研究背景與目的：自閉症患者顯示有動作協調障礙，目前僅有少數研究針對此類患者執行精細動作時，提供動作過程之客觀量化的測量，以及執行精細動作時感覺依賴的程度。本研究探討高功能自閉症兒童伸手抓握動作的運動學表現，並比較四種實驗段落的表現：(1) 有視覺回饋情境、大目標物、(2) 有視覺回饋情境、小目標物、(3) 無視覺回饋情境、大目標物及 (4) 無視覺回饋情境、小目標物，進一步討論兩組間在視覺情境與目標物大小的效應。研究方法：本研究設計採平衡重複的研究設計（couterbalanced repeated design）。研究對象包含20個高功能自閉症兒童（平均年齡 = 91.65個月）與20個年齡、慣用手配對的正常兒童（平均年齡 = 92.85個月）。利用Qualisys動作分析系統以紀錄伸手抓握動作。分析的運動學資料包含：動作時間、尖峰速率、達尖峰速率的時間、達尖峰速率的所佔時間比、標準化急動值、動作單位、最大抓握開口、標準化最大抓握開口、達最大抓握開口的時間、達最大抓握開口的所佔時間比。結果：兩組在手臂長、指幅寬與視知覺能力皆無顯著差異。運動學資料顯示在有視覺回饋、小的目標物實驗段落中，高功能自閉症兒童較正常兒童有顯著較長的動作時間、較大的標準化急動值（動作平順度的指標）、較多的動作單位（動作流暢性的指標）及較大的最大抓握開口、標準化最大抓握開口。有視覺回饋、大的目標物實驗段落中，高功能自閉症兒童亦較正常兒童有較多的動作單位與較大的最大抓握開口、標準化最大抓握開口，而標準化急動值兩組則無顯著差異。在無視覺回饋情境下，高功能自閉症兒童亦較正常兒童顯示有較長的動作時間、較大的標準化急動值、較多的動作單位，特別是在小的目標物實驗段落；而最大抓握開口與標準化最大抓握開口兩組則無顯著差異。結論：研究結果支持高功能自閉症兒童在伸手抓握動作過程有動作協調與動作平順度的問題，尤其是在無視覺回饋情境與小的目標物實驗段落，推測高功能自閉症兒童較依賴視覺的訊息，且在高精確性的活動中，動作會更不協調。

Background and Purpose: Motor coordination problems have been reported in children with autism, however there were little studies addressing sensory reliance of children with autism while performing fine motor tasks. In this study, we compared two groups of subjects on the reach-to-grasp movement in four experimental blocks: (1) large target with visual feedback (VL), (2) small target with visual feedback (VS), (3) large target with non-visual feedback (NL), and (4) small target with non-visual feedback (NS) blocks to investigate the effects of visual condition and target size during four prehension tasks in all participants. Methods: A counterbalanced repeated measure was designed. Twenty children with high functioning autism (mean age = 91.65 months) and 20 normal subjects (mean age = 92.85 months) were matched according to age and handedness. Qualisys motion analysis system was used to capture the reach-to-grasp movement. Kinematic data such as movement time (MT), peak velocity (PV), time to peak velocity, percentage of time to peak velocity (PPV), normalized jerk score (NJS), movement unit (MU), maximal grip aperture (MGA), normalized maximal grip aperture (NMGA), time to maximal grip aperture (TMGA), and percentage of time to maximal grip aperture (PMGA) were analyzed. Results: Two groups had no significant differences in hand length, finger span, and visual perception. The results of kinematic performance showed that even though children with high functioning autism have longer MT, larger NJS (which represented for motor smoothness), more MU (which represented for motor facileness), and larger MGA and NMGA than controls in VS block, and more MU, larger MGA and NMGA in VL block. No differences of NJS between two groups in VL block were found. In non-visual feedback condition, children with high functioning autism also demonstrated significantly longer MT, larger NJS and more MU than controls, especially while the target was small. No differences of MGA and NMGA between two groups in non-visual feedback condition were found. Conclusions: This study suggested that children with high functioning autism have problems on motor smoothness and coordination in the process of the reach-to-grasp movement, especially in non-visual feedback and small target blocks which suggested that children with high functioning autism depend more visual cuing on performing prehension tasks and demonstrate poor coordination in high accuracy tasks.

英文參考文獻
Alberts, J. L., Saling, M., Adler, C. H., & Stelmach, G. E. (2000). Disruptions in the reach-to-grasp actions of Parkinson's patients. Experimental Brain Research, 134(3), 353-362.
Allen, G., & Courchesne, E. (2003). Differential effects of developmental cerebellar abnormality on cognitive and motor functions in the cerebellum: an fMRI study of autism. American Journal of Psychiatry, 160(2), 262-273.
Allen, G., Muller, R. A., & Courchesne, E. (2004). Cerebellar function in autism: functional magnetic resonance image activation during a simple motor task. Biological Psychiatry, 56(4), 269-278.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders. (4th ed., text revision ed.). Washington, DC: Author.
