視覺-動作整合是指能夠適當地協調視覺技巧、視知覺及精細動作技巧的能力，這是從事日常生活任務的基本能力，特別是在學齡前兒童學習精細動作的階段尤為重要。先前研究指出，學齡前自閉症兒童經常在視覺-動作整合存在缺陷，但由於視覺-動作整合機制的複雜性和自閉症症狀的異質性，兩者之間的關係仍不明確。雖學齡前自閉症兒童在視覺-動作整合缺陷的原因尚未被證實，但進行視覺-動作整合介入對於學齡前自閉症兒童而言有其必要性。使用傳統形式或是數位形式的介入都可以顯著提升視覺-動作整合的能力。然而，這兩種介入形式都存有一些限制，例如傳統形式介入存在人力成本高、易產生厭倦感以及即時互動較少的缺點；數位形式介入則有設備取得和操作上困難、結果數據解釋不全面、介入劑量過於密集而不切實際以及缺乏難度分級等問題。本研究旨在開發一套以平板為基礎的全面性視覺-動作整合訓練，並檢驗其運用在學齡前自閉症兒童中的可行性和效果。本研究招募了15位年齡介於48至71個月的自閉症兒童進行視覺-動作整合訓練，頻率為一次進行60分鐘，每週進行1次，連續進行6週。使用「以平板為基礎視覺動作整合訓練家長滿意度問卷」評估研究可行性，並使用視知覺發展測驗第三版(Developmental Test of Visual Perception- Third Edition, DTVP-3) 和歐西瑞斯基動作能力測驗第二版(Bruininks-Oseretsky Test of Motor Proficiency- Second Edition, BOT-2) 評估介入前後在視知覺、視覺-動作整合及精細動作技巧的表現差異，數據分析使用Wilcoxon 符號排序檢定分析介入前後視知覺、視覺-動作整合及精細動作技巧表現差異以及描述性統計顯示介入一到六週的平板數據表現。結果顯示家長對此訓練方案有高程度的滿意度，經六週訓練後，學齡前自閉症兒童在視知覺發展測驗第三版的手眼協調、仿畫、背景區辨能力、視覺完形、形狀恆定性的子項目及視覺動作整合、非動作視知覺、一般視知覺的組合項目皆有顯著提升，在歐西瑞斯基動作能力測驗第二版的精細動作精確度、精細動作整合、手部靈巧度的子項目及精細手部控制、手部協調能力的組合項目皆有顯著提升，平板數據表現也客觀地呈現出介入一到六週的進步趨勢，此研究結果指出此視覺-動作整合訓練的可行性及良好的介入成效，可作為給臨床專業人員從事視覺動作整合相關訓練的依據。

Visual-motor integration (VMI) refers to the ability to effectively coordinate visual skills, visual perceptual, and fine motor skills. This capability is essential for a wide range of daily activities, particularly in the development and acquisition of fine motor skills during the preschool age. Previous studies have indicated that preschool children with autism spectrum disorder (ASD) frequently exhibit deficits in VMI. However, the connection is not entirely clear due to the complex nature of VMI and the considerable heterogeneity among children with ASD. Although the underlying mechanisms contributing to VMI deficits have not been fully elucidated, addressing VMI through targeted training in preschool children with ASD is critically important. Both traditional and digital training methods have demonstrated significant improvements in VMI abilities. However, these trainings also face certain limitations. Traditional training often requires substantial human involvement, may risk causing boredom, and typically offer limited opportunities for real-time interaction. On the other hand, digital training encounters challenges such as difficulties in acquiring and utilizing necessary equipment, incomplete outcome data, impractically intensive dosage requirements, and the lack of progressively challenging difficulty levels. This study aims to develop a comprehensive tablet-based VMI training program and to examine its feasibility and efficacy specifically for preschool children with ASD. Fifteen children diagnosed with ASD (48-71 months) were recruited. The tablet-based VMI training consisted of 60-minute sessions conducted once a week across a span of six weeks. A feasibility assessment (satisfaction questionnaire) was utilized to assess the feasibility of the training. The Developmental Test of Visual Perception, Third Edition (DTVP-3) and Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) were administered before and after the 6-week training to evaluate visual perception, visual-motor integration, and fine motor skills. Wilcoxon signed-rank tests were used to examine the differences in performance of visual perception, visual-motor integration, and fine motor skills before and after training. Descriptive statistics summarized the tablet-based performance data collected throughout weeks 1 to 6 of the training. Results indicated a high level of satisfaction with the tablet-based VMI training from parents. After six weeks of tablet-based VMI training, preschool children with ASD demonstrated significant improvements across several DTVP-3 subtests, including the eye–hand coordination, copying, figure–ground, visual closure, and form constancy. They also demonstrated gains in the visual–motor integration, motor-reduced visual perception, and general visual perception composite scores Significant improvements were also observed in BOT-2 subtests related to fine motor precision, fine motor integration, and manual dexterity, accompanied by improvements in the fine manual control and manual coordination composites. The digital performance data recorded by the tablet further corroborated these findings by showing a positive trend of progress throughout the training period. Overall, these outcomes support both the feasibility and efficacy of the tablet-based VMI training program and offer valuable insights for clinicians interested in implementing VMI training for preschool children with ASD in the future.

何怡靜、梁昭鉉、游穎軒、唐玄輝（2016）。發展遲緩兒童使用平板電腦訓練手部精細動作與手寫功能之療效。北市醫學雜誌，13(4)，490-501。
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