12-07-06 11:28 ™ÂÏ›‰·5 ANA™KO¶H™H ª¤ıÔ‰ÔÈ º˘ÛÈÎÔıÂڷ¢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˘ÛÈÎÔıÂڷ›·˜, ∆.∂.π. §·Ì›·˜ ∂ÈÎÔÈÓˆÓ›·: °ÈÒÚÁÔ˜ ¶·Ú¿˜, ∆Ì‹Ì· º˘ÛÈÎÔıÂڷ›·˜, ∆.∂.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 ÂÎÚfiÛˆÔ 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·, ÌËÚÔԉ¢ÙÈ΋ ‰È·Ù·Ú·¯‹ ÙÔ˘ ·ÓÒÚÈÌÔ˘ ∫.¡.™., Ô˘ ÂËÚ¿˙ÂÈ Ù· ÙÌ‹Ì·Ù· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Ù· ÔÔ›· 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 ÂÎÚfiÛˆÔ 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 ÛÎÔfi ·˘Ùfi ¤¯Ô˘Ì ÛÙËÓ ‰È¿ıÂÛ‹ Ì·˜ ¤Ó· ÌÂÁ¿ÏÔ ·ÚÈıÌfi ıÂڷ¢ÙÈÎÒÓ Ì¤ÛˆÓ Ô˘ ÛÙfi¯Ô ÙÔ˘˜ ¤¯Ô˘Ó ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ Î·È ÙËÓ ·ÓÂÍ·ÚÙËÙÔÔ›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 ıÂڷ¢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 ·Ô‰Â›ÍÂˆÓ ÁÈ· ÙËÓ ıÂÙÈ΋ ›‰Ú·ÛË Ù˘ Ê˘ÛÈÎÔıÂڷ›·˜, Ë Û˘Ì‚ÔÏ‹ Ù˘ ÛÙÔÓ ÚÒÈÌÔ ÂÓÙÔÈÛÌfi, ÛÙËÓ ¤ÁηÈÚË ·Ú¤Ì‚·ÛË Î·È ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË 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 ÙÚÔÔÔÈËı› Î·È ÚÔÛ·ÚÌÔÛÙ› ÛÙ· Ó¤· ÂÈÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ. £ÂˆÚ›Â˜ ÔÈ Ôԛ˜ ›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¿ ÂÈÛÙËÌÔÓÈ΋ ¤Ú¢ӷ ‰ÂÓ ¤¯ÂÈ ·Ô‰Â›ÍÂÈ ÙËÓ ·ÓˆÙÂÚfiÙËÙ· οÔÈ·˜ 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· ÂÈϤÁÂÈ 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
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· ÂÈÛÙËÌÔÓÈ΋ ∏ ‰˘Ó·ÌÈο ÌÂÙ·‚·ÏÏfiÌÂÓË ÂÈ- ¤Ú¢ӷ ‰ÂÓ ¤¯ÂÈ ·Ô‰Â›ÍÂÈ ÙËÓ ÎfiÓ· Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ·Ú¿Ï˘·ÓˆÙÂÚfiÙËÙ· οÔÈ·˜ ÚÔÛ˘, ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÔÏ˘Û¤ÁÁÈÛ˘ ‹ fiÙÈ Î¿ÔÈ· ÚÔÌÔÚÊ›· Ù˘, ηıÈÛÙ¿ ÙËÓ ·ÓÙÈÌÂÛ¤ÁÁÈÛË ÌÔÚ› ·fi ÌfiÓË Ù˘ ÙÒÈÛË ÙˆÓ ·È‰ÈÒÓ ÚfiÎÏËÛË ÁÈ· οı ıÂÚ·Â˘Ù‹. OÈ ÂÚÈÛÛfi- Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ fiÏ· Ù· ÚÔÙÂÚ˜ ıÂڷ¢ÙÈΤ˜ ÚÔÛÂÁÁ›- ‚Ï‹Ì·Ù· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·Ó·ËÚ›· ÛÂȘ ·Ó·Ù‡¯ıËÎ·Ó Ì ÛÎÔfi ÙËÓ ·ÓÙÈÌÂÙÒÈÛË 