مداخلات در بهبود هماهنگي چشم و دست كودكان فلج مغزي نقش مؤثرتري دارد.

Background & Objectives: Cerebral Palsy (CP) is a disorder of movement and posture with extensive variety and classifications. Spastic hemiplegia is the most prevalent CP type. The motor limitations appear in combination with sensory and cognitive alterations that result in great difficulties for children with CP to manipulate objects, communicate, and interact with their environment, subsequently limiting their mobility. Eye–hand coordination is the skill in which visual information from the eyes and motor data from the hands are efficiently applied to work together as an essential component of self–help activities, play, perception, and school work. Therefore, problems with eye–hand coordination make it difficult for children to experience search tasks in their daily lives, such as playing and school activities. Eye–hand coordination is critical in functional performance and should be carefully considered by coaches and occupational therapists. Thus, the current research aimed to investigate the effects of exercise interventions on eye–hand coordination in children with spastic hemiplegic CP. Methods: This was a quasi–experimental study with a pretest–posttest, a control group, and a single–blinded design. We classified three experimental groups of physical activity, virtual reality, physiotherapy, and a control group. Twenty children with spastic hemiplegic CP from Golha Special School in Shiraz City, Iran, in 2019 were selected by convenience sampling method. The inclusion criteria of the study were as follows: girls and boys with spastic hemiplegic CP (6–12–year–olds); specified as level 1–3 on the Gross Motor Function Classification System (GMFCS) (according to relevant occupational therapist & their medical records); no visual or auditory impairment; no previous experience working with Xbox; no use of anticonvulsant drugs; no orthopedic surgery; no lower limb Botox injections for 6 months prior to intervention, or the presence of other disorders, such as autism, asthma, etc. (according to their parents & their medical records). Subjects’ inability to follow the intervention program and instructions, and having more than three absences in the training sessions were the exclusion criteria of the study. Children were randomly divided into 4 groups of physical activity (a set of aerobic exercises, balance skills, coordination exercises, walking distance, ball skills, copying shapes, & painting were performed under the supervision of an occupational therapist & the relevant expert), physiotherapy (joint movement exercises, muscle extensions, muscle strength exercises, torso stability exercises, tracking, & grasping objects held by a physiotherapist, by stretching the arms in different directions in a sitting position), virtual reality (offering Xbox 360 Kinect games, including jumping, weight transfer, stepping from one side to the other, using the arms and legs to prevent bloating, or using arms and legs coordinated movements to cover the cavities created by the blows of the fish in the body of the aquarium), and the control group (exempt from intervention) (n=5/group). In addition, all study participants continued their treatment and physiotherapy programs for two weekly sessions during the research process. The experimental groups received interventions for 8 weeks, 3 sessions per week, and 30 minutes per session. The Visual Motor Integration Test (Beery, 1989) was used to assess eye–hand coordination. Repeated–measures Analysis of Variance (ANOVA) was used to explore the impact of interventions in the different stages of the test. Besides, the Bonferroni post–hoc test was used to determine the sustainability of the effect of interventions, and the level of significance was set at 0.05. Results: The obtained results indicated a significant difference between the effects of interventions on eye–hand coordination in different groups, including physical activity, physiotherapy, and virtual reality, (p<0.001). To measure the effectiveness of the interventions, according to the pretest–posttest stages, the relevant results indicated a significant effect of the interventions in all three groups of virtual reality (p<0.001), physical activity (p<0.001), and physiotherapy (p=0.008). To measure the duration of interventions according to the posttest and follow–up stages, due to the negative coefficient of difference, the duration of intervention in physical activity (p=0.010) and physiotherapy (p=0.044) was low, and the duration of virtual reality intervention, compared to the other two groups was noteworthy (p=0.108). Conclusion: According to the present study results, it can be concluded that, compared to other interventions, designing exercise programs via virtual reality environment can play a role in improving the eye–hand coordination of children with CP.