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1 Physical Activities and Participations in Children with Tourette Syndrome: Comparison with a Matched Control Group Nai-Chai Ou, Wen-Yu Liu, Hai Song Wang 2, Lin-Ya Hsu, Wei-Bin Hwang 3, Chia Yun Wu, Hsiao Wen Wu Department of Physical Therapy & Graduate Institute of Rehabilitation Science, Chang Gung University, Kweishan, Taoyuan, Taiwan. 2 Department of Pediatric Neurology, Chang Gung Memorial Hospital- Lin-Kao Medical Center, Kweishan, Taoyuan, Taiwan. 3 Department of Pediatric Rehabilitation, Chang Gung Memorial Hospital- Lin-Kao Medical Center, Kweishan, Taoyuan, Taiwan. Abstract: Objectives: To compare the level of physical activities and participation of children with Tourette syndrome (TS) and healthy control children. Method: Eight children with TS and eight healthy children matched for age and gender and participated in this study. The level of physical activities and participation were quantified by parents using Child Health Questionnaire-Parent Form 50 (CHQ-PF50), a self-made physical activity questionnaire and the disruptive behavior rating scale and completed by their parents. Independent t-test was used for comparisons. Results: Compared with the healthy control children, proxy-reported health related quality of life of children with TS was lower in several domains. There were statistically significant differences between two groups in Global Health (p=0.039), Bodily Pain (p=0.003), Behavior (p=0.020), General Health Perceptions (p=0.08), Parental Impact-Time (p=0.05), Psychosocial Summary Score (p=0.009). As expected, children with TS demonstrated

2 significantly more hyperactive behaviors than the control group. Conclusions: Despite the small sample, the preliminary findings suggested that children with TS demonstrated significant poor physical activities and participations in several domains than the control healthy children from the view of their parents. Special attention should be paid to not only their tic severity, but also the possible impact of tic on their health conditions (e.g. bodily pain) and their parental well-being.

3 妥瑞症兒童的健康相關健康相關活動活動和參與之初步探討歐乃嘉劉文瑜王煇雄 2 黃維彬 3 徐琳雅吳嘉昀吳筱雯長庚大學物理治療學系暨復健科學研究所 2 長庚紀念醫院林口兒童醫院兒童復健科 3 長庚紀念醫院林口兒童醫院兒童復健科目的 : 比較正常兒童與妥瑞症兒童在健康相關活動和參與的差異方法 : 召集健康及患有妥瑞症兒童各 8 名, 對照實驗兩組年齡性別皆有相配透過耶魯整體抽搐嚴重程度量表了解兒童的 tic 嚴重程度由父母填寫子女健康問卷 (Child Health Questionnaire-Parent Form 50, CHQ-PF50) 兒童干擾行為量表自製兒童活動參與問卷做為兒童的健康相關活動和參與評估方式使用 t-test 做為統計據分析比較結果 : 與健康兒童比較之下, 妥瑞症兒童在 Global Health, Bodily Pain, Behavior, General Health Perceptions, Parental Impact-Time, Psychosocial Summary Score 六項中較正常兒童差此外, 妥瑞兒童有過動行為機率也偏高結論 : 雖然本次實驗受測者不多, 但在父母眼中已顯示有許多健康相關活動和參與的的表現妥瑞症孩童較健康兒童差因此建議未來對於妥瑞症兒童的研究不應僅侷限在 tic 症狀, 也應關注到 tic 症狀對於兒童的健康相關活動和參與, 以及他們父母安康

