臺灣博碩士論文加值系統

早期療育的目的在促進發展遲緩兒童的功能性表現，以成功的參與其環境，居家復健計畫常被用來達到此目的。居家計畫視家長為合作夥伴，目標在強化家庭能力以促進兒童的健康與發展，與早期療育的黃金準則—「以家庭為中心」的原則相符。然而，居家計畫對發展遲緩兒童之影響的實證研究不多，因此本研究的主要目的在（1）探究「居家復健計畫」的介入對發展遲緩兒童發展、功能與日常生活獨立性的影響，以了解「居家復健計畫」是否能幫助發展遲緩兒童達成預期的功能性目標；（2）探討兒童、家庭特性與復健因素對「居家復健計畫」介入結果的影響情形，以探尋較適合採取居家復健計劃介入的兒童、家庭特性與復健因素。
本研究係採準實驗設計之前測—後測等組控制組實驗設計，受試對象為6～48個月發展遲緩兒童及其家長，取樣自中部2家衛生署核准的兒童發展聯合評估醫院，經醫師評估診斷為疑似或發展遲緩之兒童，並排除腦性麻痺、神經退化性疾病或視、聽覺損傷所造成的發展遲緩，以及已經在接受固定療育課程的個案。依家長的意願分至實驗組與控制組，控制組計有21人，接受1週2堂課每堂課60分鐘的直接復健治療；實驗組計有21人，接受1週2堂課每堂課40分鐘復健治療，再加上20分鐘的居家復健計劃之教導與追蹤，並請照顧者於居家環境中繼續依計劃執行居家活動。實驗介入期間為10週。介入前後的評估，以「嬰幼兒綜合發展測驗」（Comprehensive Developmental Inventory for Infant and Toddler；CDIIT）評估個案各領域的發展能力；及以「兒童身心障礙評估量表」 (Pediatric Evaluation of Disability Inventory；PEDI)評量個案的功能性技巧及照顧者協助程度。研究資料以SPSS 13.0英文版進行處理與分析。使用的統計方法包括：描述性分析、卡方檢定、獨立樣本t檢定、配對樣本t檢定、共變數分析（Analysis of Covariance，ANCOVA）、無母數差異性分析及斯皮爾曼等級相關（Spearman）。所有統計方法之顯著水準皆訂於0.05。
實驗結果發現：（1）「居家復健計畫」的介入對發展遲緩兒童的「各領域發展」與「功能性技巧」有正向影響，且能降低兒童在日常生活中需要照顧者協助的程度；（2）父母年齡「大於31歲」組的個案在「整體發展」與「功能性技巧」的進步較「小於30歲」組顯著，其他因素的影響則不顯著，而「照顧者協助」方面的進步情形，不會因兒童、家庭特性或復健因素的影響而有顯著不同。
本研究的居家復健計劃可有效的幫助發展遲緩兒童，提升各領域發展與功能性技巧，並能降低照顧者在日常生活中協助兒童的程度。其結果可提供復健服務提供者促進發展遲緩兒童發展與功能之參考，但在適合居家復健計劃之兒童、家庭特性與復健因素的確認上，可能因為個案數不夠多、或是沒有收集到重要影響因素，仍需更多研究作進一步的深入探討。

Early intervention for children with developmental delay focuses on improving the children’s functional performance and ability to interact with his or her physical and social environments. Home programs are used extensively as a strategy for achieving these desired outcomes. Home programs recognize family expertise, and focus on enhancing caregiver competency to improve their child’s health and development, that just match with the “gold principle: family-centered approach” in early intervention service. However, there is little evidence to demonstrate the effectiveness of such programs.
This study aimed to (1) investigate whether provision of a home program in addition to a center-based program improves development, function and living independence in children with developmental delay; (2) describe the characteristics of child, family and therapy what benefit most from the intervention.
This was a pretest-posttest equivalent-group design study, 40 children who have or are at risk for a developmental delay, aged 6-48 months, participated in the study. According to caregiver’s desire, these 40 children were assigned to two groups. All children received 20 center-based treatment sections for 10 weeks. The intervention group received an additional home program. All children were assessed before and after the intervention. We measured impact using Comprehensive Developmental Inventory for Infant and Toddler (CDIIT), and the Pediatric Evaluation of Disability Inventory (PEDI). Differences in change over time and between the intervention and control group were analyzed by repeated measures and ANCOVA. The association between characteristics of child, family and therapy with improved outcome by Mann-Whitney U test, Kruskal-Wallis H two-sample test or Spearman rank-difference coefficient of correlation.
Change in development, functional skills, and independence over time favored the children who received the home program intervention. Analysis of variance revealed more improvement for children in the intervention group from older than younger parents.
The results of this study suggest that auxiliary home programs increase development, functional skills, and independence in young children with developmental delay. We hope these results will encourage therapist to device home programs for more improves from early intervention service. Further research should clarify which variables predict most successful utilization of home program.

第一章 緒論
第一節 研究背景與研究動機……………………………1
第二節 研究目的與問題…………………………………6
第三節 名詞解釋…………………………………………8
第二章 文獻探討
第一節 早期療育復健服務的現況與困境……………..10
第二節 居家復健計畫…………………………………..19
第三節 「以家庭為中心」的理念……………………..33
第四節 發展遲緩兒童之發展與功能…………………..45
第五節 早期療育中居家復健計畫之相關研究………..58
第三章 研究方法
第一節 研究對象………………………………………..69
第二節 研究設計與實施程序…………………………..71
第三節 介入計畫的規劃與實施………………………..75
第四節 研究工具………………………………………..77
第五節 資料處理與分析………………………………..81
第四章 研究結果與討論
第一節 研究個案的描述性分析結果…………………..82
第二節 「居家復健計劃」介入對兒童之影響分析…..95
第三節 影響「居家復健計畫」介入結果的相關因素.112
第四節 綜合討論……………………………………….121
第五章 結論與建議
第一節 結論…………………………………………...134
第二節 建議…………………………………………….138
第三節 研究限制……………………………………….145
參考文獻
中文參考文獻………………………………………….147
英文參考文獻………………………………………….151

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