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論文名稱(中文) 發展性協調障礙兒童於執行移動性任務之肢段間協調控制
論文名稱(英文) The intra-limb coordination of locomotion task in children with developmental coordination disorder
校院名稱 成功大學
系所名稱(中) 物理治療研究所
系所名稱(英) Department of Physical Therapy
學年度 99
學期 2
出版年 100
研究生(中文) 洪敏真
研究生(英文) Min-Jen Hung
電子信箱 briskjane@hotmail.com
學號 T66981075
學位類別 碩士
語文別 中文
論文頁數 40頁
口試委員 指導教授-成戎珠
口試委員-陳振宇
口試委員-徐碧真
中文關鍵字 發展性協調障礙  協調  肢段間結合程度  平面共變定律  任務複雜度 
英文關鍵字 Developmental coordination disorder  Coordination  limb inter-dependency  Planar covariation  Task complexity 
學科別分類
中文摘要 研究背景與目的:移動性任務指的是個體用雙腳將身體從一地移動到另外一地的動作任務。個體本身在執行動作任務時擁有許多的動作自由度,即個體可以運用不同的動作策略完成某項動作任務。當個體在執行移動性任務時,必須控制動作自由度以及協調肢段間在時間與空間上的相對關係,以便產生一個平順、協調與具效益的動作方式。因此,肢段間的協調對於動作任務的執行,扮演著很重要的角色。臨床上有一群為數不少的兒童,他們雖然沒有明顯的醫療問題或智能缺失,但卻有動作協調缺失,這群兒童被稱為發展性協調障礙兒童,約占學齡兒童的百分之六。過去對於發展性協調障礙兒童在執行移動性任務時多從個體整體的表現探討,並未對肢段間的協調模式作細部的分析。因此本篇研究目的想要進一步探討發展性協調障礙兒童在執行移動性任務時其肢段間協調的控制與正常發展兒童之差異。方法:本研究共收取18位發展性協調障礙兒童與18位性別及年齡配對之正常發展兒童,分別執行行走、雙腳連續往前跳以及單腳連續往前跳等三項移動性任務。本研究採用Qualisys動作分析系統來收取下肢的運動學資料,並依據平面共變定律,採用主成份分析法分析下肢各肢段互相依賴的程度。結果:在雙腳連續往前跳以及單腳連續往前跳的動作上,發展性協調障礙兒童腳板仰角角度之最小值較大(雙腳連續往前跳,正常發展兒童:1.07 ± 9.23 度,發展性協調障礙兒童:8.38 ± 11.00 度,p = 0.04;單腳連續往前跳,正常發展兒童:13.01 ± 7.00 度,發展性協調障礙兒童:20.37 ± 10.64 度,p = 0.02),也就是說發展性協調障礙兒童在執行雙腳連續往前跳以及單腳連續往前跳等動作時腳板仰角角度之幅度較小;平面化指標部分,發展性協調障礙兒童在雙腳連續往前跳以及單腳連續往前跳也顯著小於正常發展兒童(雙腳連續往前跳,正常發展兒童:98.43 ± 0.64 %,發展性協調障礙兒童:97.44 ± 0.95 %,p = 0.001;單腳連續往前跳,正常發展兒童:96.54 ± 1.22 %,發展性協調障礙兒童:94.86 ± 1.24 %,p < 0.001);不論在那一項動作任務,發展性協調障礙兒童在大腿、小腿以及腳板之線性關係程度小於正常發展兒童(行走,正常發展兒童:10.66 ± 1.77 %,發展性協調障礙兒童:9.30 ± 2.04 %,p = 0.04;雙腳連續往前跳,正常發展兒童:9.61 ± 3.48 %,發展性協調障礙兒童:7.65 ± 1.96 %,p = 0.05;單腳連續往前跳,正常發展兒童:9.98 ± 1.80 %,發展性協調障礙兒童:7.90 ± 2.22 %,p = 0.004)。結論:在執行雙腳連續往前跳以及單腳連續往前跳等動作時,發展性協調障礙兒童的腳板仰角角度之幅度相對於正常發展兒童小;不論在那一個動作任務下,發展性協調障礙兒童下肢肢段間互相依賴的程度也較正常發展兒童小。依據動態發展理論,正常發展兒童的下肢肢段間協調表現呈現較穩定的表現形式,發展性協調障礙兒童在控制肢段間的協調形式呈現較不穩定的情形,相對來說也有較高的可塑性。從以上結果得知,遠端肢段的控制在發展性協調障礙兒童肢段間的協調扮演著重要的角色,因此訓練遠端肢段控制或許是一個好的介入起始。
英文摘要 Background and purposes: Human joints own redundant degrees of freedom for a certain locomotion task. However, limb motion is very stereotyped. That is a coordinated movement usually comes from a strategy of constraining excessive degrees of freedom to facilitate control. There is a small but significant group of children (about 6% of school age children) with developmental coordination disorder (DCD) who are characterized with motor coordination deficit without any medical condition or mental insufficiency. It is well known that children with DCD had poorer performance of global temporal distance parameters of walking than typically developing (TD) children. However, the differences of the strategy in intra-limb coordination between children with DCD and TD children are not clear. The purposes of this study were to examine and compare the differences of intra-limb coordination between children with DCD and TD children when they were performing three locomotion tasks. Method: Eighteen children with DCD and 18 age and gender matched