Îmbunătăţirea motricităţii fine la copiii cu nevoi speciale utilizând terapia ocupaţională

Introduction

Occupational therapy tries to develop the quality of life of any person whose functional ability is limited⁽¹⁾, this goal being achieved by greater independence⁽²⁾ in any field of occupational behaviour⁽³⁾. In the past, most of the deficient patients were condemned to unchanged disability⁽⁴⁾, but kinesitherapy⁽⁵⁾ and occupational therapy^(6-8) developed their autonomy^(2,5). The improvement of muscle tone associates better ossification^(9,10), increased muscle capacity^(4,11,12), liver function improvement^(13,14) and immunity upgrading^(15,16), in children with chronic pathologies^(10,17) being demonstrated the risks of associated fractures⁽⁹⁾ and functional impotence or immunodeficiency⁽¹⁶⁾, with subsequent respiratory and systemic infections⁽¹⁷⁾. The children with special educational needs are exposed to infectious complications⁽¹⁸⁾ due to increased susceptibility to infections during childhood⁽¹⁰⁾ and to complications associated with medication, which requires a cautious approach⁽¹⁹⁾. Like other patients with cystic fibrosis who describe hepatic⁽¹³⁾, bone⁽⁹⁾ or vitamin and mineral deficiencies, the patients with Down syndrome might have the same complications⁽²⁰⁾. Previously, people with disabilities were happy to “survive”, but today they want to “live”.

Materials and method

This research is a case study series of five children with special educational needs (Down syndrome, Pierre Robin syndrome, West syndrome, severe multicystic encephalomyelitis, craniocerebral trauma), monitored at the “Speranţa” Resource and Assistance Center (CRA) in Timişoara. The patients’ parents signed the inform consent and the inclusion into the study. Subjects benefited from occupational therapy services during the 2017-2018 school year at the occupational ergotherapy unit once a week. Parental counselling was provided in addition to individually and in multidisciplinary meetings. The elected subjects (three boys and two girls) also participate in other therapies at “Speranţa” CRA, being included in mass education, in integration classes. The age of the subjects varied from 10 to 17 years old. The research stages were: obtaining the informed consent, initial testing (September-October 2017), intervention (October 2017 – May 2018) and final testing (June 2018). The initial and final evaluation with the “Speranţa” CRA fact sheet focused on: fine motor precision, coordination, strength, amplitude, tone, manual skills and perceptual-motor structures (shape, colour, body schematics, spatial and temporal orientation).

Results and discussion

The fine mobility of pupils with special educational needs is improved (Figure 1), but not statistically significant, after the intervention through the customized occupational therapy program. Thus, preference, grip (23.69±10.99 to 44.13±15.53; p=0.002), fine motor coordination (3.66±0.29 to 3.76±0.32; p=0.6242), strength, amplitude, muscle tone (3.49±0.23 to 3.79±0.18; p=0.0557), and hand skills (2.31±0.85 to 2.68±0.74; p=0.4867) improved in all subjects (Figure 2).

Regarding fine motor coordination, all five subjects have evolved following the application of the occupatio­nal therapy program. Two subjects had a good progression and three subjects had a satisfactory evolution according to the ergotherapy sheet.

As far as prehension is concerned, all five subjects evolved statistically, following the application of the occupational therapy program – four of them obtained the mark at the end of the school year. One subject achieved the expected maximum performance, and another subject came close to the maximum score. In terms of strength, amplitude and muscle tone, all subjects had a satisfactory performance during the school year, two of them reaching the maximum score – the qualification was very good, and the other three achieved the qualification well. The testing of the manual skills showed that all subjects made progress during the school year. Thus, a patient had a good evolution, and four subjects developed satisfactorily. Regarding orientation, organization and time structure, all subjects progressed throughout the school year; a patient had a good evolution and four patients had a satisfactory evolution (Figure 3 a, b).

The perceptual-motor structures of form and colour, body schematics, orientation, organization, spatial structure, and temporal organization and structure have improved, but have evolved less than that of fine motor skills, because all subjects exhibited intellectual development disorder, and the development of perceptual-motor structures is closely related to the cognitive ability of the patient.

Conclusions

Occupational therapy must be included in the management program of children with special educational needs, due to its efficiency in promoting motor control through diverse and attractive activities. A consistent occupational therapy tailored to the needs of the child is probably the most important factor in the development of the fine motor skills and the motor perceptual structure of the child with special needs. Ergotherapy is particularly important, being the only process that combines motor skills, integrated functions of the nervous system, mental attention, problem solving and emotional satisfaction in defined tasks. Therefore, our children will live better and longer, in a healthier and happier way.

Funding: This research received no external funding.

Acknowledgments: We acknowledge the patients and their families support given with the study, and colleagues from the ambulatory setting for their help.

Conflicts of interests: The authors declare no conflict of interests.