Γιώργος Παράς - Μέθοδοι Φυσικοθεραπευτικής Προσέγγισης Παιδιών με Εγκεφαλική Παράλυση: Μύθος και Πραγματικότητα

pages 5-47

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·5 ANA™KO¶H™H ª¤ıÔ‰ÔÈ º˘ÛÈÎÔıÂÚ·¢ÙÈ΋˜ ¶ÚÔÛ¤ÁÁÈÛ˘ ¶·È‰ÈÒÓ Ì ∂ÁÎÂÊ·ÏÈ΋ ¶·Ú¿Ï˘ÛË: ª‡ıÔ˜ Î·È ¶Ú·ÁÌ·ÙÈÎfiÙËÙ· °ÈÒÚÁÔ˜ ¶·Ú¿˜ º˘ÛÈÎÔıÂÚ·Â˘Ù‹˜, Ph.D., ∂ÚÁ. ™˘ÓÂÚÁ¿Ù˘, ∆Ì‹Ì· º˘ÛÈÎÔıÂÚ·›·˜, ∆.∂.π. §·Ì›·˜ ∂ÈÎÔÈÓˆÓ›·: °ÈÒÚÁÔ˜ ¶·Ú¿˜, ∆Ì‹Ì· º˘ÛÈÎÔıÂÚ·›·˜, ∆.∂.π. §·Ì›·˜ 3Ô ¯ÏÌ ¶∂O §·Ì›·˜ - ∞ıËÓÒÓ, 35100 §·Ì›·, e-mail: g_p@teilam.gr ∂π™∞°ø°∏ ∏ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ·ÔÙÂÏ› ÙÔÓ Î˘ÚÈfiÙÂÚÔ ÂÎÚfiÛˆÔ ÙˆÓ ÛÙ·ÙÈÎÒÓ ÂÁÎÂÊ·ÏÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È Â›Ó·È Ì›· ·fi ÙȘ ‰È·Ù·Ú·¯¤˜ Ô˘ Û˘¯Ó¿ Ô‰ËÁÔ‡Ó Û ‚·ÚÈ¿ ·Ó·ËÚ›·. OÊ›ÏÂÙ·È Û ÌË-ÚÔ˚Ô‡Û·, ÌËÚÔԉ¢ÙÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÓÒÚÈÌÔ˘ ∫.¡.™., Ô˘ ÂËÚ¿˙ÂÈ Ù· ÙÌ‹Ì·Ù· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ù· ÔÔ›· Ú˘ıÌ›˙Ô˘Ó ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÛÙ¿ÛË Î·È Î›ÓËÛË ÙÔ˘ ÛÒÌ·ÙÔ˜. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ¤Ó· ¢ڇ Ê¿ÛÌ· ‰˘ÛÏÂÈÙÔ˘ÚÁÈ΋˜ ‰È·‚¿ıÌÈÛ˘, ·fi ÙËÓ ÂÏ¿¯ÈÛÙË ÂÁÎÂÊ·ÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· (Minimal Brain Dysfunction - MBD), ¤ˆ˜ ÙȘ ÛÔ‚·Ú¤˜ ÎÈÓËÙÈΤ˜ ·Ó·Ëڛ˜ (Levitt 2004). ¶·Ú¿ ÙÔÓ ÌË-ÚÔԉ¢ÙÈÎfi ¯·Ú·ÎÙ‹Ú· Ù˘ ‚Ï¿‚˘, Ë ÎÏÈÓÈ΋ Ù˘ ÂÈÎfiÓ· Û˘Ó¯Ҙ ·ÏÏ¿˙ÂÈ, ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ó·Ù˘Íȷ΋˜ ‰È·‰Èηۛ·˜. ∞˘Ùfi ÔÊ›ÏÂÙ·È ÛÙÔ ÁÂÁÔÓfi˜, fiÙÈ Ô ÂÁΤʷÏÔ˜ ÙÔ˘ ·È‰ÈÔ‡ ‚Ú›ÛÎÂÙ·È Û ‰È·Ú΋ Ó¢ÚÔ·Ó·Ù˘Íȷ΋ Û‡ÁÎÚÔ˘ÛË, ·Ó¿ÌÂÛ· ÛÙË Ê˘ÛÈÔÏÔÁÈ΋ ÔÓÙÔÁÂÓÂÙÈ΋ ÔÚ›· Î·È ˆÚ›Ì·ÓÛË Î·È ÛÙË ¶∂ƒπ§∏æ∏ ∏ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ·ÔÙÂÏ› ÙÔÓ Î˘ÚÈfiÙÂÚÔ ÂÎÚfiÛˆÔ ÙˆÓ ÛÙ·ÙÈÎÒÓ (ÌËÂÍÂÏÈÛÛfiÌÂÓˆÓ) ÂÁÎÂÊ·ÏÔ·ıÂÈÒÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜ Î·È Â›Ó·È Ì›· ·fi ÙȘ ‰È·Ù·Ú·¯¤˜ Ô˘ Û˘¯Ó¿ Ô‰ËÁÔ‡Ó Û ‚·ÚÈ¿ ·Ó·ËÚ›·. ¶·Ú¿ ÙÔÓ ÌË-ÚÔԉ¢ÙÈÎfi ¯·Ú·ÎÙ‹Ú· Ù˘ ‚Ï¿‚˘, Ë ÎÏÈÓÈ΋ Ù˘ ÂÈÎfiÓ· Û˘Ó¯Ҙ ·ÏÏ¿˙ÂÈ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·Ó·Ù˘Íȷ΋˜ ‰È·‰Èηۛ·˜. ∏ ‰˘Ó·ÌÈο ÌÂÙ·‚·ÏÏfiÌÂÓË ÂÈÎfiÓ· Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÔÏ˘ÌÔÚÊ›· Ù˘, ηıÈÛÙ¿ ÙËÓ ·ÔηٿÛÙ·ÛË ÙˆÓ ·È‰ÈÒÓ, ÚfiÎÏËÛË ÁÈ· οı ıÂÚ·Â˘Ù‹. °È· ÙÔÓ ÛÎÔfi ·˘Ùfi ¤¯Ô˘Ì ÛÙËÓ ‰È¿ıÂÛ‹ Ì·˜ ¤Ó· ÌÂÁ¿ÏÔ ·ÚÈıÌfi ıÂÚ·¢ÙÈÎÒÓ Ì¤ÛˆÓ Ô˘ ÛÙfi¯Ô ÙÔ˘˜ ¤¯Ô˘Ó ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ Î·È ÙËÓ ·ÓÂÍ·ÚÙËÙÔÔ›ËÛË ÙˆÓ ·È‰ÈÒÓ Ì ÎÈÓËÙÈ΋ ·Ó·ËÚ›·. ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‰ÂÓ Â›Ó·È Ë ·ÚÔ˘Û›·ÛË Î·È Ë ÂÚÈÁÚ·Ê‹ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÚÔÛÂÁÁ›ÛˆÓ, ·ÏÏ¿ Ë ÂÚÌËÓ›· ÙˆÓ ‚·ÛÈÎÒÓ ÙÔ˘˜ ·Ú¯ÒÓ Î·È Ù˘ ÂͤÏÈÍ‹˜ ÙÔ˘˜, ·Ó·ÊÔÚÈο Ì ÙËÓ Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ ıÂÚ·¢ÙÈ΋ ÔÚ›· ÙˆÓ ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË. ∏ ·ÓÔÌÔÈÔÁ¤ÓÂÈ· Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ‚ÈÔËıÈÎÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜, ηıÈÛÙÔ‡Ó ÙË Û˘ÁÎÚÈÙÈ΋ ÌÂϤÙË, ·ÏÏ¿ Î·È ÁÂÓÈÎfiÙÂÚ· ÙËÓ ¤Ú¢ӷ ÛÙÔÓ ÙÔ̤· ÙˆÓ ·È‰È·ÙÚÈÎÒÓ Ó¢ÚÔÏÔÁÈÎÒÓ ·ı‹ÛÂˆÓ È‰È·›ÙÂÚ· ‰‡ÛÎÔÏË. ¶·Ú¿ ÙËÓ ·Ô˘Û›· ¤ÁÎ˘ÚˆÓ ÂÚ¢ÓËÙÈÎÒÓ ·ԉ›ÍÂˆÓ ÁÈ· ÙËÓ ıÂÙÈ΋ Â›‰Ú·ÛË Ù˘ Ê˘ÛÈÎÔıÂÚ·›·˜, Ë Û˘Ì‚ÔÏ‹ Ù˘ ÛÙÔÓ ÚÒÈÌÔ ÂÓÙÔÈÛÌfi, ÛÙËÓ ¤ÁηÈÚË ·Ú¤Ì‚·ÛË Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ Â›Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙË. ¡¤Â˜ ÌÂϤÙ˜ ʤÚÓÔ˘Ó ÛÙÔ Êˆ˜ ÛÙÔȯ›· ÁÈ· ÙËÓ Î·Ù·ÓfiËÛË ÙÔ˘ ÎÈÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘, Ù˘ ÎÈÓËÙÈ΋˜ ÂÎÌ¿ıËÛ˘ Î·È Ù˘ ·Ó¿ÎÙËÛ˘ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÈηÓÔًوÓ. ŸÏ˜ ۯ‰fiÓ ÔÈ ÚÔÛÂÁÁ›ÛÂȘ ¤¯Ô˘Ó ÙÚÔÔÔÈËı› Î·È ÚÔÛ·ÚÌÔÛÙ› ÛÙ· Ó¤· ÂÈÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ. £ÂˆÚ›Â˜ ÔÈ Ôԛ˜ ›Û¯˘·Ó ϤÔÓ ‰ÂÓ ÈÛ¯‡Ô˘Ó ‹ ¤¯Ô˘Ó ÌÂÙÂÍÂÏȯı›. ∏ ¿Ô„Ë fiÙÈ ÔÈ ÚÔÛÂÁÁ›ÛÂȘ Â›Ó·È ‰È·ÊÔÚÂÙÈΤ˜ Î·È Ì¿ÏÈÛÙ· ·ÓÙÈÊ·ÙÈΤ˜ Ë Ì›· Ì ÙËÓ ¿ÏÏË ‰ÂÓ ÈÛ¯‡ÂÈ ·fiÏ˘Ù·. ∫·ÌÈ¿ ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ ‰ÂÓ ¤¯ÂÈ ·ԉ›ÍÂÈ ÙËÓ ·ÓˆÙÂÚfiÙËÙ· οÔÈ·˜ ÚÔÛ¤ÁÁÈÛ˘. ÕÏψÛÙ ‰ÂÓ Â›Ó·È Ë Ì¤ıÔ‰Ô˜ Ô˘ οÓÂÈ ÙË ‰È·ÊÔÚ¿, ·ÏÏ¿ Ë ‰ÈÔÚ·ÙÈÎfiÙËÙ· Î·È Ë ÈηÓfiÙËÙ· ÙÔ˘ ıÂÚ·Â˘Ù‹ Ó· ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙȘ Ú·ÁÌ·ÙÈΤ˜ ·Ó¿ÁΘ ÙÔ˘ οı ·È‰ÈÔ‡ ͯˆÚÈÛÙ¿, Ó· ÙȘ ÂÚÌËÓ‡ÂÈ ÛˆÛÙ¿ Î·È Ó· ÂÈϤÁÂÈ Ù· ηٷÏÏËÏfiÙÂÚ· ̤۷ ÁÈ· ÙËÓ Â›Ï˘ÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘. §¤ÍÂȘ ÎÏÂȉȿ – Key words: Cerebral palsy, Physical therapy, Treatment, Rehabilitation, Motor control £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 5 

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·6 ANA™KO¶H™H ηٷÛÙÔÏ‹ ÙˆÓ Ê·ÈÓÔÌ¤ÓˆÓ ·˘- & Kluzik 1996, Reddihough, King ÙÒÓ, ÂÍ·ÈÙ›·˜ Ù˘ ·Ô‰ÈÔÚÁ·Óˆ- & Coleman 1998). ̤Ó˘ ÂÁÎÂÊ·ÏÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (¶·ÓÙÂÏÈ¿‰Ë˜ Î·È Û˘Ó. 1998). ∫·Ì›· ˆ˜ ÙÒÚ· ÂÈÛÙËÌÔÓÈ΋ ∏ ‰˘Ó·ÌÈο ÌÂÙ·‚·ÏÏfiÌÂÓË ÂÈ- ¤Ú¢ӷ ‰ÂÓ ¤¯ÂÈ ·ԉ›ÍÂÈ ÙËÓ ÎfiÓ· Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘·ÓˆÙÂÚfiÙËÙ· οÔÈ·˜ ÚÔÛ˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÔÏ˘Û¤ÁÁÈÛ˘ ‹ fiÙÈ Î¿ÔÈ· ÚÔÌÔÚÊ›· Ù˘, ηıÈÛÙ¿ ÙËÓ ·ÓÙÈÌÂÛ¤ÁÁÈÛË ÌÔÚ› ·fi ÌfiÓË Ù˘ ÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ ÚfiÎÏËÛË ÁÈ· οı ıÂÚ·Â˘Ù‹. OÈ ÂÚÈÛÛfi- Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ fiÏ· Ù· ÚÔÙÂÚ˜ ıÂÚ·¢ÙÈΤ˜ ÚÔÛÂÁÁ›- ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·Ó·ËÚ›· ÛÂȘ ·Ó·Ù‡¯ıËÎ·Ó Ì ÛÎÔfi ÙËÓ ·ÓÙÈÌÂÙÒÈÛË Î˘Ú›ˆ˜ ÙˆÓ ÎÈÓËÙÈ∏ ·ÓÔÌÔÈÔÁ¤ÓÂÈ· Î·È ÔÏ˘ÌÔÚÎÒÓ ÙÔ˘˜ ‰È·Ù·Ú·¯ÒÓ. ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Ê›· Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘, ‰ÂÓ Â›Ó·È Ë ·Ó·Ï˘ÙÈ΋ ·ÚÔ˘Û›·- ÔÈ ‚ÈÔËıÈÎÔ› ÂÚÈÔÚÈÛÌÔ› (·Ô˘ÛË Î·È Ë ÂÚÈÁÚ·Ê‹ ÙˆÓ ‰È·ÊÔÚÂ- Û›· ÔÌ¿‰·˜ ÂϤÁ¯Ô˘ ¯ˆÚ›˜ ·ÁˆÙÈÎÒÓ ÚÔÛÂÁÁ›ÛˆÓ, ·ÏÏ¿ Ô ÁÂ- Á‹), Ë ‰˘Ó·ÌÈο ÌÂÙ·‚·ÏÏfiÌÂÓË ÓÈÎfiÙÂÚÔ˜ ηıÔÚÈÛÌfi˜ Ù˘ ÎÔÈÓ‹˜ ÎÏÈÓÈ΋ Ù˘ ÂÈÎfiÓ·, ÙÔ ÌÈÎÚfi ‰Â›Á‚¿Û˘ ¿Óˆ ÛÙËÓ ÔÔ›· ı· Ú¤- Ì· Î·È ÔÈ ‰˘ÛÎÔϛ˜ ÛÙÔÓ Î·ıÔÚÈÂÈ Ó· ÌÂÏÂÙÔ‡ÓÙ·È Î·È Ó· ÂÚÌË- ÛÌfi ÎÔÈÓ‹˜ ıÂÚ·¢ÙÈ΋˜ ÛÙÚ·ÙËÓ‡ÔÓÙ·È ÔÈ ÚÔÛÂÁÁ›ÛÂȘ, ÚÔ- ÁÈ΋˜, Â›Ó·È ÌÂÚÈÎÔ› ·fi ÙÔ˘˜ ÎÂÈ̤ÓÔ˘ Ó· ·ÔʇÁÔÓÙ·È ·Ô- ÏfiÁÔ˘˜ Ô˘ ηıÈÛÙÔ‡Ó ÙË Û˘ÁÎÚÈÏ˘ÙÔÔÈ‹ÛÂȘ Û ۯ¤ÛË Ì ÙËÓ ·ÓÙÈ- ÙÈ΋ ÌÂϤÙË – fiˆ˜ Î·È ÁÂÓÈÎfiÙÂÌÂÙÒÈÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿- Ú· ÙËÓ ¤Ú¢ӷ ÛÙÔÓ ÙÔ̤· ÙˆÓ ·È‰È·ÙÚÈÎÒÓ Ó¢ÚÔÏÔÁÈÎÒÓ ·Ï˘Û˘. ı‹ÛÂˆÓ – ȉȷ›ÙÂÚ· ‰‡ÛÎÔÏË (Scrutton, Damiano & Mayston ∂ƒ∂À¡∏∆π∫∏ ∞¶O¢∂π•∏ 2004, Hur 1995, Reddihough & al ∫∞π ¶∂ƒπOƒπ™ªOπ 1998, Tirosh & Rabino 1989, Kanda, ŸÏ˜ ÔÈ Ê˘ÛÈÎÔıÂÚ·¢ÙÈΤ˜ Yuge, Yamori & al 1984, Brandt, ̤ıÔ‰ÔÈ ˘fiÛ¯ÔÓÙ·È Î·Ï¿ ·ÔÙÂ- Lonstrup, Marner & al 1980). OÈ ‰ÔÎÈ̷ۛ˜ ·ÍÈÔÏfiÁËÛ˘ Ô˘ ϤÛÌ·Ù·. ∂›Ó·È ‰‡ÛÎÔÏÔ Ó· ·Ô¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÂÎÙ›ÌËÊ·Û›ÛÂÈ Î·Ó›˜ ÔÈ· ÚÔÛ¤ÁÁÈÛË Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË, ›Ù ÛË Ù˘ ÎÈÓËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ‚¿ÛÂÈ ÂÈÛÙËÌÔÓÈÎÒÓ ÌÂÏÂÙÒÓ, Â›Ó·È ‰ÔÌË̤Ó˜ Ì ٤ÙÔÈÔ ÙÚfiÔ, ›Ù ÛÙËÚÈ˙fiÌÂÓÔ˜ Û ıˆÚËÙÈΤ˜ ÒÛÙÂ Û˘¯Ó¿ Ó· ·˘ÙÔ-ÂȂ‚·ÈÒÓÔÓÙ·È (self-validating) Ì ‚¿ÛË ·Ú¯¤˜ (Barry 1996). ∫·Ì›· ˆ˜ ÙÒÚ· ÂÈÛÙËÌÔÓÈ΋ ÙË ıˆڛ· Ô˘ ÛÙËÚ›˙ÂÈ Ë Î¿ı ¤Ú¢ӷ ‰ÂÓ ¤¯ÂÈ ·ԉ›ÍÂÈ ÙËÓ ÚÔÛ¤ÁÁÈÛË. OÈ ÂÚÈÛÛfiÙÂÚ˜ Ì·ӈÙÂÚfiÙËÙ· οÔÈ·˜ ÚÔÛ¤ÁÁÈ- ϤÙ˜ ÂÈÎÂÓÙÚÒÓÔÓÙ·È Î˘Ú›ˆ˜ Û˘ ‹ fiÙÈ Î¿ÔÈ· ÚÔÛ¤ÁÁÈÛË ÌÔ- ÛÙË ıÂÙÈ΋ Â›‰Ú·ÛË Ù˘ ÚÒÈÌ˘ Ú› ·fi ÌfiÓË Ù˘ Ó· ·ÓÙÈÌÂÙˆ›- Ê˘ÛÈÎÔıÂÚ·¢ÙÈ΋˜ ·Ú¤Ì‚·ÛÂÈ fiÏ· Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯Â- Û˘ Û ÔÌ¿‰Â˜ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘, Ù›˙ÔÓÙ·È Ì ÙËÓ ·Ó·ËÚ›· (Mayston ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ÙËÓ ·Ô‰ÂÈÎÓ‡2004, D’ Avignon, Noren & Arman Ô˘Ó ¿ÓÙ· (Weindling 2000, ™ÎÔ˘1981, Bulter & Darrah 2001, Fetters Ù¤ÏË 1999, Kanda & al 1984, 6 Rothberg, Goodman, Jacklin & al 1991, Weindling, Hallam, Gregg & al 1996, Kong 1966, Bobath 1967). ∆· ÔÚ›ÛÌ·Ù· ÔÏÏÒÓ ÂÚ¢ÓËÙÒÓ, fiˆ˜ ÙÔ˘ Vaclav Vojta Î·È Ù˘ Elizabeth Kong Û¯ÂÙÈο Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÚÒÈÌ˘ ·Ú¤Ì‚·Û˘, ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·ԉ›ÍÔ˘Ó fiÙÈ Ë Û˘ÁÎÂÎÚÈ̤ÓË ÚÔÛ¤ÁÁÈÛË ‹Ù·Ó ÂΛÓË Ë ÔÔ›· ÂÍ·ÛÊ¿ÏÈÛ ٷ ·ÔÙÂϤÛÌ·Ù· Î·È fi¯È ÙÔ ÁÂÁÔÓfi˜, fiÙÈ ÔÏÏ¿ «‡ÔÙ·» ÁÈ· ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ‚Ú¤ÊË ı· ÌÔÚÔ‡Û·Ó Ó· ›¯·Ó ÂÍÂÏȯı› Ê˘ÛÈÔÏÔÁÈο, Ô‡Ùˆ˜ ‹ ¿Ïψ˜. (Kong 1987, Nelson & Ellenberg 1982). ∂›Û˘, ‰ÂÓ Ú¤ÂÈ Ó· ÂÚÌËÓ‡ԢÌ ÙËÓ ÂοÛÙÔÙ ‚ÂÏÙ›ˆÛË, ˆ˜ ·ÔÙ¤ÏÂÛÌ· Û˘ÁÎÂÎÚÈ̤Ó˘ ÚÔÛ¤ÁÁÈÛ˘, ·Ô˘Û›· Û˘ÁÎÚÈÙÈ΋˜ ÌÂϤÙ˘ (Knox & Evans 2002). ∫¿ı ÂÈÛÙËÌÔÓÈ΋ ÌÂϤÙË Ú¤ÂÈ Ó· ÂÈÓÔ› ·ÓÂÍ¿ÚÙËÙ˜, ¤Á΢Ú˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈΤ˜ Ù¯ÓÈΤ˜ ·ÍÈÔÏfiÁËÛ˘ Î·È Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÔÓ ¤ÏÂÁ¯Ô ÔÏÏÒÓ ÌÂÙ·‚ÏËÙÒÓ (Scrutton & al 2004, Mayston 2004). ∏ ÚÒÙË ·ÍÈfiÈÛÙË in vivo Ù˘¯·ÈÔÔÈË̤ÓË ÎÏÈÓÈ΋ ÌÂϤÙË ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ÚÒÈÌˆÓ Ó¢ÚÔ-·Ó·Ù˘ÍÈ·ÎÒÓ ÂÌÂÈÚÈÒÓ (NIDCAP) ÛÙËÓ ÂÁÎÂÊ·ÏÈ΋ ‰ÔÌ‹ Î·È ÏÂÈÙÔ˘ÚÁ›·, ·¤‰ÂÈÍ fiÙÈ Ù· ‚Ú¤ÊË Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ·ÙÔÌÈÎfi ÚfiÁÚ·ÌÌ· ·Ó·Ù˘Íȷ΋˜ ÊÚÔÓÙ›‰·˜ (Newborn Individualized Developmental Care & Assessment Program – NIDCAP), ·ÚÔ˘Û›·Û·Ó ÛËÌ·ÓÙÈÎfiÙÂÚË ‚ÂÏÙ›ˆÛË ÛÙËÓ ÂÁÎÂÊ·ÏÈ΋ ‰ÔÌ‹, ÏÂÈÙÔ˘ÚÁ›· Î·È ÓÂ˘ÚˆÓÈ΋ ˆÚ›Ì·ÓÛË, Û˘ÁÎÚÈÙÈο Ì ٷ ‚Ú¤ÊË Ô˘ ‰ÂÓ ÂÓÙ¿¯ÙËÎ·Ó ÛÙÔ ÚfiÁÚ·ÌÌ·. ∏ ¤Ú¢ӷ Ú·ÁÌ·ÙÔÔÈ‹ıËΠÛÙË £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·7 ANA™KO¶H™H ÌÔÓ¿‰· ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜, Û ‰Â›ÁÌ· 30 ÚfiˆÚˆÓ ‚ÚÂÊÒÓ ËÏÈΛ·˜ ·ËÛ˘ 28-33 ‚‰ÔÌ¿‰ˆÓ (Als, Duffy, McAnulty & al 2004). £∂øƒ∏∆π∫∞ ªO¡∆∂§∞ ∫∞𠶃O™∂°°π™∂π™ ™˘¯Ó¿ ÔÈ ÚÔÛÂÁÁ›ÛÂȘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ˆ˜ ‰È·ÊÔÚÂÙÈΤ˜ Î·È Ì¿ÏÈÛÙ· ·ÓÙÈÊ·ÙÈΤ˜ Ë Ì›· Ì ÙËÓ ‰ÂÓ ‰È·Ê¤ÚÔ˘Ó, ·ÏÏ¿ ‰È·Ù˘ÒÓÔÓÙ·È Ì ‰È·ÊÔÚÂÙÈ΋ ÔÚÔÏÔÁ›· (Levitt 2004). OÈ Ì¤ıÔ‰ÔÈ ıÂÚ·›·˜ ·ÓÙ·Ó·ÎÏÔ‡Ó ıˆڛ˜ Î·È ‚·ÛÈΤ˜ ȉ¤Â˜ ÁÈ· Ù· ·›ÙÈ· Î·È ÙË Ê‡ÛË Ù˘ ÏÂÈÙÔ˘ÚÁ›·˜ Î·È ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜. ∏ ıÂÚ·›· ÙˆÓ ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ‚·Û›˙ÂÙ·È Û ˘Ôı¤ÛÂȘ Ô˘ ËÁ¿˙Ô˘Ó ·fi ·˘Ù¤˜ ÙȘ ıˆڛ˜ (™¯‹Ì·Ù· 1, 2). ™¯‹Ì· 1. £ÂˆÚ›Â˜ ÎÈÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ (ËÁ‹: ShumwayCook &, Woollacott, 2001) ™¯‹Ì· 2. £ÂˆÚ›Â˜ ÎÈÓËÙÈ΋˜ ÂÎÌ¿ıËÛ˘ (ËÁ‹: Shumway-Cook, Woollacott, 2001) ¿ÏÏË. øÛÙfiÛÔ, ·˘Ùfi ‰ÂÓ Â›Ó·È Ú·ÁÌ·ÙÈÎfiÙËÙ·. ¶ÔÏϤ˜ ÊÔÚ¤˜, ÁÈ· ÙȘ ›‰È˜ ‹ ·ÚfiÌÔȘ ÚÔÛÂÁÁ›ÛÂȘ ·Ú¤¯ÔÓÙ·È ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÌËÓ›˜. ∆Ô ÎÔÈÓfi ÛÙÔÈ¯Â›Ô Â›Ó·È Ë Ì¤ıÔ‰Ô˜, ·ÏÏ¿ ‰È·Ê¤ÚÔ˘Ó ÔÈ ·ÈÙÈÔÏÔÁ‹ÛÂȘ Ô˘ ÚÔ‚¿ÏÏÔÓÙ·È. ™Â ¿ÏϘ ÂÚÈÙÒÛÂȘ ÔÈ ıˆÚËÙÈΤ˜ ·Ú¯¤˜ ÙˆÓ ÌÂıfi‰ˆÓ ¶ÔÏϤ˜ ·fi ÙȘ ıˆڛ˜ ÁÈ· ÙÔÓ ÎÈÓËÙÈÎfi ¤ÏÂÁ¯Ô, ÙËÓ ÎÈÓËÙÈ΋ ÂÎÌ¿ıËÛË Î·È ÙËÓ ·Ó¿ÎÙËÛË ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÈηÓÔÙ‹ÙˆÓ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ÂÚÈÔÚ›ÛÔ˘Ó ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ ıÂÚ·Â˘Ù‹ Ó· ·Ú·ÙËÚ› Î·È Ó· ÂÚÌËÓ‡ÂÈ Ù· ÚÔ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÎÈÓËÙÈ΋ ·Ó·ËÚ›·. °È· Ó· ηٷÓÔ‹ÛÔ˘Ì ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ Ú¤ÂÈ ÚÒÙ· Ó· ηٷÓÔ‹ÛÔ˘Ì ÙȘ ıˆڛ˜ ¿Óˆ ÛÙȘ Ôԛ˜ ‚·Û›˙ÔÓÙ·È. OÈ ıˆڛ˜ ·ÏÏ¿˙Ô˘Ó, ‚¿ÛÂÈ ÙˆÓ Ó¤ˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ‰Â‰Ô̤ӈÓ, ÌÂ Û˘Ó¤ÂÈ· Ó· ÙÚÔÔÔÈÔ‡ÓÙ·È Î·È Ó· ÚÔÛ·ÚÌfi˙ÔÓÙ·È ·Ó¿ÏÔÁ· Î·È ÔÈ ıÂÚ·¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ (Shumway-Cook & Woollacott 2001). ∞ÔÙ¤ÏÂÛÌ· Ù˘ ÚÔÛ·ÚÌÔÁ‹˜ ·˘Ù‹˜ ·ÔÙÂÏ› Ë ·ÊÔÌÔ›ˆÛË Ó¤ˆÓ ıˆÚÈÒÓ Î·È Ë ·ÏÏ·Á‹ ÛÙËÓ ÔÚÔÏÔÁ›· ÔÏÏÒÓ ıÂÚ·¢ÙÈÎÒÓ ÌÂıfi‰ˆÓ. °È· ·Ú¿‰ÂÈÁÌ·, ÛÙËÓ ÚÔÛ¤ÁÁÈÛË Bobath o «Ê˘ÛÈÔÏÔÁÈÎfi˜ ÛÙ·ÛÈÎfi˜ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜» (normal postural reflex mechanism) ÌÂÙÔÓÔÌ¿ÛÙËΠ۠«Ê˘ÛÈÔÏÔÁÈÎfi ÛÙ·ÛÈÎfi ¤ÏÂÁ¯Ô» (normal postural control), Ë «·Ó·¯·›ÙÈÛË» (inhibition) ¤ÁÈÓ «ÙÚÔÔÔ›ËÛË» (modification) Î·È Ù· «ÚfiÙ˘· ·Ó·ÛÙÔÏ‹˜ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ» (Reflex Inhibiting Patterns) ¤ÁÈÓ·Ó «ÚfiÙ˘· Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔÓ ÙfiÓÔ» (Tone Influencing Patterns) (Bly 1991). ™Ù· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ‘50 ·Ú¯¤˜ ÙÔ˘ ‘60 Ú·ÁÌ·ÙÔÔÈ‹ıËΠÌÈ· ÛËÌ·ÓÙÈ΋ ·ÏÏ·Á‹ ÛÙËÓ ÎÏÈÓÈ΋ ·Ú¤Ì‚·ÛË ·ÛıÂÓÒÓ Ì Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜. ◊Ù·Ó Ë ·Ó¿Ù˘ÍË ÙˆÓ ¶ÚÔÛÂÁÁ›ÛÂˆÓ ¡Â˘ÚÔ-‰È¢ÎfiÏ˘ÓÛ˘ (reflex-based neurofacilitation approaches), ÌÂÁ¿ÏÔ Ì¤ÚÔ˜ ÙˆÓ ÔÔ›ˆÓ ΢Úȷگ› ÛÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÔÈ ıÂÚ·Â˘Ù¤˜ ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ó¢ÚÔÏÔÁÈΤ˜ ‰È·Ù·Ú·¯¤˜ Û‹ÌÂÚ·. OÈ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ·fi ·˘Ù¤˜ – Rood, Bobath, Vojta, Brunnstrom, PNF, ∞ÈÛıËÙËÚȷ΋ OÏÔÎÏ‹ÚˆÛË – ‚·Û›ÛÙËηÓ, ÛÙÔ ÌÂÁ·Ï‡ÙÂÚÔ Ì¤ÚÔ˜ ÙÔ˘˜, ÛÙËÓ ∞ÓÙ·Ó·ÎÏ·ÛÙÈ- £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 7 

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·8 ANA™KO¶H™H ΋ Î·È πÂÚ·Ú¯È΋ £ÂˆÚ›· ÙÔ˘ ÎÈ- ÂϤÁ¯Ô˘. ÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘. O Bernstein ·Ó·ÁÓÒÚÈÛ fiÙÈ Â›OÈ ÛÙÚ·ÙËÁÈΤ˜ ‚ÂÏÙ›ˆÛ˘ ÙÔ˘ Ó·È ·‰‡Ó·ÙË Ë Î·Ù·ÓfiËÛË ÙÔ˘ Ó¢ÎÈÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘ Ô˘ ‚·Û›˙ÔÓÙ·È ÚÈÎÔ‡ ÂϤÁ¯Ô˘ Ù˘ ΛÓËÛ˘ ¯ˆÚ›˜ ÛÙÔ ÌÔÓÙ¤ÏÔ ÙˆÓ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÂÛÙÈ¿˙ÔÓÙ·È Û ÌÂıfi‰Ô˘˜ Ì›ˆÛ˘ ÎÒÓ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ ÎÈÓ› Ù˘ Û·ÛÙÈÎfiÙËÙ·˜ Ô˘ ı· ·˘Í‹- Î·È ÙˆÓ ÂÛˆÙÂÚÈÎÒÓ Î·È Â͈ÙÂÚÈÛÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ê˘ÛÈÔÏÔÁÈ΋˜ ÎÒÓ ‰˘Ó¿ÌÂˆÓ Ô˘ ÂÓÂÚÁÔ‡Ó ÛÙÔ Î›ÓËÛ˘. OÈ Û‡Á¯ÚÔÓ˜ ·fi„ÂȘ ÛÒÌ·. ∏ £ÂˆÚ›· ÙˆÓ ™˘ÛÙËÌ¿Ô˘ ÂÚÈÁÚ¿ÊÔ˘Ó ÙÔ ÈÂÚ·Ú¯ÈÎfi ÙˆÓ ÙÔ˘ Bernstein ·ÔÙÂÏ› ÙËÓ ÌÔÓÙ¤ÏÔ ÛÙÔ ¡.™. ·Ó·ÁÓˆÚ›˙Ô˘Ó ÈÔ Â˘Ú›· ÚÔÛ¤ÁÁÈÛË, ÂÊfiÛÔÓ fiÙÈ Î¿ı Â›Â‰Ô ÙÔ˘ ¡.™. Âȉڿ Ï·Ì‚¿ÓÂÈ ˘fi„Ë, fi¯È ÌfiÓÔ ÙË Û ¿ÏÏ· Â›‰· (·ÓÒÙÂÚ· Î·È Î·- Û˘Ì‚ÔÏ‹ ÙÔ˘ ¡.™. ÛÙË ‰Ú·ÛÙËÚÈfiÙÒÙÂÚ·), ·Ó¿ÏÔÁ· Ì ÙË ‰Ú·ÛÙË- ÙËÙ·, ·ÏÏ¿ Â›Û˘ ÙÔ˘ Ì˘ÔÛÎÂÏÂÚÈfiÙËÙ·. ÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ÙË ‰‡Ó·ÌË Ù˘ ∏ ˘fiıÂÛË fiÙÈ ‚·Ú‡ÙËÙ·˜ Î·È ÙÔ ∫.¡.™. ‰ÂÓ Â›ÙËÓ ·‰Ú¿ÓÂÈ· H ÙÂÏÂÈÔÔ›ËÛË Ù˘ Ó·È ÌfiÓÔ ¤Ó· Û‡(Bernstein Ê˘ÛÈÔÏÔÁÈ΋˜ ΛÓËÛ˘ ‰ÂÓ ÛÙËÌ· Ô˘ ·ÓÙÈ1967). Ú¤ÂÈ Û η̛· ‰Ú¿, ·ÏÏ¿ ¤Ó· ∆Ë ‰ÂηÂÙ›· ÂÚ›ÙˆÛË Ó· Á›ÓÂÈ Ô Û‡ÛÙËÌ· ‰Ú¿Û˘, ÙÔ˘ ’60 Ô Ê˘ÛÈÔ·fiÏ˘ÙÔ˜ ıÂÚ·¢ÙÈÎfi˜ Ô‰‹ÁËÛ ÛÙËÓ ·Ó¿ÏfiÁÔ˜ James Ù˘ÍË Ù˘ £ÂˆGibson ÍÂΛÓËÛÙfi¯Ô˜ Ú›·˜ ÙÔ˘ ∫ÈÓËÙÈÛ ӷ ‰ÈÂÚÂ˘Ó¿ ÎÔ‡ ¶ÚÔÁÚ·ÌÌ·ÙÈÛÌÔ‡ (motor ÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÙÔ ÎÈÓËÙÈprogramming theory) ‹ ÙˆÓ Îfi Ì·˜ Û‡ÛÙËÌ· ÂÈÙÚ¤ÂÈ Ó· ∫ÂÓÙÚÈÎÒÓ ∫ÈÓËÙÈÎÒÓ ¶ÚÔÙ‡ˆÓ ·ÏÏËÏÂȉڿÌ ·ÔÙÂÏÂÛÌ·ÙÈÎfi(central motor patterns). ∏ ÙÂÚ· Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÁÈ· ÙËÓ ¿Ô„Ë fiÙÈ Ù· ·ÓÙ·Ó·ÎÏ·ÛÙÈο ‰ÂÓ Â›Ù¢ÍË «ÚÔÛ·Ó·ÙÔÏÈṲ̂Ó˘ Ô‰ËÁÔ‡Ó Û ‰Ú¿ÛË (ΛÓËÛË), ·Ï- ÛÙÔÓ ÛÙfi¯Ô Û˘ÌÂÚÈÊÔÚ¿˜» Ï¿ ÔÈ «ÁÂÓÓ‹ÙÚȘ ÎÂÓÙÚÈÎÒÓ ÚÔ- (goal-oriented behavior). ∏ ¤ÚÂ˘Ù‡ˆÓ» (central pattern generators) Ó¿ ÙÔ˘ ÂÛÙÈ¿ÛÙËΠÛÙÔÓ ÙÚfiÔ ÌÂ Â›Ó·È Û ı¤ÛË ·fi ÌfiÓ˜ ÙÔ˘˜ Ó· ÙÔÓ ÔÔ›Ô ·ÓȯÓ‡ԢÌÂ Î·È ·ÓÙÈ·Ú¿ÁÔ˘Ó Û‡ÓıÂÙ˜ ÎÈÓ‹ÛÂȘ, ·Ô- Ï·Ì‚·ÓfiÌ·ÛÙ ÙȘ Û¯ÂÙÈΤ˜ Ì ÙȘ ÙÂÏ› Ì›· ·fi ÙȘ ‚·ÛÈΤ˜ ıˆÚË- ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÏËÚÔÊÔڛ˜ ÙÈΤ˜ ·Ú¯¤˜ ÔÏÏÒÓ ÚÔÛÂÁÁ›ÛÂ- ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ÛÙÔ ˆ˜ ˆÓ, fiˆ˜ .¯. Ù˘ Vojta (Vojta & ¯ÚËÛÈÌÔÔÈԇ̠·˘Ù¤˜ ÙȘ ÏËÚÔPeters 1992). ŒÓ·˜ ·ÍÈÔÛËÌ›ˆ- ÊÔڛ˜ ÛÙÔÓ ÎÈÓËÙÈÎfi ¤ÏÂÁ¯Ô. ∏ ÙÔ˜ ·ÚÈıÌfi˜ ÂÚ¢ÓÒÓ ˘ÔÛÙËÚ›- ¿Ô„Ë ·˘Ù‹ Â›Ó·È ÁÓˆÛÙ‹ ˆ˜ Ë ˙ÂÈ ÙËÓ ‡·ÚÍË ÈÂÚ·Ú¯Èο ÔÚÁ·- «ÔÈÎÔÏÔÁÈ΋ ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ÎÈÓËÓˆÌ¤ÓˆÓ ÎÈÓËÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿- ÙÈÎÔ‡ ÂϤÁ¯Ô˘» (ecological approach ÙˆÓ Ô˘ ·ÔıËÎÂ‡Ô˘Ó ÙÔ˘˜ ‚·ÛÈ- of motor control). ∏ OÈÎÔÏÔÁÈ΋ ÎÔ‡˜ ηÓfiÓ˜ ÙˆÓ ·Ú·ÁfiÌÂÓˆÓ £ÂˆÚ›· ‰È‡ڢÓ ÙËÓ Î·Ù·ÓfiËÛ‹ ÎÈÓ‹ÛˆÓ. ∏ ıˆڛ· ÙÔ˘ ÎÈÓËÙÈ- Ì·˜ ÁÈ· ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ Ó¢ÚÈÎÔ‡ ÚÔÁÚ·ÌÌ·ÙÈÛÌÔ‡ ‰ÂÓ Ï·Ì- ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, ·fi ·˘Ù‹ ÂÓfi˜ ‚¿ÓÂÈ ˘fi„Ë ÙȘ Ì˘ÔÛÎÂÏÂÙÈΤ˜ ÎÈÓ·ÈÛıËÙÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Ô˘ Î·È ÙȘ ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ Âȉڿ- ·ÓÙȉڿ ÛÙȘ ÂÚÈ‚·ÏÏÔÓÙÔÏÔÁÈÛÂȘ ÛÙËÓ Â›Ù¢ÍË ÙÔ˘ ÎÈÓËÙÈÎÔ‡ Τ˜ ÌÂÙ·‚ÔϤ˜, Û ·˘Ù‹ ÂÓfi˜ 8 Û˘ÛÙ‹Ì·ÙÔ˜ ·ÓÙ›Ï˄˘ - ‰Ú¿Û˘ Ô˘ ÂÍÂÚÂ˘Ó¿ ÂÓÂÚÁ¿ ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÁÈ· ÙËÓ ÈηÓÔÔ›ËÛË ÙˆÓ ÛÙfi¯ˆÓ ÙÔ˘. ∏ ‰È·›ÛÙˆÛË fiÙÈ ÔÈ ıˆڛ˜ Ó¢ÚÔ-‰È¢ÎfiÏ˘ÓÛ˘ ‹Ù·Ó Û ı¤ÛË Ó· ÂÚÌËÓ‡ÛÔ˘Ó ÌfiÓÔ Î·ıÔÚÈṲ̂ӷ ÛÙÂÚÂfiÙ˘· ÎÈÓËÙÈο ÚfiÙ˘· Ô‰‹ÁËÛ ÙË ‰ÂηÂÙ›· ÙÔ˘ ’90 ÛÙËÓ ·Ó¿Ù˘ÍË Ù˘ ¶ÚÔÛ·ÚÌÔṲ̂Ó˘ Û §ÂÈÙÔ˘ÚÁÈÎÔ‡˜ ™Ùfi¯Ô˘˜ ¶ÚÔÛ¤ÁÁÈÛ˘ (task-oriented approach) ·fi ÙÔ˘˜ Shumway-Cook & Woollacott Î·È Carr & Shepherd. ™‡Ìʈӷ Ì ·˘Ù‹, Ë Ê˘ÛÈÔÏÔÁÈ΋ ÎÈÓËÙÈÎfiÙËÙ· ÚÔ·ÙÂÈ ·fi ÙËÓ ·ÏÏËÏÂ›‰Ú·ÛË ÌÂٷ͇ ‰È·ÊÔÚÂÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ, Ì ÙÔ Î¿ı ¤Ó· ·fi ·˘Ù¿ Ó· Û˘ÓÂÈÛʤÚÂÈ Ì ÙÔ ‰ÈÎfi ÙÔ˘ ÙÚfiÔ ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ÎÈÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∏ ˘fiıÂÛË ·˘Ù‹ Ô‰‹ÁËÛ ÛÙËÓ ÙÚÔÔÔ›ËÛË Î·È ÚÔÛ·ÚÌÔÁ‹ ÙˆÓ ‚·ÛÈÎÒÓ ·Ú¯ÒÓ ÔÏÏÒÓ ÚÔÛÂÁÁ›ÛˆÓ, ÌÂٷ͇ ÙˆÓ ÔÔ›ˆÓ Ù˘ Peto, Ù˘ Bobath Î·È Ù˘ ∞ÈÛıËÙËÚȷ΋˜ OÏÔÎÏ‹ÚˆÛ˘. ∏ ·Ô‰Ô¯‹ ÙˆÓ Ó¤ˆÓ ıˆÚÈÒÓ ·fi ÙȘ ‰È·ÊÔÚÂÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ Î·È Ë ÚÔÛ·ÚÌÔÁ‹ Ù˘ ıÂÚ·›·˜ ÛÙË ‚¿ÛË ·˘ÙÒÓ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ·, Ù· fiÚÈ· ÌÂٷ͇ ÙˆÓ ÚÔÛÂÁÁ›ÛÂˆÓ Ó· Á›ÓÔÓÙ·È fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ‰˘Û‰È¿ÎÚÈÙ·. OÈ ÂÈÛÙËÌÔÓÈΤ˜ ıˆڛ˜ ·Ú¤¯Ô˘Ó ÙÔ Ï·›ÛÈÔ ÂÚÁ·Û›·˜ Ô˘ ÂÈÙÚ¤ÂÈ ÙËÓ ÂÓۈ̿وÛË Ú·ÎÙÈÎÒÓ È‰ÂÒÓ Û ÌÈ· ÏÔÁÈ΋ ÊÈÏÔÛÔÊ›· ·Ú¤Ì‚·Û˘. ∏ ÎÏÈÓÈ΋ Ú¿ÍË ÛÙËÓ ÚÔÛ¤ÁÁÈÛË ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ·ÏÏ¿˙ÂÈ, ηıÒ˜ ·ÏÏ¿˙ÂÈ Î·È Ë ÂÈÛÙËÌÔÓÈ΋ ÁÓÒÛË ÁÈ· Ù· ÛËÌ·ÓÙÈο ·˘Ù¿ ÛÙÔȯ›· Ô˘ ÂϤÁ¯Ô˘Ó ÙËÓ Î›ÓËÛË. ¶ÚÔÛÂÁÁ›ÛÂȘ ÔÈ Ôԛ˜ ‰ÂÓ ÚÔÛ·ÚÌfi˙ÔÓÙ·È ÛÙ· Ó¤· ÂÈÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ Î·È ÂÍ·ÎÔÏÔ˘ıÔ‡Ó £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·9 ANA™KO¶H™H Ó· ÛÙËÚ›˙ÔÓÙ·È Û ·Ó˘fiÛٷ٘ ıˆڛ˜, ¯¿ÓÔ˘Ó ÙËÓ ·Í›· ÙÔ˘˜. OÈ ÚÔÛÂÁÁ›ÛÂȘ ı· Ú¤ÂÈ Ó· ·Ó·Ù‡ÛÛÔÓÙ·È ÛÙË ‚¿ÛË ÙˆÓ ÈÛ¯˘Ô˘ÛÒÓ ÂÚ¢ÓËÙÈÎÒÓ ·ԉ›ÍˆÓ. ¡¤Â˜ ‹ ÌË ‰ÔÎÈÌ·Ṳ̂Ó˜ ÚÔÛÂÁÁ›ÛÂȘ, ΢ڛˆ˜ ·˘Ù¤˜ Ô˘ ·„ËÊÔ‡Ó ÙȘ ˘¿Ú¯Ô˘Û˜ ·Ú¯¤˜, Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ÛÎÂÙÈÎÈÛÌfi, ̤¯ÚÈ ÙËÓ ÂÌÊ¿ÓÈÛË ¤ÁÎ˘ÚˆÓ ÂÚ¢ÓËÙÈÎÒÓ ·ԉ›ÍÂˆÓ (Shumway-Cook & Woollacott 2001, Damiano 2004). ™¯‹Ì· 3. ¶·Ú¿ÁÔÓÙ˜ ηıÔÚÈÛÌÔ‡ Ù˘ ÎÈÓËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜. ™∆∞∆π∫O-∫π¡∏∆π∫∏* §∂π∆OÀƒ°π∞ ∫∞π ∂°∫∂º∞§π∫∏ ¶∞ƒ∞§À™∏ °È· ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ıÂÚ·¢ÙÈÎÒÓ ÚÔÛÂÁÁ›ÛÂˆÓ Â›Ó·È ··Ú·›ÙËÙË Ë ÌÂϤÙË ÙˆÓ ‚·ÛÈÎÒÓ ·Ú¯ÒÓ Ù˘ ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÙˆÓ ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË. º˘ÛÈÔÏÔÁÈ΋ ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È ·˘Ù‹ Ô˘ οı ¿ÓıÚˆÔ˜ Ì ·Î¤Ú·ÈÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· Ú·ÁÌ·ÙÔÔÈ› οو ·fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜. ∏ ÎÈÓËÙÈ΋ Ì·˜ Û˘ÌÂÚÈÊÔÚ¿ ηıÔÚ›˙ÂÙ·È ·fi ·ÙÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Î·È ·fi ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ô˘ ÂÈÙÂÏԇ̠۠ۯ¤ÛË Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ (™¯‹Ì· 3). ∫·ıÔÚÈÛÙÈ΋ Â›Û˘ ÁÈ· ÙË ‰È·ÌfiÚʈÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È Î·È Ë ÈηÓfiÙËÙ· ÚfiÛÏ˄˘ Î·È ÂÂÍÂÚÁ·Û›·˜ ÙˆÓ ·ÈÛıËÙËÚÈ·ÎÒÓ - ÎÈÓ·ÈÛıËÙÈÎÒÓ ÏËÚÔÊÔÚÈÒÓ ·fi Ù· ‰È·ÊÔÚÂÙÈο Û˘ÛÙ‹Ì·Ù·, ηıÒ˜ Â›Û˘ Î·È Ô ÚfiÏÔ˜ Ù˘ ·ÓÙ›Ï˄˘ Î·È ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ (Prechtl, Cioni, Einspieler & al 2001, Scrutton & al 2004, Wade & Jones 1997, Shumway-Cook & Woollacott 2001). °È· ÙÔ ·È‰› Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙ· Ê˘ÛÈÔÏÔÁÈÎfi, ·˘Ùfi Ô˘ ıˆÚԇ̠ÂÌ›˜ «Ê˘ÛÈÔÏÔÁÈÎfi», Ô‡Ù ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙË ‰È΋ Ì·˜ ΛÓËÛË fiˆ˜ ÙËÓ ·ÓÙÈÏ·Ì‚·ÓfiÌ·ÛÙ ÂÌ›˜. ªÂٷ͇ Ù˘ ÌË Ê˘ÛÈÔÏÔÁÈ΋˜ ÛÙ¿Û˘ - ΛÓËÛ˘ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈ΋˜ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ˘¿Ú¯ÂÈ ÌÈ· ÛËÌ·ÓÙÈ΋ ÈÛÔÚÚÔ›·. ∏ ÚÔÙÂÚ·ÈfiÙËÙ¿ Ì·˜ Û ̛· ·fi ÙȘ ·Ú·¿Óˆ ·Ú·Ì¤ÙÚÔ˘˜ ÔÈΛÏÂÈ ·fi ·È‰› Û ·È‰› Î·È ·fi ‰Ú·ÛÙËÚÈfiÙËÙ· Û ‰Ú·ÛÙËÚÈfiÙËÙ·. ™˘Ó‹ıˆ˜ Ï·Óı·Ṳ̂ӷ, ıˆÚԇ̠‰Â‰Ô̤ÓÔ fiÙÈ ÁÈ· ¤Ó· ·È‰› Ì ‰È·Ù·Ú·Á̤ÓÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· Ë Ê˘ÛÈÔÏÔÁÈ΋ ΛÓËÛË Ú¤ÂÈ Ó· Â›Ó·È Ô ‚·ÛÈÎfi˜ ıÂÚ·¢ÙÈÎfi˜ Ì·˜ ÛÙfi¯Ô˜. ∞˘Ùfi ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· Ó· ÌÂÙÚ¿Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂÚ·›·˜ ·fi ÙÔ Â¿Ó ¤¯Ô˘Ì ÚÔÛÂÁÁ›ÛÂÈ ÙÔ «Ê˘ÛÈÔÏÔÁÈÎfi» Î·È fi¯È ·fi ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ Î·È Ù˘ ÚfiÁÓˆÛ˘ (Scrutton & al 2004). O Ketelaar Î·È ÔÈ Û˘ÓÂÚÁ¿Ù˜ ÙÔ˘, Û ‰Â›ÁÌ· 55 ·È‰ÈÒÓ Ì Û·ÛÙÈ΋ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ËÏÈΛ·˜ 2-7 ÂÙÒÓ, ‰È·›ÛÙˆÛ·Ó ÛËÌ·ÓÙÈÎfiÙÂÚË ‚ÂÏÙ›ˆÛË ÙˆÓ ÎÈÓËÙÈÎÒÓ ÈηÓÔÙ‹ÙˆÓ ÛÙȘ ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÛÙ· ·È‰È¿ Ô˘ ·ÎÔÏÔ‡ıËÛ·Ó ¤Ó· ÚfiÁÚ·ÌÌ· ÏÂÈÙÔ˘ÚÁÈ΋˜ Ê˘ÛÈÎÔıÂÚ·›·˜, Û˘ÁÎÚÈÙÈο Ì ٷ ·È‰È¿ ÛÙ· ÔÔ›· ÙÔ Ê˘ÛÈÎÔıÂÚ·¢ÙÈÎfi ÚfiÁÚ·ÌÌ· ‚·Û›˙ÔÓÙ·Ó ÛÙËÓ ÔÈÔÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ΛÓËÛ˘. ∂Ô̤ӈ˜, Ë ÙÂÏÂÈÔÔ›ËÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ΛÓËÛ˘ ‰ÂÓ Ú¤ÂÈ Û η̛· ÂÚ›ÙˆÛË Ó· Á›ÓÂÈ Ô ·fiÏ˘ÙÔ˜ ıÂÚ·¢ÙÈÎfi˜ ÛÙfi¯Ô˜ (Scrutton & al 2004). ∏ ηıÔ‰ËÁËÙÈ΋ ÂÎ·›‰Â˘ÛË (conductive education) ÙÔ˘ Andreas Peto Â›Ó·È Ë ÌÔÓ·‰È΋ ›Ûˆ˜ ÚÔÛ¤ÁÁÈÛË Ô˘ ηٷÓfiËÛ ¤ÁηÈÚ· ·˘Ù‹ ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· (Scrutton & al 2004, Hari & Tillemans 1984). ∏ Ê˘ÛÈÔÏÔÁÈ΋ ΛÓËÛË Â›Ó·È ÙÔ ·ÔÙ¤ÏÂÛÌ· Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ * ¶·ÚfiÏÔ Ô˘ ÙÔ Â›ıÂÙÔ «ÛÙ·ÙÈÎfi˜» ÛËÌ·›ÓÂÈ fi¯È ÌfiÓÔ ·˘Ùfi Ô˘ ‰ÂÓ ÎÈÓ›ٷÈ, ·ÏÏ¿ Î·È ·˘Ùfi Ô˘ ·ÊÔÚ¿ ÛÙË ÛÙ¿ÛË ÙÔ˘ ÛÒÌ·ÙÔ˜ (ÂÎ ÙÔ˘ ÔÔ›Ô˘ Î·È Ô fiÚÔ˜ ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈÎfi˜), Â¤ÏÂÍ· Ó· ¯ÚËÛÈÌÔÔÈ‹Ûˆ ÙÔÓ fiÚÔ «ÛÙ·ÛÈÎfi˜», ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ·Ú·ÓÔ‹ÛˆÓ. £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 9 

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·10 ANA™KO¶H™H ÏÂÈÙÔ˘ÚÁ›·˜ Î·È fi¯È ÙÔ ·›ÙÈÔ ·˘Ù‹˜ (Scrutton & al 2004). ∞ÎÚÈ‚Ò˜ ÁÈ· ·˘Ùfi, ÛÙfi¯Ô˜ Ì·˜ ÛÙË ıÂÚ·›· ı· Ú¤ÂÈ Ó· Â›Ó·È Ë ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ, Ô˘ ÂÈÙ˘Á¯¿ÓÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÈηÓÔÙ‹ÙˆÓ Ì¤Û· ·fi ÙËÓ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ ηıËÌÂÚÈÓ‹˜ ˙ˆ‹˜. £· Ú¤ÂÈ fiÏÔÈ Ì·˜ Ó· ηٷÓÔ‹ÛÔ˘Ì fiÙÈ Ë ÎÈÓËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ‰ÂÓ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÌfiÓÔ Ù˘ ‚Ï¿‚˘, ·ÏÏ¿ Î·È ÙˆÓ ÚÔÛ·ıÂÈÒÓ ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ Ó· ·ÓÙÈÛÙ·ıÌ›ÛÔ˘Ó ÙËÓ ·ÒÏÂÈ· Î·È Ó· ·Ú·Ì›ÓÔ˘Ó ÏÂÈÙÔ˘ÚÁÈο (Shumway-Cook & Woollacott 2001). ∞˜ ·Ó·ÚˆÙËıÔ‡ÌÂ: ¶Ò˜ ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ¤Ó· ·È‰› Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ÙË ‰È΋ Ì·˜ Ê˘ÛÈÔÏÔÁÈ΋ ΛÓËÛË; ∂›Ó·È ‰˘Ó·Ù‹ Ë Â›Ù¢ÍË Ê˘ÛÈÔÏÔÁÈ΋˜ ΛÓËÛ˘ ·fi ¤Ó· Ó¢ÚÈÎfi Û‡ÛÙËÌ· Ô˘ ‰˘ÛÏÂÈÙÔ˘ÚÁ› Î·È ·Ó Ó·È Û ÔÈÔ ‚·ıÌfi; ¶ÔÈ· Â›Ó·È Ë ‰˘Ó·ÌÈ΋ Ù˘ ·Ú¤Ì‚·Û‹˜ Ì·˜ Î·È ÙÈ Ú·ÁÌ·ÙÈο ÌÔÚԇ̠Ӓ ·ÏÏ¿ÍÔ˘ÌÂ; £∂ƒ∞¶∂À∆π∫∂™ ¶ƒO™∂°°π™∂π™ OÚÈṲ̂Ó˜ ÚÔÛÂÁÁ›ÛÂȘ (fiˆ˜ ÙˆÓ Vojta, Doman Delacato, Katona), ˘ÔÛÙËÚ›˙Ô˘Ó, fiÙÈ Î·ıÒ˜ ÂÎÌÂÙ·ÏχÔÓÙ·È ÙËÓ ·˘ÍË̤ÓË Ï·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ Î·È ‚ÚÂÊÈÎÔ‡ ∫.¡.™. ÌÔÚÔ‡Ó Ó· ÙÚÔÔÔÈ‹ÛÔ˘Ó ÙË ‰ÔÌ‹ Î·È ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ó· ÂÌÔ‰›ÛÔ˘Ó ÙËÓ ¤Î‚·ÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘Û˘ (Mayston 2004, Vojta 1988, Katona 1989). ™‡Ìʈӷ Ì ÙÔÓ Vaclav Vojta «Ë ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ·ÔÙÂÏ› ÌÈ· ‰˘Ó·ÌÈο ÂÍÂÏÈÛÛfiÌÂÓË ‰È·Ù·Ú·¯‹ Î·È ÂÔ̤ӈ˜ Ú¤ÂÈ Î·È Ë ·Ú¤Ì‚·Û‹ Ì·˜ Ó· Â›Ó·È ‰˘Ó·ÌÈ΋». ∞Ó Î·È ‰ÂÓ ÙÔÔıÂÙÔ‡ÓÙ·È Ù· ·È‰È¿ Û ÏÂÈÙÔ˘ÚÁÈΤ˜ ı¤ÛÂȘ, ıˆÚ› fiÙÈ Ì ÙËÓ ∞ÓÙ·Ó·ÎÏ·ÛÙÈ΋ ∫ÈÓËÙÔÔ›ËÛË ÂÎ·È‰Â‡ÔÓÙ·È fiϘ ·˘Ù¤˜ ÔÈ ÎÈÓËÙÈΤ˜ Û˘ÓÂÚÁ›Â˜ Ô˘ Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙËÓ Â›Ù¢ÍË ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÛÙfi¯ˆÓ. ÀÔÛÙËÚ›˙ÂÈ fiÙÈ Ë ÏÂÈÙÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË ÂȉÂÈÓÒÓÂÈ Ù· ‹‰Ë ·ıÔÏÔÁÈο ÎÈÓËÙÈο ÚfiÙ˘· Î·È fiÙÈ ı· Ú¤ÂÈ Ó· ·ÔʇÁÂÙ·È Ë Ï‹„Ë ı¤ÛÂˆÓ Î·È Ë ÂÎÙ¤ÏÂÛË ÎÈÓ‹ÛˆÓ, ÔÈ Ôԛ˜ ÚÔ¸Ôı¤ÙÔ˘Ó ÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ ÈÂÚ·Ú¯Èο ·ÓÒÙÂÚˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‰ÔÌÒÓ. ∞Ó Î·È ÔÈ ÂÈÏÂÁ̤Ó˜ ı¤ÛÂȘ Â›Ó·È ÛÙ·ÙÈΤ˜, ÔÈ ÎÈÓËÙÈΤ˜ ·ÓÙȉڿÛÂȘ ¤¯Ô˘Ó ‰˘Ó·ÌÈÎfi ¯·Ú·ÎÙ‹Ú· Î·È ·ÔÙÂÏÔ‡Ó ÙÌËÌ·ÙÈο ‹ ÔÏÈο ÚfiÙ˘· Ù˘ ·˘ıfiÚÌËÙ˘ ÎÈÓËÙÈÎfiÙËÙ·˜ (Vojta 1988, Vojta & Peters 1992). O Katona ıˆÚ› fiÙÈ Ù· ÚÒÈÌ· ÎÈÓËÙÈο ÚfiÙ˘· ÙˆÓ ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Â›Ó·È Úfi‰ÚÔÌ· ÙˆÓ ÌÂÙ·ÁÂÓ¤ÛÙÂÚˆÓ ·˘ıfiÚÌËÙˆÓ ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈÎÒÓ ‰Ú·ÛÙËÚÈÔًوÓ, ÂÓÒ Ô Temple Fay, ·ÓÙÈÌÂÙÒÈÛ ÙËÓ ·Ó¿Ù˘ÍË ˆ˜ ·Ó·ÎÂÊ·Ï·›ˆÛË Ù˘ Ê˘ÏÔÁÂÓÂÙÈ΋˜ ÂͤÏÈ͢. ¶ÚÔÙ›Ó ÙËÓ ÛÙ·‰È·Î‹ ·Ó¿Ù˘ÍË Ù˘ ΛÓËÛ˘ ·fi ÙȘ ÔÊÈÔÂȉ›˜ ÂÚ˘ÛÙÈΤ˜ ÎÈÓ‹ÛÂȘ ÙˆÓ ·ÌÊÈ‚›ˆÓ ÛÙËÓ ÙÂÙÚ·Ô‰È΋ ΛÓËÛË ÙˆÓ ıËÏ·ÛÙÈÎÒÓ ¤ˆ˜ ÙËÓ fiÚıÈ· ÌÂٷΛÓËÛË. ™ÙȘ ·Ú·¿Óˆ ÚÔÛÂÁÁ›ÛÂȘ ‰ÂÓ Ï·Ì‚¿ÓÂÙ·È ÛÔ‚·Ú¿ ˘fi„Ë ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Ë ÎÈÓËÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ηıÔÚ›˙ÂÙ·È ÛËÌ·ÓÙÈο ·fi ÙË Û¯¤ÛË ÙÔ˘ ·ÙfiÌÔ˘ Ì ÙȘ ÔÈΛϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ô˘ ÂÈÙÂÏ› ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ‰ÂÓ Á›ÓÂÙ·È Î·Ì›· ·Ó·ÊÔÚ¿ ÛÙË Û˘Ì‚ÔÏ‹ Ù˘ ·ÓÙ›Ï˄˘ Î·È ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ (Û¯‹Ì· 3). ∏ Ó¢ÚÔ-ˆÚ›Ì·ÓÛË Â›Ó·È ·ÓÂ·Ú΋˜ ·fi ÌfiÓË Ù˘ ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. ∏ ıˆڛ· ÙˆÓ ‰˘Ó·ÌÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ (systems theory) ‰›ÓÂÈ ¤ÌÊ·ÛË ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÏÏ¿ ‰È·ÊÔÚÂÙÈο ˘ÔÛ˘ÛÙ‹Ì·Ù· (Ó¢ÚÈÎfi, Ì˘ÔÛÎÂÏÂÙÈÎfi, ·ÓÙÈÏËÙÈÎfi, ÁÓˆÛÙÈÎfi Î·È Û˘Ó·ÈÛıËÌ·ÙÈÎfi) Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ (Galea 2004). ¡¤Â˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Ë ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· ηıÔÚ›˙ÂÙ·È, fi¯È ÙfiÛÔ ·fi ÙËÓ ‰È¿ÚÎÂÈ· Ù˘ Ú·ÎÙÈ΋˜ ¿ÛÎËÛ˘, ·ÏÏ¿ ΢ڛˆ˜ ·fi ÙËÓ ÔÈÎÈÏÔÌÔÚÊ›· Ù˘ (Shumway-Cook & Woollacott 2001). ∞˘Ùfi ÛÙȘ ·Ú·¿Óˆ ÚÔÛÂÁÁ›ÛÂȘ ‰ÂÓ ÈÛ¯‡ÂÈ ·ÊÔ‡ Ù· ·È‰È¿ ÙÔÔıÂÙÔ‡ÓÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ı¤ÛÂȘ Î·È ÂÎÙÂÏÔ‡Ó Î·ıÔÚÈṲ̂Ó˜ ÎÈÓ‹ÛÂȘ. ÕÏψÛÙÂ, ‰ÂÓ ÁÓˆÚ›˙Ô˘Ì ÙÔÓ ÙÚfiÔ ÚÔÛ·ÚÌÔÁ‹˜ ÙˆÓ ·È‰ÈÒÓ Û ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÛÙȘ Ôԛ˜ ‰ÂÓ ¤¯Ô˘Ó ÚÔËÁÔ˘Ì¤Óˆ˜ ÂÎ·È‰Â˘Ù›. ™ÙȘ ÏÂÁfiÌÂÓ˜ ¡Â˘ÚÔ-·Ó·Ù˘ÍȷΤ˜ ¶ÚÔÛÂÁÁ›ÛÂȘ fiˆ˜ Ë ¡Â˘ÚÔ-∞Ó·Ù˘Íȷ΋ ∞ÁˆÁ‹ (NDT)* ÙˆÓ Berta Î·È Karel Bobath Î·È Ë * O fiÚÔ˜ «Ó¢ÚÔ-ÂÍÂÏÈÎÙÈ΋ ·ÁˆÁ‹» Â›Ó·È Ï·Óı·Ṳ̂ÓÔ˜, ·ÊÂÓfi˜ ‰ÈfiÙÈ Neuro-Developmental Treatment ÛËÌ·›ÓÂÈ ¡Â˘ÚÔ-∞Ó·Ù˘Íȷ΋ ·ÁˆÁ‹ (Development = ·Ó¿Ù˘ÍË), ·ÊÂÙ¤ÚÔ˘ ‰ÈfiÙÈ Ë ÂͤÏÈÍË (evolution) ÂÌϤÎÂÈ ÛÙËÓ ·Ó·Ù˘Íȷ΋ ‰È·‰Èηۛ· Ê˘ÏÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, Ú¿ÁÌ· ÙÔ ÔÔ›Ô ‰ÂÓ ÈÛ¯‡ÂÈ ·fiÏ˘Ù· ÛÙËÓ NDT. 10 £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·11 ANA™KO¶H™H ∞ÈÛıËÙËÚȷ΋ OÏÔÎÏ‹ÚˆÛË (Sensory Integration) Ù˘ Jean Ayres ˘ÔÛÙËÚ›˙ÂÙ·È Ë ÙÚÔÔÔ›ËÛË ÙˆÓ ·ıÔÏÔÁÈÎÒÓ ÚÔÙ‡ˆÓ Ì ÙËÓ ·Ú¿ÏÏËÏË ‰È¢ÎfiÏ˘ÓÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÎÈÓ·ÈÛıËÙÈ΋˜ Î·È ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜. OÈ Ê˘ÏÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ‰ÂÓ Ï·Ì‚¿ÓÔÓÙ·È ÛÔ‚·Ú¿ ˘fi„Ë ÛÙË ıÂÚ·›· Î·È ıˆÚÔ‡ÓÙ·È ˘‡ı˘ÓÔÈ ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ·ıÔÏÔÁÈÎÒÓ ÚÔÙ‡ˆÓ. ¶ÔÏϤ˜ ·fi ÙȘ ·Ú¯¤˜ ÙˆÓ ÚÔÛÂÁÁ›ÛÂˆÓ ·˘ÙÒÓ Û˘Ó¯›˙Ô˘Ó Ó· ‚·Û›˙ÔÓÙ·È ·ÎfiÌ· Î·È Û‹ÌÂÚ· Û ıˆڛ˜, ÔÈ Ôԛ˜ ‰ÂÓ ÈÛ¯‡Ô˘Ó ·fiÏ˘Ù·, fiˆ˜ .¯. Ë «ÙÔÓÈ΋ ·ÓÙ·Ó·ÎÏ·ÛÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·» Î·È Ë ÛËÌ·Û›· Ù˘ ÛÙËÓ ‰È¿ÁÓˆÛË Î·È ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÙˆÓ ·È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË (Clopton, Duvall, Ellis & al 2000, Bobath 1980). ∞Ó Î·È Ô ·Ú¯ÈÎfi˜ ÙÔ˘˜ ÛÙfi¯Ô˜ ‹Ù·Ó Ë ‚ÂÏÙ›ˆÛË ÙÔ˘ ÂϤÁ¯Ô˘ Ù˘ ÛÙ¿Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙˆÓ ÎÈÓËÙÈÎÒÓ ÈηÓÔًوÓ, ¯ˆÚ›˜ ··Ú·›ÙËÙ· Ù· ·È‰È¿ Ó· ÂÎ·È‰Â‡ÔÓÙ·È Û ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÔÈ Ù¯ÓÈΤ˜ ÙÔ˘˜ Û‹ÌÂÚ· ÂÓۈ̷ÙÒÓÔÓÙ·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹ Ì ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜. OÈ ÚÔÛÂÁÁ›ÛÂȘ ·˘Ù¤˜ ·Ó·ÁÓˆÚ›˙Ô˘Ó fiÙÈ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ·ÈÛıËÙËÚÈ·ÎÔ›, ÁÓˆÛÙÈÎÔ›, ·ÓÙÈÏËÙÈÎÔ› ÂÚÈÔÚ›˙Ô˘Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ·ÛıÂÓÔ‡˜ ÛÙȘ ηıËÌÂÚÈÓ¤˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (Mayston 2004, Bly 1991). ∏ Bobath ıˆÚ› fiÙÈ ÁÈ· ÙËÓ Â›Ù¢ÍË ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Ù˘ ηıËÌÂÚÈÓ‹˜ ˙ˆ‹˜ Ô Ê˘ÛÈÔÏÔÁÈÎfi˜ ‹ ۯ‰fiÓ Ê˘ÛÈÔÏÔÁÈÎfi˜ Ì˘˚Îfi˜ ÙfiÓÔ˜ Â›Ó·È ··Ú·›ÙËÙÔ˜ (Mayston 2002). ∂ÓÙÔ‡ÙÔȘ, Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ Ê˘- Û¤ÁÁÈÛË Bobath ‰ÂÓ ·Ú¤¯ÂÈ ÌÈ· ÛÈÔÏÔÁÈÎÔ‡ Ì˘˚ÎÔ‡ ÙfiÓÔ˘ ÛÙÔÓ Û˘ÓÔÏÈ΋ ·ÁˆÁ‹ ÁÈ· Ù· ·È‰È¿ Ì ηıÔÚÈÛÌfi Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË Î·È ‰ÂÓ ¤¯ÂÈ ˘ÂÚÂÎÙÈÌËı›. ∂‰Ò Î·È ‰Â- ÌÔÚ› ·fi ÌfiÓË Ù˘ Ó· ·ÓÙÈÌÂηÂٛ˜ ÁÓˆÚ›˙Ô˘Ì fiÙÈ ‰ÂÓ ˘¿Ú- Ùˆ›˙ÂÈ fiϘ ÙȘ ·Ó¿ÁΘ ÙˆÓ ·È¯ÂÈ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÙÔ˘ ·ıÔ- ‰ÈÒÓ. §fiÁˆ Ù˘ ¤ÌÊ·Û˘ Ô˘ ÏÔÁÈÎÔ‡ Ì˘˚ÎÔ‡ ÙfiÓÔ˘, ÙˆÓ ÂÎÔ‡- ‰fiıËΠÛÙȘ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ Ì˘˚ÛÈˆÓ ÎÈÓ‹ÛÂˆÓ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈ- ÎÔ‡ ÙfiÓÔ˘ ·Ú·ÌÂÏ‹ıËÎ·Ó ·fi ÎfiÙËÙ·˜. ∆Ô Î‡ÚÈÔ Úfi‚ÏËÌ· ÙˆÓ ÙÔ˘˜ ıÂÚ·Â˘Ù¤˜ Bobath ÛËÌ··È‰ÈÒÓ Ì ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘- ÓÙÈÎfiٷٷ ‰›·, fiˆ˜ Ë Ì˘˚΋ ÛË ‰ÂÓ Â›Ó·È Ô ‰È·Ù·Ú·Á̤ÓÔ˜ Ì˘˚- ÂÓ‰˘Ó¿ÌˆÛË Î·È ÔÈ ÂÌ‚ÈÔÌ˯·ÓÈÎfi˜ ÙfiÓÔ˜, ·ÏÏ¿ Ô ÂÏÏÂÈ‹˜ ¤ÏÂÁ- ÎÔ› ·Ú¿ÁÔÓÙ˜» (Mayston 2004). ¯Ô˜ Ù˘ ÛÙ¿Û˘ ÙÔ˘ ÛÒÌ·ÙÔ˜, Ë ·‰˘Ó·Ì›· ‰Ú·ÛÙËÚÈÔÔ›ËÛ˘ ÂÓ¿- ∞¶O ∆O ¶∞ƒO¡ ™∆O ÓÙÈ· ÛÙË ‚·Ú‡ÙËÙ·. ¶.¯. ¤Ó· ·È‰› ª∂§§O¡ Ì ·˘ÍË̤ÓÔ Ì˘˚Îfi ÙfiÓÔ ÌÔÚ› ªÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ Ó¤· Ó· ÔÚıÔÛÙ·Ù›, Ó· ‚·‰›˙ÂÈ Î·È Ó· Â›Ó·È ÏÂÈÙÔ˘ÚÁÈÎfi, ÂÓÒ ¤Ó· ¿ÏÏÔ ÂÈÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ ‹Úı·Ó ÌÂ Ê˘ÛÈÔÏÔÁÈÎfiÙÂÚÔ Ì˘˚Îfi ÙfiÓÔ ÛÙÔ Êˆ˜ Î·È ÚԤ΢„Â Ë ·Ó¿ÁÎË Ó· ÌËÓ Â›Ó·È ÈηÓfi ÁÈ· ·ÚfiÌÔÈ· Û‡Ó‰ÂÛ˘ ÙˆÓ ıÂÚ·¢ÙÈÎÒÓ ÙÂÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·, ·ÎfiÌ· Î·È fiÙ·Ó ¯ÓÈÎÒÓ Ì ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ Ë Û·ÛÙÈÎfiÙËÙ· ÂÍ·ÏÂÈÊı› ‹ ÌÂÈ- ηıËÌÂÚÈÓ‹˜ ˙ˆ‹˜. ™ÙË ÏÂÁfiÌÂÓË ¶ÚÔÛ·ÚÌÔṲ̂ÓË ˆı› (Levitt 2004). O Giuliani (1992) ·Ó·Ê¤ÚÂÈ ÌÂٷ͇ ¿ÏÏˆÓ fiÙÈ «Ó·È Û §ÂÈÙÔ˘ÚÁÈÎÔ‡˜ ™Ùfi¯Ô˘˜ ¶ÚÔÌÂÓ Ë Ì›ˆÛË Ù˘ Û·ÛÙÈÎfiÙËÙ·˜ Û¤ÁÁÈÛË (task-oriented approach) ÌÔÚ› Ó’ ·˘Í‹ÛÂÈ ÙÔ Â‡ÚÔ˜ ΛÓË- ‰ÂÓ ·ÓÙÈÌÂÙˆ›˙ÂÙ·È «Ë ΛÓËÛË ÁÈ· ÙËÓ Î›ÓËÛË», ·ÏÏ¿ Û˘, ·ÏÏ¿ Èı·∏ ÂÌÌÔÓ‹ Û Ϸ̂¿ÓÔÓÙ·È ˘fi„Ë ÔÈ ÓfiÓ Ó· ·Ôη··Ú·›ÙËÙ˜ ÚÔ¸Ôχ„ÂÈ ˘ÊÈÛÙ¿ÌÂıÂÚ·¢ÙÈΤ˜ ı¤ÛÂȘ ÁÈ· ÙËÓ Â›Ù¢ÍË ÓË ·‰˘Ó·Ì›·, ÚÔÛÂÁÁ›ÛÂȘ ‹ ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ ÛÙfi·Ú¿ ˘ÊÈÛÙ¿ÌÂÁÂÓÈÎfiÙÂÚ· Û ÓÔ ¤ÏÂÁ¯Ô». ∏ ÊÈÏÔÛÔʛ˜ ıˆÚÂ›Ù·È ¯ˆÓ, ÔÈ Ôԛ˜ ÂÌÂÚȤ¯Ô˘Ó ÙËÓ ·ÏÏËÏÂ›‰Ú·Û·ÛÙÈÎfiÙËÙ· ϤÔÓ ‰ÔÁÌ·ÙÈ΋ ÛË ÙÔ˘ ·È‰ÈÔ‡ Ì ÙÔ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· ÛÙÔ ‚·ıÌfi ÂÚÈ‚¿ÏÏÔÓ. ∏ ›‰È· ‰Ú·ÛÙËÚÈfiÙËÔ˘ Ë ÚÒÙË Û˘Ì‚¿ÏÂÈ ÛÙËÓ ·Ó¿- Ù·, ÂÈÙÂÏÔ‡ÌÂÓË Û ‰È·ÊÔÚÂÙÈÎfi Ù˘ÍË ·ıÔÏÔÁÈÎÒÓ ÛÙ¿ÛˆÓ, ÂÚÈ‚¿ÏÏÔÓ, ÚÔ¸Ôı¤ÙÂÈ Î·È ‚Ú·¯‡ÓÛÂˆÓ Î·È ·Ú·ÌÔÚÊÒÛÂ- ‰È·ÊÔÚÂÙÈΤ˜ ÎÈÓËÙÈΤ˜ ÛÙÚ·ÙËÁȈÓ. (Levitt 2004, Nathan 1969, Τ˜. ∂Ô̤ӈ˜, Â›Ó·È ·Ó·Áη›· Ë ÔÈÎÈÏ›· ÂÚÈ‚·ÏÏÔÓÙÔÏÔÁÈÎÒÓ Pederson 1969). ªÈ· ·fi ÙȘ ÛËÌ·ÓÙÈÎfiÙÂÚ˜ ÂÎ- Û˘ÓıËÎÒÓ Î·È Î·Ù·ÛÙ¿ÛÂˆÓ ÚÔÛÒÔ˘˜ Ù˘ ¡Â˘ÚÔ-∞Ó·Ù˘- (Levitt 2004). ™Â ·ÓÙ›ıÂÛË Ì ÙȘ ÔÈΛϘ Íȷ΋˜ ∞ÁˆÁ‹˜ Ë Dr. Margaret Mayston ·Ó·Ê¤ÚÂÈ fiÙÈ «Ë ÚÔ- ÂÚÌËÓ›˜, Ô˘ ‰›ÓÔÓÙ·È ·fi ÙȘ £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 11 

