Journal of Taiwan Occupational Therapy Research and Practice
目的:體能活動是不可或缺的重要職能表現，參與體能活動可促使學齡前兒童發展勝 任動作技巧的能力，進而增進其健康狀態。部分文獻已針對學齡前腦性麻痺兒童的活動量 狀況進行檢測和探討;美國及加拿大也提供有關於障礙幼童族群的體能活動建議和指引， 然而，台灣至今尚未訂定有關障礙幼童族群的建議和指引。本篇研究目的在於透過系統性 回顧文獻的方式，提供有關不同粗大動作障礙程度的學齡前(3-5 歲)腦性痲痺兒童體能 活動狀況之探討，以期提供未來臨床介入和制訂相關健康政策的指引。方法:本文使用電 子資料庫 Pubmed、Scopus、Medline、Google Scholar、台灣博碩士論文知識加值系統、 以及手動搜尋的方式，蒐集近 20 年來的中英文文獻資料。使用 cerebral palsy、physical activity、preschool children、young children、gross motor function 以及腦性麻痺、學齡 前兒童、體能活動、粗大動作功能等關鍵字搜尋，依照實證層級和個案特徵、評估方式、 活動頻率/時間/強度的分類來探討結果。結果:本回顧共篩選出 8 篇觀察性文獻，大多 屬於牛津大學實證醫學中心(OCEBM)證據等級 4 到 3b 的研究，證據層級偏低，且個 案多為粗大動作功能(GMFCS)嚴重度為輕度(階級 I 和 II)的腦性麻痺兒童為主;評 估方式則以使用三軸加速規測量活動次數、久坐時間和消耗能量為主;而學齡前腦性麻痺 兒童參與體能活動的次數、久坐時間因不同粗大動作障礙程度而有所不同;GMFCS 階級I 和 II 的兒童的體能活動和久坐行為狀況與同年齡之典型發展兒童相似，階級 III 至 V 之兒 童的體能活動比階級 I 和 II 的兒童少一半量，久坐行為狀況則多 10%~20% 的時間。結論:這是第一篇探討不同粗大動作障礙程度的學齡前腦性麻痺兒童體能活動之狀況的回顧型文 獻，結果建議有獨立移行能力的兒童應維持與同年齡典型發展兒童類似的活動量和久坐行 為標準;但有部分獨立移行、和無獨立移行能力之兒童(GMFCS levels 3-5)，考量其 身體功能和實際體能活動狀況，建議活動量或許可為輕度障礙兒童之一半。未來研究可進 一步利用此建議標準，檢測不同粗大動作障礙能力之學齡前腦性痲痺兒童，特別是對於動 作能力發展和健康狀況之影響;另可藉由三軸加速規搭配活動紀錄表的評估方式，提供更 多嚴謹、高實證層級的研究。
Objective: Physical activity is the essential and important occupational performance.Participation in physical activity is able to enhance preschoolers’ competence on mastering motor skills and further promote their health conditions. Some literature has examined and discussed the conditions of physical activity in preschoolers with cerebral palsy (CP); theUnited States of America and Canada have provided suggestions and guidelines of physicalactivity for young children with disabilities. However, up to date, there is no suggestion and guideline for young children with disabilities in Taiwan. To provide guidelines for futureintervention and the development of health-related policies, this study aims to provide thediscussion on physical activity in preschoolers (3-5 years old) with CP of different levels of gross motor severity through the application of systematic review. Methods: Keyword and reference search were conducted on electronic databases (Pubmed, Scopus, Medline, Google Scholar, National Digital Library of Theses and Dissertations in Taiwan, and manual searches) for the recent 20 years, including both Chinese and English literature. Keywords includedcerebral palsy, physical activity, preschool children, young children, gross motor function andthe same phrases in Chinese characters. The results were presented and discussed based on level of evidence, participants’ characteristics, assessment tools, and activity frequency/ duration/intensity. Results: Eight observational studies met the inclusion criteria and most ofthem had levels 4 and 3b based on Oxford Centre for Evidence-Based Medicine (OCEBM), which were categorized as low level of evidence. Most recruited participants’ level of severity were mild (level I and II) according to the Gross Motor Function Classification System (GMFCS). The 3-axis accelerometer was frequently used to measure the activity counts, sedentary time and energy expenditure. The physical activity counts and sedentary time were different in preschoolers with CP of different levels of gross motor severity. The physical activity and sedentary behavior in children with CP of GMFCS level I and II were similar to typical children with the same age. Children with CP of GMFCS level III to V only had half amount of the physical activity in children with CP of GMFCS level I and II; their sedentary time was 10% to 20% more than those of mild gross motor severity. Conclusion: This is the rst review article on examining the physical activity in preschoolers with CP of different levels of gross motor severity. The nding suggests those children with CP classi ed as ambulatorychildren should adopt the same standard of physical activity and sedentary behavior as typical children. Nevertheless, considering body function and the actual condition of physical activity,marginally ambulatory and nonambulatory children (GMFCS levels 3-5) may have half amount of physical activity in children with mild gross motor severity. Future research can apply these suggestions to further examine their impacts on the development of motor capacity and health condition in preschoolers with CP different levels of gross motor severity. In addition, 3-axis accelerometers and the activity log can be both used to provide more rigorous studies withhigh level of evidence.