背景：注意力缺失過動症候(attention-deficit/hyperactivity disorder, ADHD)是目前學齡兒童最普遍的神經行為障礙，有些研究證實ADHD兒童除了核心症狀外，會伴隨許多不同的動作或感覺方面的問題出現，如平衡能力、感覺調節能力等。而在ADHD兒童平衡能力的相關研究中，對於其平衡能力問題的探討有些不一致，主要不同的地方在於ADHD兒童各亞型的平衡能力表現，而單獨對於動態平衡方面的深入探討亦較少，此外，目前已有一些研究支持ADHD兒童有感覺調節能力缺失的問題，但有完整研究測試及架構之研究仍較少，而且認為ADHD兒童之差異性很大，可能有部分之ADHD兒童沒有感覺調節的問題，故本研究會加以驗證是否ADHD兒童有感覺調節的問題，並進一步了解ADHD兒童的感覺調節能力與平衡能力之相關性。目前對於ADHD兒童平衡能力的訓練及介入成效之研究較少，本研究以騎馬治療進行個案討論，採用的騎馬機(Joba® EU-6441, Matsushita Electric Industrial Co., Ltd., Japan)是根據真實馬運動時的動作模式所設計出來的，臨床上認為騎馬機有可增進平衡能力的功用，目前已逐漸被臨床治療師廣泛使用，但對於騎馬機的確切療效仍沒有研究加以證實，尤其是騎馬機是否對於平衡能力或是感覺調節能力有所幫助等。
目的：探討ADHD兒童之平衡能力與感覺調節能力問題，及兩者之相關性，並藉由客觀之動作分析方式來比較ADHD兒童與一般發展兒童於騎騎馬機之過程中，兩者間動作模式之差異。
方法：本研究參與之受試者分為以下兩組：(1)ADHD (N=20)；(2)一般發展兒童組(N=20)。分別測試其平衡能力、感覺調節能力及收集騎馬機的動作分析數據等，並探討平衡及感覺調節能力之相關性，而願意接受訓練之ADHD兒童會接著進行12週的騎馬機騎馬治療，結束後會再次進行上述能力之後測，以了解騎馬治療對於ADHD兒童平衡能力及感覺調節能力是否有所幫助。
結果：(1)無論在功能性平衡能力評估或是動作分析之結果，ADHD兒童之BOTMP、MABC與動作分析結果均明顯低於一般發展兒童(p<.05)；(2)ADHD兒童之SP總分亦明顯低於一般發展兒童(p=.00)，但其變異性在兩組間無明顯差別(p=.16)；(3)感覺調節能力與平衡能力間有正向相關性存在，其相關性都在低到中高度相關；(4)ADHD兒童經過12週之騎馬機訓練後，無論是感覺調節能力或是平衡能力均有上升的趨勢存在。
結論：ADHD兒童之平衡能力無論在功能性評估或是經由動作分析均可發現缺失，而在動態坐姿平衡的缺失會在合適的挑戰活動中顯現，經過動作分析後則可得到更多平衡能力的相關訊息，如策略使用等，因此平衡能力對ADHD兒童應該是個重要的議題，此外，ADHD兒童之感覺調節能力確實較一般發展兒童差，而且平衡能力與感覺調節能力間屬正向相關，可作為臨床介入之參考，且騎馬機訓練對於ADHD兒童或許是個有效的介入方式。

Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most pervasive neurobehavioral disorders in school-age children. Except for their core symptoms－inattention, impulsiveness, hyperactivity, many researchers had confirmed that approximately a half of children with ADHD may have various motor difficulties, such as balance, sensory modulation, etc.
Among the researches discussing balance ability of children with ADHD, one of the main conflict points is about the balance ability regarding the ADHD subtypes. In addition, there are few research deeply analyzing the dynamic balance in children with ADHD. Furthermore, some researches support that children with ADHD may have sensory modulation dysfunction, but they also found that children with ADHD demonstrate great variability in sensory modulation problems. Our study will examine the balance ability and sensory modulation problems in children with ADHD, and explore the relationship between sensory modulation and balance ability in children.
Therapeutic horseback riding have been believed as a good media to improve balance ability. We proceeded to do a case study, by the use of a mechanical horse made by Joba® EU-6441, Matsushita Electric Industrial Co., Ltd., Japan. This mechanical horse is designed according to the movement pattern of a real horse. The seat is designed to move in a pattern based on the figure of eight. Many clinics begin to adopt the mechanical horses as treatment tools, but its effectiveness in children with ADHD remains unknown.
Purpose: We investigated the balance ability and sensory modulation ability in children with ADHD as well as the connection between these two abilities. By using an objective motion analysis(Qualisys motion capture system), we could compare the difference of dynamic sitting balance between ADHD and normal subjects.
Methods: Subjects included two groups: (1) ADHD group (N=20); (2) typically developing children group (N=20). The balance abilities and sensory modulation abilities of subjects were tested, including collection of motion analysis data from riding mechanical horse. Then, we provided one volunteer of ADHD group a course of 12-weeks therapeutic mechanical horseback riding. After the training course was done, the volunteer was post-tested. The case study aimed to examine the effects of applying mechanical horseback riding in balance ability and sensory modulation ability of children with ADHD.
Results: (1) There were significant difference in the scores of BOTMP, MABC and motion analysis data between the ADHD and typically developing children(p<.05). Children with ADHD demonstrated worse ability of balance than typically developing children. (2) Children with ADHD were significant lower than typically developing children in total score of SP(0=.00), which indicated poorer ability of sensory modulation. (3) The sensory modulation and balance ability were significantly positively correlated. (4) After the training course was done, we noticed that the application of mechanical horseback riding in children with ADHD could improve the balance and sensory modulation ability.
Conclusion: Whether in the functional measurements or motion analysis, children with ADHD do have worse balance ability. By using motion analysis, we could get more information about balance ability, such as the strategy used. We also suggest that balance ability is an important issue to children with ADHD. In addition, Children with ADHD also have worse sensory modulation ability. The balance and sensory modulation ability were positive correlated in children. Our findings supported that mechanical horseback riding may ameliorate difficulties of balance and sensory modulation in children with ADHD, and help the therapists to set therapeutic plan.

中文參考書目
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