Middle Eastern Journal of Disability Studies

fa مقایسۀ تأثیر مداخلات تمرینی بر هماهنگی چشم و دست کودکان فلج مغزی همی‌پلژی اسپاستیک The Effects of Exercise Interventions on Eye-Hand Coordination in Children with Spastic Hemiplegic Cerebral Palsy توانبخشی Rehabilitation مقاله پژوهشی اصیل Original Research Article <div style="text-align: justify;">زمینه و هدف: مداخلات‌ انجام‌شده در زمینۀ بهبود هماهنگی چشم و دست به‌عنوان عنصر اساسی در فعالیت‌های روزمرهٔ کودکان فلج مغزی، بسیار محدود است؛ بنابراین این مطالعه با هدف مقایسهٔ تأثیر مداخلات تمرینی بر هماهنگی چشم و دست کودکان فلج مغزی همی‌پلژی اسپاستیک انجام شد. روش‌بررسی: این پژوهش از نوع نیمه‌تجربی با طرح پیش‌آزمون و پس‌آزمون با گروه گواه بود. ۲۰ کودک فلج مغزی همی‌پلژی اسپاستیک از مدرسهٔ استثنایی گلها در شیراز در سال ۱۳۹۸ به روش نمونه‌گیری دردسترس انتخاب شدند. سپس به‌صورت تصادفی در چهار گروه ۵نفره، مداخلات فعالیت بدنی، فیزیوتراپی و واقعیت مجازی را دریافت کردند و گروه گواه هیچ مداخلاتی دریافت نکرد. مداخلات به‌مدت هشت هفته و هر هفته سه جلسه و هر جلسه ۳۰ دقیقه اجرا شد. آزمون یکپارچگی بینایی‌حرکتی (بیری، ۱۹۸۹) به‌منظور ارزیابی هماهنگی چشم و دست به‌کار رفت؛ همچنین برای سنجش تأثیر مداخلات در مراحل مختلف آزمون از آزمون تحلیل واریانس با اندازه‌گیری مکرر و برای تعیین ماندگاری تأثیر مداخلات از آزمون تعقیبی بونفرونی استفاده شد. سطح معناداری ۰٫۰۵ در نظر گرفته شد. یافته‌ها: در سنجش تأثیر مداخله، نتایج بیانگر تفاوت معنادار تأثیر مداخلات بر هماهنگی چشم و دست در گروه‌های مختلف شامل فعالیت بدنی (۰٫۰۰۱>p)، فیزیوتراپی (۰٫۰۰۸=p) و واقعیت مجازی (۰٫۰۰۱>p) بود. در سنجش میزان ماندگاری مداخلات باتوجه به مراحل پس‌آزمون و پیگیری، در گروه واقعیت مجازی میزان ماندگاری مداخله درمقایسه با دو گروه دیگر درخورتوجه بود (۰٫۱۰۸=p).  نتیجه‌گیری: طراحی برنامه‌های تمرینی با استفاده از محیط واقعیت مجازی درمقایسه با سایر مداخلات در بهبود هماهنگی چشم و دست کودکان فلج مغزی نقش مؤثرتری دارد.</div> <div style="text-align: justify;">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.</div> فلج مغزی همی‌پلژی اسپاستیک, هماهنگی چشم و دست, واقعیت مجازی, فیزیوتراپی, فعالیت بدنی. Spastic hemiplegic cerebral palsy, Eye–Hand coordination, Virtual reality, Physiotherapy, Physical activity. 200 200 http://jdisabilstud.org/browse.php?a_code=A-10-1643-1&slc_lang=fa&sid=1 Zahra Ranjbar زهرا رنجبر ranjbarz94@yahoo.com 100319475328460052053 100319475328460052053 No Department of Physical Education and Sports Sciences, Science and Research Branch, Islamic Azad University گروه تربیت‌بدنی و علوم ورزشی، واحد علوم و تحقیقات، دانشگاه آزاد اسلامی Elahe Arab Ameri الهه عرب عامری eameri@ut.ac.ir 100319475328460052054 100319475328460052054 Yes Department of Physical Education and Sports Sciences, University of Tehran گروه تربیت‌بدنی و علوم ورزشی، واحد تهران Keyvan Molanorouzi کیوان ملانوروزی keivannorozy@gmail.com 100319475328460052055 100319475328460052055 No Department of Sports Management, Islamshahr Branch, Islamic Azad University گروه مدیریت ورزشی، واحد اسلامشهر، دانشگاه آزاد اسلامی Masoumeh Shojaei معصومه شجاعی e5shojaei@yahoo.com 100319475328460052056 100319475328460052056 No Department of Motor Behavior, Faculty of Sport Sciences, AlZahra University گروه رفتار حرکتی، دانشکدهٔ علوم ورزشی، دانشگاه الزهرا Afkham Daneshfar افخم دانشفر afkham.danesh@gmail.com 100319475328460052057 100319475328460052057 No Department of Motor Behavior, Faculty of Sport Sciences, AlZahra University گروه رفتار حرکتی، دانشکدهٔ علوم ورزشی، دانشگاه الزهرا