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系統識別號 U0026-3108201115012600
論文名稱(中文) 發展性動作協調障礙兒童之接球表現:動作分析及虛擬實境訓練之療效
論文名稱(英文) Ball catching in children with DCD: Motion analysis and virtual reality training effect
校院名稱 成功大學
系所名稱(中) 職能治療學系碩博士班
系所名稱(英) Department of Occupational Therapy
學年度 99
學期 2
出版年 100
研究生(中文) 賴宣安
研究生(英文) Hsuan-An Lai
學號 t76981043
學位類別 碩士
語文別 中文
論文頁數 169頁
口試委員 指導教授-徐永玟
口試委員-成戎珠
口試委員-馬慧英
口試委員-郭立杰
中文關鍵字 發展性動作協調疾患  接球  動作分析  虛擬實境 
英文關鍵字 developmental coordination disorder  ball catching  motion analysis  virtual reality 
學科別分類
中文摘要 背景及動機:接球對於孩童來說是一個很重要的職能活動,但是患有發展性動作協調疾患(Developmental coordination disorder;DCD)的孩童,在接球這個需要較高度協調及控時能力(timing)的活動執行上更為困難。相關文獻只探討DCD孩童接球時肘、腕關節的動作表現,缺乏完整的手臂各關節動作之分析;此外,過去研究對於DCD孩童特殊的動作表現是遲緩抑或是異常的研究結果並不一致,因此本研究目的第一個目的是探討DCD孩童接球時肩、肘及腕關節之動作表現,並且探討這些表現是否為發展遲緩所造成。另外,由於過去的研究顯示任務導向治療對於DCD孩童具有療效,而且近來虛擬實境廣泛的被運用在醫學復健方面,因此,本研究的第二個目的是探討DCD孩童接受虛擬實境接球訓練之療效。
研究方法:(實驗一)共有51位受試者,20位DCD,分成5~6及7~8歲兩組,21位配對組孩童,以及10位健康成人,分別進行接網球活動,過程中利用動作捕捉系統記錄其軌跡,並使用臨床觀察評分表來看孩童接球整體的表現。(實驗二)20位DCD孩童隨機分配至實驗組及控制組,實驗組孩童接受12次,為期6週的虛擬實境接球訓練,控制組孩童則進行與接球活動無關之認知活動訓練,實驗前、後分別記錄兩組接網球活動之表現,並進行前後測的比較。
結果分析:我們把動作捕捉系統收到資料轉化為動作參數(例如:起始時間、最大速度及加速度、動作單位)、動作幅度以及各關節動作相關性,以變異數分析(ANOVA)、獨立樣本t檢定(Student t test)、卡方檢定(Chi-square test)、單因子共變數分析(ANCOVA)比較DCD組、配對組、成人組以及實驗組與控制組在各變項的差異。
結果:(實驗一)DCD孩童相較於同齡配對組孩童與成人,在各肢段的動作參數大多有顯著差異,他們較早起始伸手動作預備(ps’<.01),整體動作時間長(ps’<.005),花費較長的時間到達最大減速度(ps’<.01),動作單元數多(ps’<.001);抓握期花費較長的時間到達最大減速度(p=.013),到達最大開掌及最大減速時間所占比例高(p=.016),動作單元數多(p=.021)。而與年輕配對組孩童比起來,雖在接球結果有相似的表現(接球數、接球分數),但他們的動作卻有顯著的差異,各關節的伸手期起始早(ps’<.04),較早到達最大速度(ps’<.04),動作單元數多(ps’<.04);抓握期動作單元數多(p=.009),另外,DCD孩童在動作起始時間、總動作時間及接球分數也隨著練習的次數增加而出現了改變。(實驗二)DCD孩童在經過12次虛擬實境接球訓練後,比起接受認知訓練的控制組,在各項動作參數變項進步幅度均未有顯著差異;我們發現,兩組孩童都傾向於更早起始,我們推論他們都發展出此代償方式,,以增加錯誤動作的容忍程度。在臨床評量上,實驗組DCD孩童在接球數及接球分數比控制組有較多的進步,雖未達顯著差異,但效果量達高度以上(ŋ2>.124),顯示經過多次的相似環境練習,可以增加DCD孩童的接球成功率。
總結:DCD孩童在各項接球動作參數及表現大多與同齡配對組有顯著差異,個體間變異性大,即使與接球表現(接球數)相似的年輕配對組比起來,DCD孩童與他們在各項動作參數仍有顯著差異,暗示DCD孩童在接球動作表現較差並非發展上的遲緩,而是異常的表現。另外,我們也認為DCD孩童隨著經驗累積,會自行發展出一套代償的動作,以增加其接球成功率。在第二部分實驗中的結果顯示,經過12次任務導向的虛擬實境接球訓練後,可以改善他們實際接球的成功率。
英文摘要 Ball catching is a functional and important occupation which children with developmental coordination disorder (DCD) are worse at.