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·12 ANA™KO¶H™H ‰È·ÊÔÚÂÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÙfiÛÔ ÁÈ· ÙÔ˘˜ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜, fiÛÔ Î·È ÁÈ· ÙÔ˘˜ ÌË Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜ ÛÙ¿Û˘, ÈÛÔÚÚÔ›·˜ Î·È Î›ÓËÛ˘ – ÔÈ Ôԛ˜ ‰ÂÓ ‚Ú›ÛÎÔÓÙ·È ¿ÓÙ· ÛÂ Û˘Ìʈӛ· Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Ó¢ÚÔÂÈÛÙËÌfiÓˆÓ – Ë ™˘Ó‰˘·ÛÙÈ΋ - ∂ÎÏÂÎÙÈ΋ ∞ÁˆÁ‹ (combined – eclectic approach) Ô‰ËÁ› ÛÙË Û‡ÓıÂÛË ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂıfi‰ˆÓ ıÂÚ·›·˜, ·ÚfiÏÔ Ô˘ ›¯·Ó ¢ڤˆ˜ ıˆÚËı› ˆ˜ ·ÌÔÈ‚·›· ·ÔÎÏÂÈfiÌÂÓ˜ (Levitt 2004, Damiano 2004). ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ϤÔÓ ÂÈÛËÌ·›ÓÔ˘Ó ÙËÓ ‡·ÚÍË ·ÍÈfiÏÔÁˆÓ ÛÙÔȯ›ˆÓ Û οı ̛· ·fi ÙȘ ÚÔÛÂÁÁ›ÛÂȘ, ·ÏÏ¿ Î·È ÙËÓ ‡·ÚÍË ÎÔÈÓ‹˜ ‚¿Û˘ Û ·˘Ù¤˜, Ì ·ÔÙ¤ÏÂÛÌ· Ë ∂ÎÏÂÎÙÈ΋ ÕÔ„Ë ÛÙË ıÂÚ·›· Á›ÓÂÙ·È fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ·Ô‰ÂÎÙ‹ (Levitt 2004, Umphred 1984, Farber 1982, McLellan 1984, Griffiths & Clegg 1988, Dietz 1992, Burns & McDonald 1996, Bower & al 1992, 1996 & 2001, Dunn & al 1990, APCP 2002, Horn & al 1995). ¶·Ú¿ÏÏËÏ·, ÔÏϤ˜ Ê˘ÛÈÎÔıÂÚ·¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÂÂÎÙ¿ıËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Î·È Û ¿ÏÏÔ˘˜ ÙÔÌ›˜, Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜: ñ ∆¯ÓÈΤ˜ Ì˘˚΋˜ ÂÓ‰˘Ó¿ÌˆÛ˘ (muscle strengthening) ñ ∂·Ó·Ï·Ì‚·ÓfiÌÂÓË ÎÈÓËÙÈ΋ ÂÎ·›‰Â˘ÛË (repetitive motor training) ñ §ÂÈÙÔ˘ÚÁÈ΋ ÂÎ·›‰Â˘ÛË (task-related training) ñ ¶ÂÚÈÔÚÈÛÙÈ΋ – ¶ÚÔÎÏËÙ‹ ıÂÚ·›· (constraint-induced therapy) (Taub & al 2002 & 2004, Damiano & Abel 1998 & 2002, 12 (Mayston 2004). ∫¿ı ıÂÚ·Â˘Ù‹˜ ÔÊ›ÏÂÈ Ó· ·Ó·˙ËÙ¿ «ÁÈ·Ù› οÓÂÈ ·˘Ùfi Ô˘ οÓÂÈ» Î·È Ó· ÌËÓ ·Ô‰¤¯ÂÙ·È ÌÈ· ÚÔÛ¤ÁÁÈÛË ÂÂȉ‹ ÙÔ˘ ·Ú¤¯ÂÈ ÙË ‰È΋ Ù˘ ¤ÙÔÈÌË ÂÍ‹ÁËÛË (Levitt 2004). ∏ ÂÌÌÔÓ‹ Û ÔÔÈ·‰‹ÔÙ ÊÈÏÔÛÔÊ›· ‹ ÚÔÛ¤ÁÁÈÛË Ì ıÚË™Àª¶∂ƒ∞™ª∞∆∞ Û΢ÙÈ΋ Â˘Ï¿‚ÂÈ·, οÓÂÈ Î·Îfi, ∆Ș ÙÂÏÂ˘Ù·›Â˜ ‰ÂηÂٛ˜ ÔÈ ıÂ- fi¯È ÌfiÓÔ Û ÂÌ¿˜ ÙÔ˘˜ ıÂÚ·Ú·¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÁÈ· ÙËÓ Â˘Ù¤˜, ·ÏÏ¿ ΢ڛˆ˜ ÛÙ· ·È‰È¿ ·ÔηٿÛÙ·ÛË ·È‰ÈÒÓ Ì ÂÁÎÂ- Ô˘ ıÂÚ·‡ԢÌÂ. °ÂÓÈÎfiÙÂÚ·, Ë Ê·ÏÈ΋ ·Ú¿Ï˘ÛË ÂÍÂÏ›¯ÙËηÓ, ÚÔÛÎfiÏÏËÛË Û ÊÈÏÔÛÔʛ˜ ÂÌÔ·fi ·Ϥ˜ ÔÚıÔ‰ÈΤ˜ ·ÚÂÌ‚¿- ‰›˙ÂÈ ÙËÓ ¤ÁηÈÚË ÂÓۈ̿وÛË ÛÂȘ, Û Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈΤ˜, ÂÎ·È- Ó¤ˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ‰Â‰ÔÌ¤ÓˆÓ ‰Â˘ÙÈΤ˜ Î·È ÂÌ‚ÈÔÌ˯·ÓÈΤ˜. ¶ÔÏ- ÛÙÔ ÁÓˆÛÙÈÎfi Ì·˜ ‰›Ô Î·È ‰ÂÓ Ï¤˜ ·fi ·˘Ù¤˜ ‰ÂÓ ¤ÌÂÈÓ·Ó ÛÙ¿ÛÈ- ÂÈÙÚ¤ÂÈ ÙËÓ ·ÍÈÔÔ›ËÛË ÙˆÓ ‰È̘, ·ÏÏ¿ ÂÂÎÙ¿ıËÎ·Ó Î·È Û ÎÒÓ Ì·˜ ‰˘Ó·ÙÔًوÓ. ºÈÏÔÛÔ¿ÏÏÔ˘˜ ÙÔÌ›˜, fiˆ˜ ÚԷӷʤ- ʛ˜ Ô˘ ÚÔÛʤÚÔ˘Ó Ì›· «Û˘ÓÔÚ·Ì (Helders, Engelbert, ÏÈ΋» ÚÔÛ¤ÁÁÈÛË ÛÙË ıÂÚ·›·, Custers & al 2003, Mayston 2004). Ë ÔÔ›· ‰ÂÓ ‚·Û›˙ÂÙ·È Û ¤Á΢Ú˜ ∏ fiÏÔ Î·È ·˘Í·ÓfiÌÂÓË Î·Ù·Ófi- ÂÈÛÙËÌÔÓÈΤ˜ ·Ú¯¤˜ ‹ ·ÔÙ˘Á¯¿ÓÔ˘Ó Ó· ÂÓۈ̷ËÛË ÙˆÓ ÂÁÎÂÊ·ÏÈ∫¿ı ıÂÚ·Â˘Ù‹˜ ÙÒÛÔ˘Ó ¿ÏϘ ıÂÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ú·›˜, Ô˘ ÔÊ›ÏÂÈ Ó· ·Ó·˙ËÙ¿ Ù˘ ÎÈÓËÙÈ΋˜ Û˘Ì¤¯Ô˘Ó ·Ô‰ÂÈÚÈÊÔÚ¿˜ Û˘ÓÂÈÛʤ«ÁÈ·Ù› οÓÂÈ ·˘Ùfi Ô˘ ¯ı› fiÙÈ Â›Ó·È ÂÍ›ÚÂÈ ÛÙË ‚ÂÏÙ›ˆÛË Î¿ÓÂÈ» Î·È Ó· ÌËÓ ÛÔ˘ ‹ ÂÚÈÛÛfiÙˆÓ ÁÓÒÛÂÒÓ Ì·˜. ·Ô‰¤¯ÂÙ·È ÌÈ· ÙÂÚÔ ·ÔÙÂÏÂÛÌ·°È· ·˘Ùfi, ıˆڛ˜ Î·È Ì‡ıÔÈ Ô˘ ÂÚÈ- ÚÔÛ¤ÁÁÈÛË ÂÂȉ‹ ÙÔ˘ ÙÈΤ˜ ÛÙËÓ ‚Â·Ú¤¯ÂÈ ÙË ‰È΋ Ù˘ ÏÙ›ˆÛË Ù˘ ηٿ‚¿ÏÏÔ˘Ó Â‰Ò Î·È ÛÙ·Û˘ ÙˆÓ ·È¤ÙÔÈÌË ÂÍ‹ÁËÛË ¯ÚfiÓÈ· ÙȘ ÚÔÛÂÁÁ›‰ÈÒÓ, ı· Ú¤ÂÈ ÛÂȘ ·˘Ù¤˜, Ú¤ÂÈ Ó· Â·ÓÂÍÂÙ·ÛÙÔ‡Ó Î·È Ó· ·Ó·- Ó· ·ÔÚÚ›ÙÔÓÙ·È (Damiano 2004). ∞ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ, Û η̛· ıˆÚËıÔ‡Ó, ÛÙË ‚¿ÛË Ù˘ ÙÚ¤¯Ô˘ÂÚ›ÙˆÛË ‰ÂÓ ÌÔÚ› Ó· ÚÔÛ·˜ ÁÓÒÛ˘, ¯ˆÚ›˜ ‚¤‚·È· Ó· ·ÔÚÚÈÊıÔ‡Ó ÔÈ ˘¿Ú¯Ô˘Û˜ Û·ÚÌfi˙ÂÙ·È, Ó· ÙÚÔÔÔÈÂ›Ù·È ‹ ıÂÚ·¢ÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜. ∞˘Ùfi Î·È Ó· ·ÔÎÚ‡ÙÂÙ·È Ë ÂÈÛÙËÌÔÔ˘ ‰ËÏ·‰‹ ¯ÚÂÈ¿˙ÂÙ·È, Â›Ó·È Ë ÓÈ΋ ÁÓÒÛË, ÂÂȉ‹ ¤Ú¯ÂÙ·È ÛÂ Û˘Ó¯‹˜ ÌÂϤÙË ÙˆÓ ‚·ÛÈÎÒÓ Û‡ÁÎÚÔ˘ÛË Ì ‚·ÛÈΤ˜ ·Ú¯¤˜ ÙˆÓ ·Ú¯ÒÓ Î·È ıˆÚÈÒÓ ¿Óˆ ÛÙȘ ÚÔÛÂÁÁ›ÛˆÓ. ∞ÓÙ›ıÂÙ·, Â›Ó·È Ôԛ˜ ÛÙËÚ›˙ÔÓÙ·È ÔÈ ÚÔÛÂÁÁ›- ·Ó¿ÁÎË ·˘Ù‹ Ó· ·ÔÙÂÏ› ÙË ‚¿ÛÂȘ ·˘Ù¤˜, ¤ÙÛÈ ÒÛÙ ӷ ÌÔÚÔ‡- ÛË ÁÈ· ÙËÓ ÌÂϤÙË ÙˆÓ ÎÈÓËÙÈÎÒÓ Ì ӷ ·Ú¤¯Ô˘Ì ıÂÚ·›·, Ë ‰È·Ù·Ú·¯ÒÓ Î·È Ù˘ ·ÓÙÈÌÂÙÒÈÔÔ›· Ó· ‚·Û›˙ÂÙ·È Û ÏÔÁÈÎÔ‡˜ Û‹˜ ÙÔ˘˜. ηÓfiÓ˜ Î·È Û˘Á¯ÚfiÓˆ˜ Ó· Â›Ó·È ŒÓ·˜ ·ÎfiÌË ÂÓ ‰˘Ó¿ÌÂÈ Î›Ó‰˘ÓÔ˜ ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È Ú·ÏÈÛÙÈ΋ Û¯ÂÙÈο Ì ÙȘ ÊÈÏÔÛÔʛ˜ Â›Ó·È Ë Damiano & al 1995, Dodd, Taylor et al 2002, Hesse & al 2000, Dean & Shepherd 1997, Butefisch & al 1995, Kim & al 2004, Bonifer et al 2005, Pierce & al 2002, Taub, Ramey, DeLuca & al 2004, Gordon, Charles & Wolf 2005). £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 

pages 5-47

12-07-06 11:28 ™ÂÏ›‰·13 ANA™KO¶H™H ÚÔÛ¤ÁÁÈÛË «·Î¤ÙÔ» (packaged approach) ÙÔ ÔÔ›Ô Â›Ù ÙÔ ‰Â¯fiÌ·ÛÙÂ Û˘ÓÔÏÈο ›Ù ÙÔ ·ÔÚÚ›ÙÔ˘ÌÂ. ∏ ˘ÈÔı¤ÙËÛË ÌÈ·˜ Û˘ÁÎÂÎÚÈ̤Ó˘ ÚÔÛ¤ÁÁÈÛ˘ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ, ÂÛÎÂÌ̤ӷ ‹ fi¯È, ÛÙËÓ ·fiÚÚÈ„Ë ¿ÏÏˆÓ ·ÓÙ·ÁˆÓÈÛÙÈÎÒÓ ÊÈÏÔÛÔÊÈÒÓ, ·ÓÂÍ¿ÚÙËÙ· ·fi Ù· ÏÂÔÓÂÎÙ‹Ì·Ù· ÙÔ˘˜ (Damiano 2004). øÛÙfiÛÔ, ÔÈ Â‰Ú·ÈˆÌ¤Ó˜ Ú·ÎÙÈΤ˜ ‰ÂÓ ¤¯Ô˘Ó ¯¿ÛÂÈ ÙËÓ ·Í›· ÙÔ˘˜. ¶ÔÏϤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÂÈ‚›ˆÛ·Ó ·ÊÔÌÔÈÒÓÔÓÙ·˜ Ó¤· ÛÙÔȯ›· ÛÙÔ ıÂÚ·¢ÙÈÎfi ÙÔ˘˜ Ï·›ÛÈÔ, ·Ê‹ÓÔÓÙ·˜ ¤Íˆ, fiÛ· ‰ÂÓ ·ÓÙÈÚÔÛÒ¢·Ó ·fiÏ˘Ù· ÙȘ ıÂÚ·¢ÙÈΤ˜ ÙÔ˘˜ ÚÔÙ¿ÛÂȘ. ∏ ÂÔ¯‹ Ù˘ ·ÓÙÈ·Ú¿ıÂÛ˘ ÁÈ· ÙÔ ÔÈ· Â›Ó·È Ë Î·Ù·ÏÏËÏfiÙÂÚË ıÂÚ·¢ÙÈ΋ ̤ıÔ‰Ô˜ ¤¯ÂÈ ·Ú¤ÏıÂÈ. ¡¤Â˜ ȉ¤Â˜, ·ÏÏ¿ ΢ڛˆ˜ Ӥ˜ ÁÓÒÛÂȘ ÍÂÚÔ‚¿ÏÏÔ˘Ó ÛÈÁ¿-ÛÈÁ¿, ÔÏϤ˜ ıˆڛ˜ ÂÚÓ¿Ó ÛÙËÓ ÈÛÙÔÚ›· Î·È Ó¤Â˜ ıÂÚ·¢ÙÈΤ˜ ̤ıÔ‰ÔÈ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË (Scrutton & al 2004). ∏ ÂÌÌÔÓ‹ Û ıÂÚ·¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ‹ ÁÂÓÈÎfiÙÂÚ· Û ÊÈÏÔÛÔʛ˜ ıˆÚÂ›Ù·È