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研究生： 侯秋如
Hou, Ciou-Ru
論文名稱： 愛平衡訓練對於發展性協調障礙學齡兒童平衡能力之成效
Effect of iBalance training program on balance ability in school-aged children with developmental coordination disorder
指導教授： 成戎珠
Cherng, Rong-Ju
學位類別： 碩士
Master
系所名稱： 醫學院 - 物理治療學系
Department of Physical Therapy
論文出版年： 2017
畢業學年度： 105
語文別： 英文
論文頁數： 49
中文關鍵詞： 發展性協調障礙 、互動式視頻遊戲訓練 、平衡訓練 、平衡評估
外文關鍵詞： Developmental coordination disorder, Active video game training, Balance training, Balance assessment
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    • 研究背景與目的：發展性協調障礙兒童會因為動作技巧問題而導致日常活動及學業表現受影響，同時照顧者也會抱怨小朋友平衡能力不佳且經常跌倒。這類兒童因為平衡及動作表現不佳而使體能活動參與受限，進而導致能夠改善動作技巧、促進身體健康的機會被剝奪。因此，提供一個可改善發展性調障礙兒童平衡表現及動作技巧的訓練計畫相形重要，根據不同理論基礎衍生出各式各樣的訓練計劃。實際上，小朋友常抱怨一般傳統治療比較枯燥乏味、無法維持注意力，所以如果訓練計畫是有趣的且能幫助小朋友增加參與動機就更顯重要。在此，我們實驗室目前研發出一套以遊戲活動為基礎的「愛平衡」視頻平衡訓練計畫，同時使用卡通圖畫吸引兒童目光，以增加參與動機。因此，根據上述，本研究目的為探討實驗室研發的愛平衡訓練計畫用於發展性協調障礙兒童平衡能力訓練之成效。研究方法：本研究從台南地區國民小學篩檢出20位發展性協調障礙兒童及10位同年齡的正常發展兒童。發展性協調障礙兒童被隨機分成實驗組及控制組，實驗組兒童會接受每次四十分鐘、一週兩次、為期三週的訓練。此研究使用「愛平衡評估」及「兒童動作ABC 評量表第二版」測試兒童在訓練前、後的表現及三週後的追蹤。訓練成效結果量測包含愛平衡測量及臨床測量。愛平衡測量包含靜態及動態平衡參數，靜態平衡參數則是身體壓力中心移動的軌跡長及20秒內單腳站立時間；動態平衡參數則是動態平衡任務成功次數及平均完成一次任務所需軌跡長度。臨床測量則使用兒童動作ABC 評量表第二版的總項目及平衡分項目的百分位數。使用重複量數二因子變異數分析方法，分析組別及時間之變數差異。結果：在靜態平衡任務中，無論是睜眼或閉眼雙腳站結果皆顯示身體壓力中心移動的軌跡長沒有組別差異，也沒有時間差異與交互作用，亦即無顯著之訓練效果；睜眼單腳站20秒內的單腳站立時間，實驗組雖在訓練後增加，此增加也可維持到三周後，但卻無達統計意義。在動態平衡任務中，控制身體重心左右位移的結果顯示實驗組訓練後成功次數顯著增加，同時平均完成一次任務所需軌跡長度也顯著減少，訓練後也跟控制組有顯著差異，但三週後則無；相同結果也在前後位移任務中觀察到。在臨床成效結果量測方面，實驗組兒童在訓練後，兒童在兒童動作ABC 評量表第二版平衡分項目的百分位數皆有顯著改善，也跟控制組有顯著差異，但與對照組則無統計差異，顯示實驗組兒童在訓練後，其在兒童動作ABC 評量表第二版平衡分項目的百分位數已與對照組的正常兒童無統計差異了。
    結論：愛平衡是一套具有潛力改善發展性協調障礙兒童之平衡表現的訓練計畫，尤其在動態能力的訓練較果更佳，此訓練計劃可提供臨床人員針對發展性協調障礙兒童的平衡復健計畫的替代方案。