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 ÔÔ›· ı· Ú¤- Ì· Î·È ÔÈ ‰˘ÛÎÔϛ˜ ÛÙÔÓ Î·ıÔÚÈÂÈ Ó· ÌÂÏÂÙÔ‡ÓÙ·È Î·È Ó· ÂÚÌË- ÛÌfi ÎÔÈÓ‹˜ ıÂڷ¢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˘ÙÔÔÈ‹ÛÂȘ Û ۯ¤ÛË Ì ÙËÓ ·ÓÙÈ- ÙÈ΋ ÌÂϤÙË – fiˆ˜ Î·È ÁÂÓÈÎfiÙÂÌÂÙÒÈÛË 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˘ÛÈÎÔıÂڷ¢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¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÙËÓ ÂÎÙ›ÌËÊ·Û›ÛÂÈ Î·Ó›˜ ÔÈ· ÚÔÛ¤ÁÁÈÛË Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË, ›Ù ÛË Ù˘ ÎÈÓËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ‚¿ÛÂÈ ÂÈÛÙËÌÔÓÈÎÒÓ ÌÂÏÂÙÒÓ, Â›Ó·È ‰ÔÌË̤Ó˜ Ì ٤ÙÔÈÔ ÙÚfiÔ, ›Ù ÛÙËÚÈ˙fiÌÂÓÔ˜ Û ıˆÚËÙÈΤ˜ ÒÛÙÂ Û˘¯Ó¿ Ó· ·˘ÙÔ-ÂȂ‚·ÈÒÓÔÓÙ·È (self-validating) Ì ‚¿ÛË ·Ú¯¤˜ (Barry 1996). ∫·Ì›· ˆ˜ ÙÒÚ· ÂÈÛÙËÌÔÓÈ΋ ÙË ıˆڛ· Ô˘ ÛÙËÚ›˙ÂÈ Ë Î¿ı ¤Ú¢ӷ ‰ÂÓ ¤¯ÂÈ ·Ô‰Â›ÍÂÈ ÙËÓ ÚÔÛ¤ÁÁÈÛË. OÈ ÂÚÈÛÛfiÙÂÚ˜ Ì·ӈÙÂÚfiÙËÙ· οÔÈ·˜ ÚÔÛ¤ÁÁÈ- ϤÙ˜ ÂÈÎÂÓÙÚÒÓÔÓÙ·È Î˘Ú›ˆ˜ Û˘ ‹ fiÙÈ Î¿ÔÈ· ÚÔÛ¤ÁÁÈÛË ÌÔ- ÛÙË ıÂÙÈ΋ ›‰Ú·ÛË Ù˘ ÚÒÈÌ˘ Ú› ·fi ÌfiÓË Ù˘ Ó· ·ÓÙÈÌÂÙˆ›- Ê˘ÛÈÎÔıÂڷ¢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, fiˆ˜ ÙÔ˘ Vaclav Vojta Î·È Ù˘ Elizabeth Kong Û¯ÂÙÈο Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ÚÒÈÌ˘ ·Ú¤Ì‚·Û˘, ‰ÂÓ ÌÔÚÔ‡Ó Ó· ·Ô‰Â›ÍÔ˘Ó fiÙÈ Ë Û˘ÁÎÂÎÚÈ̤ÓË ÚÔÛ¤ÁÁÈÛË ‹Ù·Ó ÂΛÓË Ë ÔÔ›· ÂÍ·ÛÊ¿ÏÈÛ ٷ ·ÔÙÂϤÛÌ·Ù· Î·È fi¯È ÙÔ ÁÂÁÔÓfi˜, fiÙÈ ÔÏÏ¿ «‡ÔÙ·» ÁÈ· ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË ‚Ú¤ÊË ı· ÌÔÚÔ‡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 ÂÈÛÙËÌÔÓÈ΋ ÌÂϤÙË Ú¤ÂÈ Ó· ÂÈÓÔ› ·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 ·ÍÈfiÈÛÙË in vivo Ù˘¯·ÈÔÔÈË̤ÓË ÎÏÈÓÈ΋ ÌÂϤÙË ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙˆÓ ÚÒÈÌˆÓ Ó¢ÚÔ-·Ó·Ù˘ÍÈ·ÎÒÓ ÂÌÂÈÚÈÒÓ (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·ÙÔÔÈ‹ıËΠÛÙË £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006