Arbib, M. A. (1985). Schemas for the temporal organization of behaviour. Human neurobiology, 4(2), 63-72.
Bailey, A., Luthert, P., Dean, A., Harding, B., Janota, I., Montgomery, M., et al. (1998). A clinicopathological study of autism. Brain, 121, 889-905.
Baranek, G. T., Parham, L. D., & Bodfish, J. W. (2005). Sensory and motor features in autism: assessment and intervention. In F. R. Volkmar, Paul, R., Klin A., & Cohen, D. (Ed.), Handbook of autism and pervasive developmental disorders. (pp. 831-857). Hoboken, NJ: John Wiley.
Bauman, M. L. (1992). Motor dysfunction in autism. In A. B. Y. Joseph, R. R. (Ed.), Movement disorders in neurology and neuropsychiatry (pp. 658-661). Boston, MA: Blackwell Scientific.
Bauman, M. L., & Kemper, T. L. (1994). Neuroanatomic observations of the brain of autism. In M. L. Bauman & T. L. Kemper (Eds.), The neurobiology of autism. (pp. 119-145). Baltimore: Johns Hopkins University Press.
Brasic, J. R. (1999). Movements in autistic disorder. Medical Hypotheses, 53(1), 48-49.
Bundy, A. C., Lane, S. J., & Murray, E. A. (2002). Sensory integration:theory and practice Philadelphia: F. A. Davis Company.
Chang, J. J., Wu, T. I., Wu, W. L., & Su, F. C. (2005). Kinematical measure for spastic reaching in children with cerebral palsy. Clinical Biomechanics, 20(4), 381-388.
Chow, S. M. K., & Henderson, S. E. (2003). Interrater and test-retest reliability of the Movement Assessment Battery for Chinese preschool children. American Journal of Occupational Therapy, 57(5), 574-577.
Croce, R. V., Horvat, M., & McCarthy, E. (2001). Reliability and concurrent validity of the movement assessment battery for children. Perceptual & Motor Skills, 93(1), 275-280.
Day, B. L., Thompson, P. D., Harding, A. E., & Marsden, C. D. (1998). Influence of vision on upper limb reaching movements in patients with cerebellar ataxia. Brain, 121, 357-372.
Desmurget, M., Grea, H., Grethe, J. S., Prablanc, C., Alexander, G. E., & Grafton, S. T. (2001). Functional anatomy of nonvisual feedback loops during reaching: a positron emission tomography study. Journal of Neuroscience, 21(8), 2919-2928.
Eigsti, I. M., & Shapiro, T. (2003). A systems neuroscience approach to autism: biological, cognitive, and clinical perspectives. Mental Retardation & Developmental Disabilities Research Reviews, 9(3), 205-215.
Fasoli, S. E., Trombly, C. A., Tickle-Degnen, L., & Verfaellie, M. H. (2002). Effect of instructions on functional reach in persons with and without cerebrovascular accident. American Journal of Occupational Therapy, 56(4), 380-390.
Fombonne, E. (2005). Epidemiological studies of pervasive developmental disorders. In F. R. Volkmar, Paul, R., Klin A., & Cohen, D. (Ed.), Handbook of autism and pervasive developmental disorders. (pp. 42-69). Hoboken, NJ: John Wiley.
Freitag, C. M., Kleser, C., Schneider, M., & von Gontard, A. (2007). Quantitative assessment of neuromotor function in adolescents with high functioning autism and Asperger Syndrome. Journal of autism and developmental disorders, 37(5), 948-959.
Gentilucci, M., Castiello, U., Corradini, M. L., Scarpa, M., Umilta, C., & Rizzolatti, G. (1991). Influence of different types of grasping on the transport component of prehension movements. Neuropsychologia, 29(5), 361-378.
Ghaziuddin, M., & Butler, E. (1998). Clumsiness in autism and Asperger syndrome: a further report. Journal of Intellectual Disability Research 42, 43-48.
Gilliam, J. E. (2006). Gilliam Autism Rating Scale (2nd ed.). Austin, TX: ProEd.
Glazebrook, C. M., Elliott, D., & Lyons, J. (2006). A kinematic analysis of how young adults with and without autism plan and control goal-directed movements. Motor Control, 10(3), 244-264.
Henderson, S. E., & Sugden, D. A. (1992). Movement Assessment Battery for Children: Manual. London: Psychological Corporation.
Huebner, R. A., & Lane, S. J. (2001). Neuropsychological findings, etiology and implications for autism. In R. A. Huebner (Ed.), Autism: A sensorimotor approach to management. (pp. 61-99). Austin, TX: ProEd.
Jakobson, L. S., & Goodale, M. A. (1991). Factors affecting higher-order movement planning: a kinematic analysis of human prehension. Experimental Brain Research, 86(1), 199-208.
Jeannerod, M. (1981). Intersegmental coordination during reaching at natural visual objects. In J. Long, & Baddeley, A. (Ed.), Attention and performance IX. (pp. 153-168). Hillsdale, NJ: Lawrence Erlbaum Associates.