4 前言妥瑞症 (Tourette syndrome) 是一種神經生物學上的疾病, 會反覆出現半不自主的動作及聲音上的 tic 過去的研究指出妥瑞症患者的生活品質較健康人來的差 (Elstner et al. 200; Storch et al. 2007), 不過過去的研究常包括慢性 tic 疾病的兒童或成人並非全為妥瑞症兒童, 參與人數為白種人因此為了解妥瑞症兒童在台灣的健康相關生活品質, 本報告的目的是利用常見物理治療檢查及問卷來初步比較正常兒童與妥瑞症兒童在健康相關活動和參與的差異研究方法本研究選取 8 位妥瑞症兒童, 及對照組為 8 位健康兒童, 平均年齡 8.5±0.9 歲表. (Table.), 由家長填寫兒童干擾行為量表 ( 家裡版 )(Barkley 和 Murphy 998) 兒童健康問卷(Children Health questionnaire Parent Form-50) 及自製兒童活動參與問卷, 用來了解兒童家中行為和日常體能活動參與情形用獨立 t 檢定做為資料分析比較表. 妥瑞和健康兒童兒童之年齡之年齡體重體重身高身高性別對照性別對照及 tic 嚴重程度等級 Healthy Control TS Age Mean (years) SD Height Mean (cm) SD Weight Mean (kg) SD 5.5.8

5 Gender Boy/Girl 6/2 6/2 Tic severity Mild/Moderate - 6/2 (YGTSS scores) 結果 CHQ-PF-50 量表數據顯示表 2. (Table2.), 妥瑞症兒童在很多方面都比健康兒童來得差, 例如 : 全球健康 (Global Health) 身體不適(Bodily Pain) 行為 (Behavior) 普遍健康知覺(General Health Perceptions) 父母親影響時間 (Parental Impact-Time) 社會心理總和成績 (Psychosocial Summary Score) 這六方面如同預期的, 妥瑞症兒童有明顯過動行為表 3. (Table3.) 表 2. CHQ-PF-50 個項數據比較 CHQ-PF-50 Healthy Control TS P Global Health 65.00± ± * Physical Functioning 90.27± ± Role Limitations- Emotional/Behavioral 9.66± ± Role Limitations-Physical 95.83± ± Bodily Pain 86.25± ± * Behavior 72.50± ± * General Health Perceptions 69.38± ± *

6 Mental Health 75.00± ± Self-Esteem 90.63± ± General Health Perception 59.79± ± Changes in Health 3.88± ± Parental Impact-Emotion 77.08± ± Parental Impact-Time 79.6± ± * Family Activity 86.97± ± Family Cohesion 68.75± ± Physical Summary Score 0.00± ± Psychosocial Summary Score 0.0± ± * 表 3. 兒童干擾行為量表數據比較 Disruptive Behavior Rating Scales Healthy Control TS P Inattention 6.25± ± Hyperactive 5.87± ± * Oppositional Defiant Disorder 0.87± ± 結論儘管這次實驗受測者人數較少, 但是初步結果顯示出妥瑞症兒童有比較不理想健康相關活動參與方面, 因此治療介入及評估不應該只把重點只擺在 tic 嚴重度

7 上, 而要注意 tic 對身體健康情形的影響, 例如 : 身體的疼痛, 以及對於家庭生活的影響此外, 過動行為還需要特別觀察在妥瑞症兒童的平常生活中, 即使尚未診斷出過動傾向在臨床意義上, 本報告的初步結果可以做為臨床上妥瑞症兒童進行一般日常活動參與的評估之參考致謝所有參與本實驗的兒童與家長們長庚紀念醫院林口兒童醫院兒童復健科物理治療師, 以及, 還有數位協助我們完成本實驗的研究生學姊參考資料 Elstner K, Selai CE, Trimble MR, Robertson MM. Quality of Life (QOL) of patients with Gilles de la Tourette's syndrome. Acta Psychiatr Scand. 200;03: Storch EA, Merlo LJ, Lack C, Milsom VA, Geffken, GR, Goodman WK, Murphy TK. Quality of life in youth with Tourette's syndrome and chronic tic disorder. J Clin Child Adolesc Psychol. 2007;36(2):27-27.

现代药物与临床 Drugs & Clinic 第 29 卷第 9 期 2014 年 9 月 1045 and simulation of Tiapride Tablets, 3 times/d, 4 6 years old patients: 1 tablet/time; 7 11 y

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