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 ıÂڷ›·˜ ·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›·˜. ∏ ıÂڷ›· 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 ÂÚÈÙÒÛÂȘ 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 Ôԛ˜ ‚·Û›˙ÔÓÙ·È. OÈ ıˆڛ˜ ·ÏÏ¿˙Ô˘Ó, ‚¿ÛÂÈ ÙˆÓ Ó¤ˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ‰Â‰Ô̤ӈÓ, ÌÂ Û˘Ó¤ÂÈ· Ó· ÙÚÔÔÔÈÔ‡ÓÙ·È Î·È Ó· ÚÔÛ·ÚÌfi˙ÔÓÙ·È ·Ó¿ÏÔÁ· Î·È ÔÈ ıÂڷ¢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 ıÂڷ¢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 «ÙÚÔÔÔ›ËÛË» (modification) Î·È Ù· «ÚfiÙ˘· ·Ó·ÛÙÔÏ‹˜ ·ÓÙ·Ó·ÎÏ·ÛÙÈÎÒÓ» (Reflex Inhibiting Patterns) ¤ÁÈÓ·Ó «ÚfiÙ˘· Ô˘ ÂËÚ¿˙Ô˘Ó ÙÔÓ ÙfiÓÔ» (Tone Influencing Patterns) (Bly 1991). ™Ù· Ù¤ÏË Ù˘ ‰ÂηÂÙ›·˜ ÙÔ˘ ‘50 ·Ú¯¤˜ ÙÔ˘ ‘60 Ú·ÁÌ·ÙÔÔÈ‹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 ÔÔ›ˆÓ ΢Úȷگ› ÛÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›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
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¿ıÂ Â›Â‰Ô ÙÔ˘ ¡.™. Âȉڿ Ï·Ì‚¿ÓÂÈ ˘fi„Ë, fi¯È ÌfiÓÔ ÙË Û ¿ÏÏ· ›‰· (·ÓÒÙÂÚ· Î·È Î·- Û˘Ì‚ÔÏ‹ ÙÔ˘ ¡.™. ÛÙË ‰Ú·ÛÙËÚÈfiÙÒÙÂÚ·), ·Ó¿ÏÔÁ· Ì ÙË ‰Ú·ÛÙË- ÙËÙ·, ·ÏÏ¿ ›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 ÙÂÏÂÈÔÔ›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˜ ıÂڷ¢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 ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ÙÔ ÎÈÓËÙÈprogramming theory) ‹ ÙˆÓ Îfi Ì·˜ Û‡ÛÙËÌ· ÂÈÙÚ¤ÂÈ Ó· ∫ÂÓÙÚÈÎÒÓ ∫ÈÓËÙÈÎÒÓ ¶ÚÔÙ‡ˆÓ ·ÏÏËÏÂȉڿÌ ·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˘ÌÂÚÈÊÔÚ¿˜» Ï¿ ÔÈ «ÁÂÓÓ‹ÙÚȘ ÎÂÓÙÚÈÎÒÓ ÚÔ- (goal-oriented behavior). ∏ ¤ÚÂ˘Ù‡ˆÓ» (central pattern generators) Ó¿ ÙÔ˘ ÂÛÙÈ¿ÛÙËΠÛÙÔÓ ÙÚfiÔ ÌÂ Â›Ó·È Û ı¤ÛË ·fi ÌfiÓ˜ ÙÔ˘˜ Ó· ÙÔÓ ÔÔ›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, fiˆ˜ .¯. Ù˘ Vojta (Vojta & ¯ÚËÛÈÌÔÔÈԇ̠·˘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˜ Âȉڿ- ·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 ÈηÓÔÔ›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 ·ÏÏËÏ›‰Ú·ÛË ÌÂٷ͇ ‰È·ÊÔÚÂÙÈÎÒÓ Û˘ÛÙËÌ¿ÙˆÓ, Ì ÙÔ Î¿ı ¤Ó· ·fi ·˘Ù¿ Ó· Û˘ÓÂÈÛʤÚÂÈ Ì ÙÔ ‰ÈÎfi ÙÔ˘ ÙÚfiÔ ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙÔ˘ ÎÈÓËÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∏ ˘fiıÂÛË ·˘Ù‹ Ô‰‹ÁËÛ ÛÙËÓ ÙÚÔÔÔ›ËÛË Î·È ÚÔÛ·ÚÌÔÁ‹ ÙˆÓ ‚·ÛÈÎÒÓ ·Ú¯ÒÓ ÔÏÏÒÓ ÚÔÛÂÁÁ›ÛˆÓ, ÌÂٷ͇ ÙˆÓ ÔÔ›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˘ ıÂڷ›·˜ 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 ÂÈÛÙËÌÔÓÈΤ˜ ıˆڛ˜ ·Ú¤¯Ô˘Ó ÙÔ Ï·›ÛÈÔ ÂÚÁ·Û›·˜ Ô˘ ÂÈÙÚ¤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 ÂÈÛÙËÌÔÓÈ΋ ÁÓÒÛË ÁÈ· Ù· ÛËÌ·ÓÙÈο ·˘Ù¿ ÛÙÔȯ›· Ô˘ ÂϤÁ¯Ô˘Ó ÙËÓ Î›ÓËÛË. ¶ÚÔÛÂÁÁ›ÛÂȘ ÔÈ Ôԛ˜ ‰ÂÓ ÚÔÛ·ÚÌfi˙ÔÓÙ·È ÛÙ· Ó¤· ÂÈÛÙËÌÔÓÈο ‰Â‰Ô̤ӷ Î·È ÂÍ·ÎÔÏÔ˘ıÔ‡Ó £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006
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 ·Ô‰Â›ÍˆÓ. ¡¤Â˜ ‹ ÌË ‰ÔÎÈÌ·Ṳ̂Ó˜ ÚÔÛÂÁÁ›ÛÂȘ, ΢ڛˆ˜ ·˘Ù¤˜ Ô˘ ·„ËÊÔ‡Ó ÙȘ ˘¿Ú¯Ô˘Û˜ ·Ú¯¤˜, Ú¤ÂÈ Ó· ·ÓÙÈÌÂÙˆ›˙ÔÓÙ·È Ì ÛÎÂÙÈÎÈÛÌfi, ̤¯ÚÈ ÙËÓ ÂÌÊ¿ÓÈÛË ¤ÁÎ˘ÚˆÓ ÂÚ¢ÓËÙÈÎÒÓ ·Ô‰Â›ÍÂˆÓ (Shumway-Cook & Woollacott 2001, Damiano 2004). ™¯‹Ì· 3. ¶·Ú¿ÁÔÓÙ˜ ηıÔÚÈÛÌÔ‡ Ù˘ ÎÈÓËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜. ™∆∞∆π∫O-∫π¡∏∆π∫∏* §∂π∆OÀƒ°π∞ ∫∞π ∂°∫∂º∞§π∫∏ ¶∞ƒ∞§À™∏ °È· ÙËÓ Î·Ù·ÓfiËÛË ÙˆÓ ıÂڷ¢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 ¿ÓıÚˆÔ˜ Ì ·Î¤Ú·ÈÔ Ó¢ÚÈÎfi Û‡ÛÙËÌ· Ú·ÁÌ·ÙÔÔÈ› οو ·fi Ê˘ÛÈÔÏÔÁÈΤ˜ Û˘Óı‹Î˜. ∏ ÎÈÓËÙÈ΋ Ì·˜ Û˘ÌÂÚÈÊÔÚ¿ ηıÔÚ›˙ÂÙ·È ·fi ·ÙÔÌÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, Î·È ·fi ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ô˘ ÂÈÙÂÏԇ̠۠ۯ¤ÛË Ì ÙÔ ÂÚÈ‚¿ÏÏÔÓ (™¯‹Ì· 3). ∫·ıÔÚÈÛÙÈ΋ ›Û˘ ÁÈ· ÙË ‰È·ÌfiÚʈÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È Î·È Ë ÈηÓfiÙËÙ· ÚfiÛÏ˄˘ Î·È ÂÂÍÂÚÁ·Û›·˜ ÙˆÓ ·ÈÛıËÙËÚÈ·ÎÒÓ - ÎÈÓ·ÈÛıËÙÈÎÒÓ ÏËÚÔÊÔÚÈÒÓ ·fi Ù· ‰È·ÊÔÚÂÙÈο Û˘ÛÙ‹Ì·Ù·, ηıÒ˜ ›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 fiˆ˜ 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˜ ıÂڷ¢ÙÈÎfi˜ Ì·˜ ÛÙfi¯Ô˜. ∞˘Ùfi ¤¯ÂÈ ˆ˜ Û˘Ó¤ÂÈ· Ó· ÌÂÙÚ¿Ì ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ıÂڷ›·˜ ·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 ۷ÛÙÈ΋ 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˘ÛÈÎÔıÂڷ›·˜, Û˘ÁÎÚÈÙÈο Ì ٷ ·È‰È¿ ÛÙ· ÔÔ›· ÙÔ Ê˘ÛÈÎÔıÂڷ¢ÙÈÎfi ÚfiÁÚ·ÌÌ· ‚·Û›˙ÔÓÙ·Ó ÛÙËÓ ÔÈÔÙÈ΋ ‚ÂÏÙ›ˆÛË Ù˘ ΛÓËÛ˘. ∂Ô̤ӈ˜, Ë ÙÂÏÂÈÔÔ›ËÛË Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ΛÓËÛ˘ ‰ÂÓ Ú¤ÂÈ Û η̛· ÂÚ›ÙˆÛË Ó· Á›ÓÂÈ Ô ·fiÏ˘ÙÔ˜ ıÂڷ¢ÙÈÎfi˜ ÛÙfi¯Ô˜ (Scrutton & al 2004). ∏ ηıÔ‰ËÁËÙÈ΋ Âη›‰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˘ ÔÔ›Ô˘ Î·È Ô fiÚÔ˜ ÛÙ·ÙÈÎÔ-ÎÈÓËÙÈÎfi˜), ¤ÏÂÍ· Ó· ¯ÚËÛÈÌÔÔÈ‹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
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 ıÂڷ›· ı· Ú¤ÂÈ Ó· Â›Ó·È Ë ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ ÙˆÓ ·È‰ÈÒÓ, Ô˘ ÂÈÙ˘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˘ÌÂÚÈÊÔÚ¿ 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 ÌÔÚԇ̠Ӓ ·ÏÏ¿ÍÔ˘ÌÂ; £∂ƒ∞¶∂À∆π∫∂™ ¶ƒO™∂°°π™∂π™ OÚÈṲ̂Ó˜ ÚÔÛÂÁÁ›ÛÂȘ (fiˆ˜ ÙˆÓ Vojta, Doman Delacato, Katona), ˘ÔÛÙËÚ›˙Ô˘Ó, fiÙÈ Î·ıÒ˜ ÂÎÌÂÙ·ÏχÔÓÙ·È ÙËÓ ·˘ÍË̤ÓË Ï·ÛÙÈÎfiÙËÙ· ÙÔ˘ ÓÂÔÁÓÈÎÔ‡ Î·È ‚ÚÂÊÈÎÔ‡ ∫.¡.™. ÌÔÚÔ‡Ó Ó· ÙÚÔÔÔÈ‹ÛÔ˘Ó ÙË ‰ÔÌ‹ Î·È ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Ó· ÂÌÔ‰›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 ÂÔ̤ӈ˜ Ú¤ÂÈ Î·È Ë ·Ú¤Ì‚·Û‹ Ì·˜ Ó· Â›Ó·È ‰˘Ó·ÌÈ΋». ∞Ó Î·È ‰ÂÓ ÙÔÔıÂÙÔ‡ÓÙ·È Ù· ·È‰È¿ Û ÏÂÈÙÔ˘ÚÁÈΤ˜ ı¤ÛÂȘ, ıˆÚ› fiÙÈ Ì ÙËÓ ∞ÓÙ·Ó·ÎÏ·ÛÙÈ΋ ∫ÈÓËÙÔÔ›ËÛË Âηȉ‡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. ÀÔÛÙËÚ›˙ÂÈ fiÙÈ Ë ÏÂÈÙÔ˘ÚÁÈ΋ ·ÔηٿÛÙ·ÛË ÂȉÂÈÓÒÓÂÈ 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 Ôԛ˜ ÚÔ¸Ôı¤ÙÔ˘Ó ÙËÓ ·ÎÂÚ·ÈfiÙËÙ· ÙˆÓ ÈÂÚ·Ú¯Èο ·ÓÒÙÂÚˆÓ ÂÁÎÂÊ·ÏÈÎÒÓ ‰ÔÌÒÓ. ∞Ó Î·È ÔÈ ÂÈÏÂÁ̤Ó˜ 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, ·ÓÙÈÌÂÙÒÈÛ 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˘ÌÂÚÈÊÔÚ¿ ηıÔÚ›˙ÂÙ·È ÛËÌ·ÓÙÈο ·fi ÙË Û¯¤ÛË ÙÔ˘ ·ÙfiÌÔ˘ Ì ÙȘ ÔÈΛϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ô˘ ÂÈÙÂÏ› 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 ·Ó·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, ·ÓÙÈÏËÙÈÎfi, ÁÓˆÛÙÈÎfi Î·È Û˘Ó·ÈÛıËÌ·ÙÈÎfi) Û˘Ì‚¿ÏÏÔ˘Ó ÛÙÔÓ Î·ıÔÚÈÛÌfi Ù˘ ÎÈÓËÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ (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¿ ÙÔÔıÂÙÔ‡ÓÙ·È ÛÂ Û˘ÁÎÂÎÚÈ̤Ó˜ ı¤ÛÂȘ Î·È ÂÎÙÂÏÔ‡Ó Î·ıÔÚÈṲ̂Ó˜ ÎÈÓ‹ÛÂȘ. ÕÏψÛÙÂ, ‰ÂÓ ÁÓˆÚ›˙Ô˘Ì ÙÔÓ ÙÚfiÔ ÚÔÛ·ÚÌÔÁ‹˜ ÙˆÓ ·È‰ÈÒÓ Û ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÛÙȘ Ôԛ˜ ‰ÂÓ ¤¯Ô˘Ó ÚÔËÁÔ˘Ì¤Óˆ˜ ÂÎ·È‰Â˘Ù›. ™ÙȘ ÏÂÁfiÌÂÓ˜ ¡Â˘ÚÔ-·Ó·Ù˘ÍȷΤ˜ ¶ÚÔÛÂÁÁ›ÛÂȘ fiˆ˜ 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) ÂÌϤÎÂÈ ÛÙËÓ ·Ó·Ù˘Íȷ΋ ‰È·‰Èηۛ· Ê˘ÏÔÁÂÓÂÙÈÎÔ‡˜ Ì˯·ÓÈÛÌÔ‡˜, Ú¿ÁÌ· ÙÔ ÔÔ›Ô ‰ÂÓ ÈÛ¯‡ÂÈ ·fiÏ˘Ù· ÛÙËÓ NDT. 10 £∂ª∞∆∞ ºÀ™π∫√£∂ƒ∞¶∂π∞™ ñ ∆√ª√™ 4 - ∆∂ÀÃ√™ 2 - A¶PI§IO™ - IOYNIO™ 2006
12-07-06 11:28 ™ÂÏ›‰·11 ANA™KO¶H™H ∞ÈÛıËÙËÚȷ΋ OÏÔÎÏ‹ÚˆÛË (Sensory Integration) Ù˘ Jean Ayres ˘ÔÛÙËÚ›˙ÂÙ·È Ë ÙÚÔÔÔ›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 ıÂڷ›· Î·È ıˆÚÔ‡ÓÙ·È ˘Â‡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 Ôԛ˜ ‰ÂÓ ÈÛ¯‡Ô˘Ó ·fiÏ˘Ù·, fiˆ˜ .¯. 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˘ÌÂÚÈÊÔÚ¿˜ 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· Âηȉ‡ÔÓÙ·È Û ÏÂÈÙÔ˘ÚÁÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÔÈ Ù¯ÓÈΤ˜ ÙÔ˘˜ Û‹ÌÂÚ· ÂÓۈ̷ÙÒÓÔÓÙ·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹ Ì ÛÎÔfi ÙË ‚ÂÏÙ›ˆÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜. OÈ ÚÔÛÂÁÁ›ÛÂȘ ·˘Ù¤˜ ·Ó·ÁÓˆÚ›˙Ô˘Ó fiÙÈ Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ·ÈÛıËÙËÚÈ·ÎÔ›, ÁÓˆÛÙÈÎÔ›, ·ÓÙÈÏËÙÈÎÔ› 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- ÌÔÚ› ·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 ‰›·, fiˆ˜ 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·ÛÙËÚÈÔÔ›ËÛ˘ ÂÓ¿- ∞¶O ∆O ¶∞ƒO¡ ™∆O ÓÙÈ· ÛÙË ‚·Ú‡ÙËÙ·. ¶.¯. ¤Ó· ·È‰› ª∂§§O¡ Ì ·˘ÍË̤ÓÔ Ì˘˚Îfi ÙfiÓÔ ÌÔÚ› ªÂ ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ Ó¤· Ó· ÔÚıÔÛÙ·Ù›, Ó· ‚·‰›˙ÂÈ Î·È Ó· Â›Ó·È ÏÂÈÙÔ˘ÚÁÈÎfi, ÂÓÒ ¤Ó· ¿ÏÏÔ ÂÈÛÙËÌÔÓÈο ‰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 ıÂڷ¢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) ÌÔÚ› 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¿ÌÂıÂڷ¢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 Ôԛ˜ ÂÌÂÚȤ¯Ô˘Ó ÙËÓ ·ÏÏËÏ›‰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·ÛÙËÚÈfiÙËÔ˘ Ë ÚÒÙË Û˘Ì‚¿ÏÂÈ ÛÙËÓ ·Ó¿- Ù·, ÂÈÙÂÏÔ‡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 ÚÔÛÒÔ˘˜ 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