A few studies have noted that there were differences in movement initiation time, movement units, range of motion between DCD and controls with DCD moving their arms rigidly. However, studies only focused on elbow and wrist joints and those discussed whether DCD is a developmental delay or a deficit concluded different results. Moreover, two reviewed papers concluded that task specific training had great effects for children with DCD. Also, we found that virtual reality have recently been used in medical rehabilitation with its motivation-elevated and harmless characteristics.
Therefore, the first purpose of this study was to investigate differences in ball catching performance between DCD and paired controls. Second, we investigated the effect of ball catching training with virtual reality environment in DCD.
In part one, we recruited 51 subjects, including 20 5~6 & 7~8 year-old children with DCD, 21 children as paired controls and 10 adults. Each subjects participated a ball catching test with motion capture system and qualitative observation.
In part two, we randomly assigned the children with DCD in part one to participate the experimental or control group. The experimental groupl joined a ball catching training in virtual reality environment for 12 sessions twice a week while the control group will join a cognitive program. We used the motion capture system and qualitative observation as pretest and post test.
For the motion data of part one, we translated them into kinematic variables ( ex: movement initiation time、movement units、movement time、peak velocity), range of motion and correlation between joints. Then, we used a two way ANOVA to analyze the differences. For the qualitative score of part one, we used two way ANOVA and Chi-square test for analysis. In part two, a one way ANCOVA and Chi-square test was used to analyze the differences between pretest and post test.
The results showed that compared to their age-matched control and adults, DCD initiated earlier(ps’<.01), prolonged movement(ps’<.005), arrived maximum deceleration late(ps’<.01), had larger movement unit(ps’<.001 in transport phase, p=.021 in grasping phase), arrived maximum deceleration late(p=.013), and had larger percentage to reach maximum deceleration(p=.016) in grasping phase. Also, the variation between DCD subjects were larger. Although they were matched with the younger typically developmental children by catches, they still performed in a totally different way which was considered a compensatory strategy. It implied that DCD might not a developmental delay but rather a deficit.
After a 12-session ball catching training in the virtual environment, DCD could improve in the catches and catching scores, but they still performed in a less advanced way which was not significantly different from the control group. The improvement was not seen in every subjects could be contributed to the heterogeneity of DCD.
論文目次 目錄
第一章、緒論 1
第一節、研究動機及目的 1
第二章、文獻回顧 4
第一節、動作發展協調疾患及其表現的缺失 4
壹、動作發展協調疾患簡介 4
貳、DCD孩童動作障礙之機轉 5
第二節、動作發展協調疾患(DCD)的孩童在接球活動的表現 15
壹、感覺及感覺處理失能 15
貳、動作控制失能 18
參、發展 20
第三節、關於動作發展協調疾患(DCD)孩童的療效探討 23
壹、關於DCD孩童的介入方法 23
貳、任務導向治療對於DCD孩童的療效 24
第四節、虛擬實境系統 29
壹、虛擬實境系統定義及應用 29
第五節、研究問題與假設 31
壹、第一部分研究問題與假設 32
貳、第二部分研究問題與假設 35
第三章、研究方法 36
第一節、研究受試者 36
第二節、實驗工具 39
壹、篩選工具 39
貳、實驗設備 40
第三節、實驗流程 47
壹、第一部分實驗流程 47
貳、第二部分實驗流程 47
第四節、重要參數定義及資料處理 51
壹、量性分析 51
貳、臨床觀察 52
參、統計方法 53
第四章、結果 56
第一節、DCD孩童、同齡配對組孩童及成人之接球表現各項動作參數比較 56
壹、量性分析 56
貳、臨床觀察 96
第二節、DCD孩童與年輕配對組孩童之接球表現各項動作參數比較 102
壹、量性分析 102
貳、臨床觀察 110
第三節、DCD孩童經過虛擬實境接球訓練後之各項動作參數比較 116
壹、量性分析 116
貳、臨床觀察 122
第五章、討論 126
第一節、DCD孩童與同齡配對組孩童接球表現各項動作參數比較之討論 126
壹、量性分析 127
貳、臨床觀察 134
參、練習效應 135
肆、肩、腕、肘關節之動作參數差異 136
伍、總結 137
第二節、DCD孩童動作異常或發展遲緩之討論 139
壹、量性分析 140
貳、臨床觀察 145
參、總結 146
第三節、DCD孩童經過虛擬實境接球訓練後各項動作參數比較之討論 148
壹、量性分析 148
貳、臨床觀察 153
參、總結 155
第六章、結論 156
第一節、總結實驗結果 156
第二節、研究限制 158
參考文獻 160
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