第十四屆 身心障礙孩童參與手部精細動作情境的影響因子：概念模式暨初步分析

Factors affecting participation in hand-use life situations in children with disabilities: A conceptual model and preliminary analysis

簡啟文^1,*   Sylvia Rodger¹   Jodie Copley¹

Chi-Wen Chien¹   Sylvia Rodger¹   Jodie Copley¹

¹澳洲昆士蘭大學健康與復健科學系之職能治療組

¹Occupational Therapy Division, School of Health and Rehabilitation Sciences, Faculty of Health Science, The University of Queensland, Brisbane, Australia

Background and Purpose: Participation in everyday life has been recognized as an importance outcome and ultimate goal for rehabilitation and healthcare services in children with disabilities. Research has focused largely on identification of potential factors supporting children’s participation in recreational or general life situations. However, there is little attention on the factors affecting the life situations that require children to use the hands specifically during participation (e.g., manipulative play, personal care, or writing assignments). Therapists need to know this information in order to design suitable interventions that promote hand-use life participation in children with disabilities.  The purpose of this study was to present a conceptual model for children's participation in hand-use during life situations and to explore potential factors. Methods: Our literature review of participation-related models and research concluded that a number of child, family, and environmental factors could affect children's participation in hand-use life situations. A potential conceptual model was thus proposed by incorporating the Internal Classification of Functioning, Disability, and Health. In our model, grasping strength, range of motion and visual function at child’s body function/structure level are proposed to have a direct effect on activity and an indirect effect through hand-use participation. At child’s activity level, fine motor development, manual ability, real-life hand skill performance and adaptive behavior are also proposed to have a direct effect on hand-use participation. At family level, parental self-efficacy, the number of siblings, and the socio-demographics such as parents’ education, employment, age and family income could have a direct effect on hand-use participation. At environmental level, restrictions on home, school, or community may have a direct or indirect effect on hand-use participation. To further explore the suitability of this model, children with disabilities attending special schools were assessed using the Children's Assessment of Participation in life situations with Hands (CAP-Hand questionnaire) as participation outcome and a number of parent-report, observational and standardized assessments addressing child, family and environmental characteristics. Results: A total of 41 children aged 31 to 162 months (23 boys and 18 girls) were recruited from five special schools in Brisbane, Australia. Most of the children had multiple diagnoses/disabilities including autism (43.9%), developmental delay (41.5%), speech delay (41.5%), intellectual disabilities (36.6%) and others. Preliminary correlation analyses revealed that those children’s diversity scores of hand-use life participation (as measured by the CAP-Hand) associated moderately to highly (Spearman's rho coefficients=0.47 to 0.89) with 15 child factors (e.g., grasping strength, manual ability, developmental milestones, real-life hand skill performance, etc.) and two family factors (mother's education and age). The other participation dimensions of the CAP-Hand (i.e., frequency, assistance, and parents' desire for change) also exhibited moderate correlations with some factors. Conclusions: The findings contributed to preliminary understanding of the complexity of children’s participation in hand-use life situations and could help further planning of regression analysis that disentangles the possible pathways leading to children's participation in hand-use life situations. This proposed model, once being supported by further regression analysis on a sizable sample, can be used to guide development of specific interventions that focus on facilitating factors as well as clinical programs/services that are effective in enhancing children’s participation in hand-use life situations. 

Keywords: Participation, hand use, conceptual model