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 Ôԛ˜ ‰ÂÓ ‚Ú›ÛÎÔÓÙ·È ¿ÓÙ· ÛÂ Û˘Ìʈӛ· Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Ó¢ÚÔÂÈÛÙËÌfiÓˆÓ – Ë ™˘Ó‰˘·ÛÙÈ΋ - ∂ÎÏÂÎÙÈ΋ ∞ÁˆÁ‹ (combined – eclectic approach) Ô‰ËÁ› ÛÙË Û‡ÓıÂÛË ÙˆÓ ‰È·ÊÔÚÂÙÈÎÒÓ ÌÂıfi‰ˆÓ ıÂڷ›·˜, ·ÚfiÏÔ Ô˘ ›¯·Ó ¢ڤˆ˜ ıˆÚËı› ˆ˜ ·ÌÔÈ‚·›· ·ÔÎÏÂÈfiÌÂÓ˜ (Levitt 2004, Damiano 2004). ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ϤÔÓ ÂÈÛËÌ·›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΋ ÕÔ„Ë ÛÙË ıÂڷ›· 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˘ÛÈÎÔıÂڷ¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÂÂÎÙ¿ıËÎ·Ó Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· Î·È Û ¿ÏÏÔ˘˜ ÙÔÌ›˜, Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·˜: ñ ∆¯ÓÈΤ˜ Ì˘˚΋˜ ÂÓ‰˘Ó¿ÌˆÛ˘ (muscle strengthening) ñ ∂·Ó·Ï·Ì‚·ÓfiÌÂÓË ÎÈÓËÙÈ΋ Âη›‰Â˘ÛË (repetitive motor training) ñ §ÂÈÙÔ˘ÚÁÈ΋ Âη›‰Â˘ÛË (task-related training) ñ ¶ÂÚÈÔÚÈÛÙÈ΋ – ¶ÚÔÎÏËÙ‹ ıÂڷ›· (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 ÂÂȉ‹ ÙÔ˘ ·Ú¤¯ÂÈ ÙË ‰È΋ Ù˘ ¤ÙÔÈÌË ÂÍ‹ÁËÛË (Levitt 2004). ∏ ÂÌÌÔÓ‹ Û ÔÔÈ·‰‹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˘˜ ıÂڷڷ¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ÁÈ· ÙËÓ Â˘Ù¤˜, ·ÏÏ¿ ΢ڛˆ˜ ÛÙ· ·È‰È¿ ·ÔηٿÛÙ·ÛË ·È‰ÈÒÓ Ì ÂÁÎÂ- Ô˘ ıÂڷ‡ԢÌÂ. °ÂÓÈÎfiÙÂÚ·, Ë Ê·ÏÈ΋ ·Ú¿Ï˘ÛË ÂÍÂÏ›¯ÙËηÓ, ÚÔÛÎfiÏÏËÛË Û ÊÈÏÔÛÔʛ˜ ÂÌÔ·fi ·Ï¤˜ ÔÚıÔ‰ÈΤ˜ ·ÚÂÌ‚¿- ‰›˙ÂÈ ÙËÓ ¤ÁηÈÚË ÂÓۈ̿وÛË ÛÂȘ, Û Ó¢ÚÔÊ˘ÛÈÔÏÔÁÈΤ˜, ÂηÈ- Ó¤ˆÓ ÂÈÛÙËÌÔÓÈÎÒÓ ‰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- ÂÈÙÚ¤ÂÈ ÙËÓ ·ÍÈÔÔ›ËÛË ÙˆÓ ‰È̘, ·ÏÏ¿ ÂÂÎÙ¿ıËÎ·Ó Î·È Û ÎÒÓ Ì·˜ ‰˘Ó·ÙÔًوÓ. ºÈÏÔÛÔ¿ÏÏÔ˘˜ ÙÔÌ›˜, fiˆ˜ ÚԷӷʤ- ʛ˜ Ô˘ ÚÔÛʤÚÔ˘Ó Ì›· «Û˘ÓÔÚ·Ì (Helders, Engelbert, ÏÈ΋» ÚÔÛ¤ÁÁÈÛË ÛÙË ıÂڷ›·, Custers & al 2003, Mayston 2004). Ë ÔÔ›· ‰ÂÓ ‚·Û›˙ÂÙ·È Û ¤Á΢Ú˜ ∏ fiÏÔ Î·È ·˘Í·ÓfiÌÂÓË