    Background and Purpose: Developmental coordination disorder (DCD) refers to a motor skill disorder, which adversely affects daily activities and academic performance. Poor balance and frequent falling are some of the chief complaints given by caregivers. Poor balance and poor motor performance limit the children’s participation in physical activities and then diminish the opportunities of motor practices, thus depriving the chances of improvement in motor skill and physical health. Therefore, it is important to provide training to improve the children’s balance performance and motor skills. There are various training programs based on different theories. However, children usually find those traditional training programs boring. An interesting training program that increases children’s motivation and participation is important. Our laboratory has developed a video balance-training program (iBalance) which uses cartoon figures and is based on game activities. The purpose of the study was to examine the effect of iBalance on the balance performance in children with DCD.
    Methods: Twenty children with DCD and ten age-matched typically developing children (TD) were recruited from elementary schools in Tainan. Children with DCD were randomly divided into two groups: the experimental group (DCD-exp) and the control group (DCD-con). The DCD-exp group received intervention with iBalance for 40 min/time, 2 times a week for 3 weeks. iBalance evaluation test and Movement Assessment Battery for Children-Second edition (MABC-2) were used to measure the children’s performance before, immediately after the intervention, and three weeks later. The outcome measures for the training effect included iBalance output measures and clinical measures. The iBalance output measures included static and dynamic balance parameters. The static balance parameters included trajectory of the center of pressure (COP), time of single leg standing in 20 seconds. The dynamic balance parameters included the number of success trial and the average of the trajectory of COP in each success trial. The clinical measures were the percentile rank scores of the total score of MABC-2 and its balance subtest score. Two-way repeated measures ANOVAs were used to test the differences in these variables between groups and among time.
    Results: The training results of the static balance task with double leg standing and eye open and eye closed showed no significant main effect of groups, times and their interaction in the trajectory of COP. For the static balance task with single leg standing and open eyes, the results showed an increase in the time of single leg standing in 20 seconds for the DCD-exp group and the improvement was maintained at follow-up. However, the effect was not statistically significant. The results of the dynamic balance task in left and right (LR) weight shifting showed that there were significant group and time interaction. Further analyses showed that the number of task success trial and the trajectory of COP per success trial improved significantly in DCD-exp group after training. The performances of dynamic balance task (LR) in DCD-exp were significantly better than that in DCD-con and were not different from the comparison TD. The training effect did not last in the follow-up test. The number of success trial was significantly decreased in DCD-exp but there was no difference with TD and DCD-con group. DCD-exp group had significant differences of the number of success trial in the dynamic balance task of AP weight shifting at posttest and follow-up compared with pretest. After training, DCD-exp had significantly more success trial than DCD-con group. At follow-up, there were no significant differences between groups. On the other hand, the clinical measures outcome showed DCD-exp group presented significant improvement in the percentile rank scores of MABC-2 balance subtest after training and the training effect last for follow-up test. Moreover, the DCD-exp group performed better than DCD-con group after training and had no differences with TD group.
    Conclusion: The study results suggest that the iBalance training program has potential to improve the dynamic balance performance in children with DCD. The iBalance training program may provide the clinical therapists an alternative option for training the balance control for children with DCD.

    Abstract III 中文摘要 V 致謝 VII Contents VIII Lists of table IX Lists of figure X 1 Introduction 1 1.1 Children with Developmental coordination disorder (DCD) 1 1.2 The subtypes of children with DCD 3 1.3 Balance ability 4 1.4 Clinical measurements of balance ability in children 6 1.5 Interventions of balance ability on children with DCD 6 1.6 Active video games 8 1.7 Purpose of the study 9 1.8 Hypotheses of the study 9 2 Research design and Methodology 10 2.1 Research design and setting 10 2.2 Participants 11 2.3 Research instruments 12 2.4 iBalance tasks 14 2.5 Procedure 16 2.6 Outcome measures 17 2.7 Statistical Analysis 18 3 Results 19 3.1 Basic data 19 3.2 iBalance output measures 20 3.3 Clinical measures 24 4 Discussion 25 4.1 Static balance parameters 25 4.2 Dynamic balance parameters 27 4.3 The effect of intervention 28 5 Conclusions 30 6 References 31   Lists of table Table 1. Demographic and clinical characteristics of the groups 34 Table 2. Within groups results of static balance ability test in iBalance measures 35 Table 3. Between groups results of static balance ability test in iBalance measures 36 Table 4. Within groups results of dynamic balance ability test in iBalance measures. 37 Table 5. Between groups results of dynamic balance ability test in iBalance measures. 38   Lists of figure Fig. 1. Movement Assessment Battery for Children-Second Edition (MABC-2) 39 Fig. 2. Peabody Picture Vocabulary Test – Revised (PPVT-R) 39 Fig. 3. iBalance interface 40 Fig. 4. The view of anterior-posterior weight shifting and the left-right weight shifting 41 Fig. 5. The Nintendo Wii board 41 Fig. 6. The research setting 41 Fig. 7. Mean of the trajectory of COP in double leg standing with eye open condition. 42 Fig. 8. The trajectory of COP in double leg standing with eye closed condition 43 Fig. 9. The standing time of one leg standing with eye open in three groups 44 Fig. 10. The number of success trial under left-right weight shifting condition 45 Fig. 11. The average trajectory of each success trial under left-right weight shifting condition 46 Fig. 12. The number of success trial under anterior-posterior weight shifting condition 47 Fig. 13. The average trajectory of each success trial under anterior-posterior weight shifting condition 48 Fig.14. MABC-2 subtest balance percentile rank of three groups 49

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