TD children participated and performed self-selected speed of walking, consecutive forward jumping and consecutive forward hopping. A six camera Qualisys motion capture system was used to collect the kinematic data of the lower limbs. Following the law of the planar covariation, we used the principal component analysis to analyze the contributions of each segment of lower limb and elevation angle into a planarity configurations and their inter-dependency. Results: The results showed that the minimum of foot elevation angle was larger in children with DCD than TD children in jumping and hopping (jumping, TDC group: 1.07 ± 9.23; DCD group: 8.38 ± 11.00, p = 0.04;hopping, TDC group: 13.01 ± 7.00; DCD group: 20.37 ± 10.64, p = 0.02). This is, the amplitude of foot elevation angle was smaller in children with DCD than TD children in jumping and hopping. The planarity indices were also smaller in children with DCD than TD children in jumping and hopping (jumping, TDC group: 98.43 ± 0.64; DCD group: 97.44 ± 0.95, p = 0.001; hopping, TDC group: 96.54 ± 1.22: DCD group: 94.86 ± 1.24, p < 0.001). Children with DCD also have lower value of ratio of λ1 to λ2 which represents the degree of linear relationship of thigh, shank and foot elevation angles in each task than TDC group (walking, TDC group: 10.66 ± 1.77; DCD group: 9.30 ± 2.04 ,p = 0.04; jumping, TDC group: 9.61 ± 3.48; DCD group: 7.65 ± 1.96, p = 0.05; hopping, TDC group: 9.98 ± 1.80; DCD group: 7.90 ± 2.22, p = 0.004). Conclusions: Children with DCD have poorer distal control in jumping and hopping and smaller limb inter-dependency in lower limb during walking, jumping and hopping. On the other hand, TD children have more stable intra-limb coordination than children with DCD. Following dynamic system theory, children with DCD may have greater plasticity to change the pattern of intra-limb coordination than TD children. Distal control of ankle segment may be a key factor of intra-limb coordination of locomotion tasks in children with DCD. Improving the ankle control may be a good start to improve the intra-limb coordination of locomotion tasks in children with DCD.
論文目次 中文摘要 Ⅰ
英文摘要 Ⅲ
誌謝 Ⅴ
目錄 Ⅵ
表目錄 Ⅸ
圖目錄 Ⅸ
第一章 前言 1
1.1 移動性任務 1
1.1.1 移動性任務之控制 1
1.1.2 肢段間協調 2
1.1.3 移動性任務之發展 3
1.1.3.1行走 3
1.1.3.2雙腳連續往前跳 4
1.1.3.3單腳連續往前跳 4
1.2發展性協調障礙兒童 5
1.2.1 定義 5
1.2.2 發展性協調障礙兒童在移動性任務之表現 6
1.3肢段間協調之分析方法 7
1.3.1 平面共變定律 7
1.3.2 平面共變定律假說 8
1.3.3 共變角度的統計特色之量化 9
1.3.3.1平面化指標 10
1.3.3.2平面方向 11
1.3.3.3第一個主成份的變異量相對於第二個主成份的變異量之比例 11
1.3.4 平面共變定律之結論 11
1.4研究的目的與實驗假設 12
1.4.1 研究目的 12
1.4.2 實驗假設 12
第二章 研究方法 13
2.1研究對象 13
2.2測驗工具 14
2.2.1兒童動作評估測驗-第二版 14
2.2.2畢保德圖畫詞彙測驗修訂版 15
2.3資料收集 15
2.4實驗任務 16
2.5實驗流程 18
2.6資料處理和統計分析 20
第三章 研究結果 20
3.1基本資料以及基本測試 20
3.2大腿、小腿以及腳板之仰角角度 21
3.3共變平面之方向 24
3.4平面共變指標 25
3.5第一個主成份的變異量相對於第二個主成份的變異量之比例 27
第四章 討論 29
4.1大腿、小腿以及腳板之仰角角度 29
4.2共變平面之方向 31
4.3平面共變指標 31
4.4第一個主成份的變異量相對於第二個主成份的變異量之比例 32
4.5研究限制與未來研究方向之建議 33
第五章 結論與臨床意義 34
第六章 文獻參考 35
自述 40
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