Î·Ù·Ófi- ÂÈÛÙËÌÔÓÈΤ˜ ·Ú¯¤˜ ‹ ·ÔÙ˘Á¯¿ÓÔ˘Ó Ó· ÂÓۈ̷ËÛË ÙˆÓ ÂÁÎÂÊ·ÏÈ∫¿ı ıÂÚ·Â˘Ù‹˜ ÙÒÛÔ˘Ó ¿ÏϘ ıÂÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ú·Â›Â˜, 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 ÂÂȉ‹ ÙÔ˘ ÙÈΤ˜ ÛÙËÓ ‚·ڤ¯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· ·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 ÌÔÚ› Ó· ÚÔÛ·˜ ÁÓÒÛ˘, ¯ˆÚ›˜ ‚¤‚·È· Ó· ·ÔÚÚÈÊıÔ‡Ó ÔÈ ˘¿Ú¯Ô˘Û˜ Û·ÚÌfi˙ÂÙ·È, Ó· ÙÚÔÔÔÈÂ›Ù·È ‹ ıÂڷ¢ÙÈΤ˜ ÛÙÚ·ÙËÁÈΤ˜. ∞˘Ùfi Î·È Ó· ·ÔÎÚ‡ÙÂÙ·È Ë ÂÈÛÙËÌÔÔ˘ ‰ËÏ·‰‹ ¯ÚÂÈ¿˙ÂÙ·È, Â›Ó·È Ë ÓÈ΋ ÁÓÒÛË, ÂÂȉ‹ ¤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 Ôԛ˜ ÛÙËÚ›˙ÔÓÙ·È ÔÈ ÚÔÛÂÁÁ›- ·Ó¿ÁÎË ·˘Ù‹ Ó· ·ÔÙÂÏ› ÙË ‚¿ÛÂȘ ·˘Ù¤˜, ¤ÙÛÈ ÒÛÙ ӷ ÌÔÚÔ‡- ÛË ÁÈ· ÙËÓ ÌÂϤÙË ÙˆÓ ÎÈÓËÙÈÎÒÓ Ì ӷ ·Ú¤¯Ô˘Ì ıÂڷ›·, Ë ‰È·Ù·Ú·¯ÒÓ Î·È Ù˘ ·ÓÙÈÌÂÙÒÈÔÔ›· 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
12-07-06 11:28 ™ÂÏ›‰·13 ANA™KO¶H™H ÚÔÛ¤ÁÁÈÛË «·Î¤ÙÔ» (packaged approach) ÙÔ ÔÔ›Ô Â›Ù ÙÔ ‰Â¯fiÌ·ÛÙÂ Û˘ÓÔÏÈο ›Ù ÙÔ ·ÔÚÚ›ÙÔ˘ÌÂ. ∏ ˘ÈÔı¤ÙËÛË ÌÈ·˜ Û˘ÁÎÂÎÚÈ̤Ó˘ ÚÔÛ¤ÁÁÈÛ˘ ÌÔÚ› 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 ÂÈ‚›ˆÛ·Ó ·ÊÔÌÔÈÒÓÔÓÙ·˜ Ó¤· ÛÙÔȯ›· ÛÙÔ ıÂڷ¢ÙÈÎfi ÙÔ˘˜ Ï·›ÛÈÔ, ·Ê‹ÓÔÓÙ·˜ ¤Íˆ, fiÛ· ‰ÂÓ ·ÓÙÈÚÔÛÒ¢·Ó ·fiÏ˘Ù· ÙȘ ıÂڷ¢ÙÈΤ˜ ÙÔ˘˜ ÚÔÙ¿ÛÂȘ. ∏ ÂÔ¯‹ Ù˘ ·ÓÙÈ·Ú¿ıÂÛ˘ ÁÈ· ÙÔ ÔÈ· Â›Ó·È Ë Î·Ù·ÏÏËÏfiÙÂÚË ıÂڷ¢ÙÈ΋ ̤ıÔ‰Ô˜ ¤¯ÂÈ ·Ú¤ÏıÂÈ. ¡¤Â˜ ȉ¤Â˜, ·ÏÏ¿ ΢ڛˆ˜ Ӥ˜ ÁÓÒÛÂȘ ÍÂÚÔ‚¿ÏÏÔ˘Ó ÛÈÁ¿-ÛÈÁ¿, ÔÏϤ˜ ıˆڛ˜ ÂÚÓ¿Ó ÛÙËÓ ÈÛÙÔÚ›· Î·È Ó¤Â˜ ıÂڷ¢ÙÈΤ˜ ̤ıÔ‰ÔÈ Á›ÓÔÓÙ·È ·Ô‰ÂÎÙ¤˜ ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË (Scrutton & al 2004). ∏ ÂÌÌÔÓ‹ Û ıÂڷ¢ÙÈΤ˜ ÚÔÛÂÁÁ›ÛÂȘ ‹ ÁÂÓÈÎfiÙÂÚ· Û ÊÈÏÔÛÔʛ˜ ıˆÚÂ›Ù·È Ï¤ÔÓ ‰ÔÁÌ·ÙÈ΋. ∏ ÂÔ¯‹ Ô˘ οÔÈÔÈ ‰È·Î‹Ú˘ÙÙ·Ó ÙË ÌÔÓ·‰ÈÎfiÙËÙ· Ù˘ ‰È΋˜ ÙÔ˘˜ «Ì›·˜ Î·È ·ÏËıÈÓ‹˜ ıÂڷ›·˜» ¤¯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· ÂÈϤÁÂÈ 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·ÓÙfiÔ˘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·˘ÚÔÔ‡ÏÔ˘, Ê˘ÛÈÎÔıÂڷ‡ÙÚÈ· Ó¢ÚÔ-·Ó·Ù˘Íȷ΋˜ ·ÁˆÁ‹˜ Î·È ÙËÓ Î. ¢¤ÛÔÈÓ· §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
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