ϤÔÓ ‰ÔÁÌ·ÙÈ΋. ∏ ÂÔ¯‹ Ô˘ οÔÈÔÈ ‰È·Î‹Ú˘ÙÙ·Ó ÙË ÌÔÓ·‰ÈÎfiÙËÙ· Ù˘ ‰È΋˜ ÙÔ˘˜ «Ì›·˜ Î·È ·ÏËıÈÓ‹˜ ıÂÚ·›·˜» ¤¯ÂÈ ÂÚ¿ÛÂÈ. ∆Ë ı¤ÛË Ù˘ ‚‚·ÈfiÙËÙ·˜ ·›ÚÓÂÈ Â‰Ò Î·È ¯ÚfiÓÈ· Ë ·Ó·˙‹ÙËÛË (Scrutton & al 2004). ∂ÓÙ¤ÏÂÈ, ‰ÂÓ Â›Ó·È Ë Ì¤ıÔ‰Ô˜ Ô˘ οÓÂÈ ÙË ‰È·ÊÔÚ¿ ·ÏÏ¿ Ë ‰ÈÔÚ·ÙÈÎfiÙËÙ· Î·È Ë ÈηÓfiÙËÙ· ÙÔ˘ ıÂÚ·Â˘Ù‹ Ó· ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙȘ Ú·ÁÌ·ÙÈΤ˜ ·Ó¿ÁΘ ÙÔ˘ οı ·È‰ÈÔ‡ ͯˆÚÈÛÙ¿, Ó· ÙȘ ÂÚÌËÓ‡ÂÈ ÛˆÛÙ¿ Î·È Ó· ÂÈϤÁÂÈ Ù· ηٷÏÏËÏfiÙÂÚ· ̤۷ ÁÈ· ÙËÓ Â›Ï˘ÛË ÙˆÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙÔ˘˜. ANAºOPE™ Bobath B. (1967) The very early treatment of cerebral palsy. Developmental medicine & child neurology, 9, 373-390. Butefisch C., Hummelsheim H., Denzler P., Mauritz K.H. (1995) Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand. Journal of the neurological sciences, 130, 59-68. ¶·ÓÙÂÏÈ¿‰Ë˜ ÃÚ., ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∞. ¢È·Ì·ÓÙfiÔ˘ÏÔ˜ ¡. (1998) ∂ÁÎÂÊ·ÏÈ΋ ¶·Ú¿Ï˘ÛË – ·ÚÂÏıfiÓ, ·ÚfiÓ, ̤ÏÏÔÓ. ∂ΉfiÛÂȘ °È·¯Ô‡‰Ë – °È·Ô‡ÏË, £ÂÛÛ·ÏÔÓ›ÎË. ™ÎÔ˘Ù¤ÏË ∂. (1999) ¶ÚÔÁÚ¿ÌÌ·Ù· ÚÒÈÌ˘ ·Ú¤Ì‚·Û˘: ̇ıÔ˜ ‹ Ú·ÁÌ·ÙÈÎfiÙËÙ·; ¶Ú·ÎÙÈο 12Ô˘ ·ÓÂÏÏËÓ›Ô˘ ÌÂÙÂÎ·È‰Â˘ÙÈÎÔ‡ ÛÂÌÈÓ·Ú›Ô˘ ÂÓÙ·ÙÈ΋˜ ÓÔÛËÏ›·˜ ÓÂÔÁÓÒÓ, ∞ı‹Ó·. Als H., Duffy F., McAnulty G. et al (2004) Early experience alters brain function and structure. Pediatrics, vol. 113, No 4, pp. 846-857. APCP (2002) Paediatric physiotherapy guidance for good practice. Available from association of paediatric chartered physiotherapists, c/o CSP, 14 Bedford Row, London WCIR 4ED. Barry M. (1996) Physical therapy interventions for patients with movement disorders due to cerebral palsy. Journal of child neurology, Vol. 11, supplement 1, S51-S60. Bernstein N. (1967) Coordination and regulation of movement. London: Pergamon. In: ShumwayCook A., Woollacott H.M. Motor control – theory and practical applications. 2nd edition. Lippincott Williams & Wilkins, Philadelphia (2001). Bly L. (1991) A historical and current view of the basis of NDT. Pediatric Physical Therapy. 3, 131-135. Bonifer N., Anderson K., Arciniegas D. (2005) Constraint-induced movement therapy after stroke: Efficacy for patients with minimal upper-extremity motor ability. Arch phys med rehabil, vol. 86, pp. 1867-1873. Bobath K. (1980) A neurophysiological basis for the treatment of cerebral palsy. Clinics in developmental medicine No. 75, 2nd edition, Mac Keith Press, Oxford. Bower E., McLellan D.L. (1992) Effect of increased exposure to physiotherapy on skill acquisition of children with cerebral palsy. Developmental medicine & child neurology, 34, 25. Bower E., McLellan D.L., Arney J., Campbell M.J. (1996) A randomized controlled trial of different intensities of physiotherapy and different goal-setting procedures in 44 children with cerebral palsy. Developmental medicine & child neurology, 38, 226-237. Bower E., Michell D., Burnett M., Campbell M.J., McLellan D.L. (2001) Randomized controlled trial of physiotherapy in 56 children with cerebral palsy followed for 18 months. Developmental medicine & child neurology, 43, 4-15. Brandt S., Lonstrup H.V., Marner T. et al (1980) Prevention of cerebral palsy in motor risk infants by treatment ad modum Vojta. Acta Paediatr Scand, 69, 283-286. Bulter C., Darrah J. (2001) Effects of neurodevelopmental treatment (NDT) for cerebral palsy: an AACPDM evidence report. Developmental medicine & child neurology, 43, 778-790. Burns Y., McDonald J. (1996) Physiotherapy and the growing child. WB Saunders Ltd, London. ∂˘¯·ÚÈÛٛ˜ £· ‹ıÂÏ· Ó· ¢¯·ÚÈÛÙ‹Ûˆ ÙËÓ Î. ¡Ù¤ÌË ¶··˚ˆ¿ÓÓÔ˘ – ™Ù·˘ÚÔÔ‡ÏÔ˘, Ê˘ÛÈÎÔıÂÚ·‡ÙÚÈ· Ó¢ÚÔ-·Ó·Ù˘Íȷ΋˜ ·ÁˆÁ‹˜ Î·È ÙËÓ Î. ¢¤ÛÔÈÓ· §ÈfiÏÈÔ˘, ÏÔÁÔ‰ÈÎfi, ÁÈ· ÙËÓ ÛËÌ·ÓÙÈ΋ ÙÔ˘˜ Û˘Ì‚ÔÏ‹ ÛÙË Û˘ÁÁÚ·Ê‹ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘. Clopton N., Duvall T., Ellis B. et al. (2000) Investigation of trunk and extremity movement associated with passive head turning in newborns. Physical therapy. Vol. 80, No 2, pp. 152-159 D’ Avignon M., Noren L., Arman T. (1981) Early physiotherapy ad modum Vojta or Bobath in infants with suspected neuromotor disturbance. Neuropediatrics, Vol. 12, No 3, 232-241. Damiano D., Vaughan C., Abel M. (1995) Muscle response to heavy resistance exercise in children with spastic cerebral palsy. Developmental medicine & child neurology, 37, 731-739. Damiano D., Abel M. (1998) Functional outcomes of strength training in spastic cerebral palsy. Arch Phys Med Rehabil. Vol 79, 119-125. Damiano D., Abel M. (2002) Relationships among impairments, motor function, and perceived health status in spastic cerebral palsy: a multi-center collaboration. Developmental medicine & child neurology, 42, suppl. 83, 42. (Abstract). Damiano D. (2004) Physiotherapy Management in cerebral palsy: Moving Beyond Philosophies. In: Scrutton D., Damiano D., Mayston M. Management of the motor disorder of children with cerebral palsy. 2nd edition. Clinics in developmental medicine No. 161, Mac Keith Press – Cambridge University Press, pp. 161169. £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006 13 

https://flipbooks.fleepit.com/f-55298-___________

Fleepit Digital © 2021