Jeannerod, M. (1984). The timing of natural prehension movements. Journal of Motor Behavior, 16(3), 235-254.
Kuhtz-Buschbeck, J. P., Stolze, H., Boczek-Funcke, A., Johnk, K., Heinrichs, H., & Illert, M. (1998a). Kinematic analysis of prehension movements in children. Behavioural Brain Research, 93(1-2), 131-141.
Kuhtz-Buschbeck, J. P., Stolze, H., Johnk, K., Boczek-Funcke, A., & Illert, M. (1998b). Development of prehension movements in children: a kinematic study. Experimental Brain Research, 122(4), 424-432.
Lawrence, D. G. (1994). Central neural mechanisms of prehension. Canadian Journal of Physiology & Pharmacology, 72(5), 580-582.
Lord, C., & Risi, S. (1998). Frameworks and methods in diagnosing autism spectrum disorders. Mental Retardation and Developmental Disabilities Research Reviews., 4, 90-96.
Manjiviona, J., & Prior, M. (1995). Comparison of Asperger syndrome and high-functioning autistic children on a test of motor impairment. Journal of Autism and Developmental Disorders, 25(1), 23-39.
Mari, M., Castiello, U., Marks, D., Marraffa, C., & Prior, M. (2003). The reach-to-grasp movement in children with autism spectrum disorder. Philosophical Transactions of the Royal Society of London - Series B: Biological Sciences, 358(1430), 393-403.
Marteniuk, R. G., Leavitt, J. L., MacKenzie, C. L., & Athenes, S. (1990). Functional relationships between grasp and transport components in a prehension task. Human Movement Science, 9, 149-176.
Marteniuk, R. G., MacKenzie, C. L., Jeannerod, M., Athenes, S., & Dugas, C. (1987). Constraints on human arm movement trajectories. Canadian Journal of Psychology, 41(3), 365-378.
Martineau, J., Schmitz, C., Assaiante, C., Blanc, R., & Barthelemy, C. (2004). Impairment of a cortical event-related desynchronisation during a bimanual load-lifting task in children with autistic disorder. Neuroscience Letters, 367(3), 298-303.
Masterton, B. A., & Biederman, G. B. (1983). Proprioceptive versus visual control in autistic children. Journal of Autism & Developmental Disorders, 13(2), 141-152.
McCrea, P. H., Eng, J. J., & Hodgson, A. J. (2002). Biomechanics of reaching: clinical implications for individuals with acquired brain injury. Disability and Rehabilitation, 24(10), 534-541.
Minshew, N. J., Sung, K., Jones, B. L., & Furman, J. M. (2004). Underdevelopment of the postural control system in autism. Neurology, 63, 2056-2061.
Miyahara, M., Tsujii, M., Hori, M., Nakanishi, K., Kageyama, H., & Sugiyama, T. (1997). Brief report: motor incoordination in children with Asperger syndrome and learning disabilities. Journal of Autism & Developmental Disorders, 27(5), 595-603
Molloy, C. A., Dietrich, K. N., & Bhattacharya, A. (2003). Postural stability in children with autism spectrum disorder. Journal of Autism and Developmental Disorder s, 33(6), 643-652.
Noterdaeme, M., Mildenberger, K., Minow, F., & Amorosa, H. (2002). Evaluation of neuromotor deficits in children with autism and children with a specific speech and language disorder. European Child & Adolescent Psychiatry, 11(5), 219-225.
Rand, M. K., Shimansky, Y., Stelmach, G. E., Bracha, V., & Bloedel, J. R. (2000). Effects of accuracy constraints on reach-to-grasp movements in cerebellar patients. Experimental Brain Research, 135(2), 179-188.
Rinehart, N. J., Bellgrove, M. A., Tonge, B. J., Brereton, A. V., Howells-Rankin, D., & Bradshaw, J. L. (2006). An examination of movement kinematics in young people with high-functioning autism and Asperger's disorder: further evidence for a motor planning deficit. Journal of Autism & Developmental Disorders, 36(6), 757-767.
Seidel, A. C., & Dutton, R. (1998). Theories derived from rehabilitation perspectives. In M. E. Neistadt & E. B. Crepeau (Eds.), Willard and Spackman's occupational therapy (9 th ed.). Philadelphia, PA: Lippincott-Raven Publishers.
Shumway-Cook, A., & Woollacott, M. H. (2001). Motor control: theory and practical applications. Baltimore MA: Lippincott Williams & Willkins.
Smyth, M. M., Anderson, H. I., & Churchill, A. C. (2001). Visual information and the control of reaching in children: a comparison between children with and without developmental coordination disorder. Journal of Motor Behavior, 33(3), 306-320.
Smyth, M. M., Katamba, J., & Peacock, K. A. (2004). Development of prehension between 5 and 10 years of age: distance scaling, grip aperture, and sight of the hand. Journal of motor behavior, 36(1), 91-103.
Tidmarsh, L., & Volkmar, F. R. (2003). Diagnosis and epidemiology of autism spectrum disorders. Canadian Journal of Psychiatry., 48(8), 517-525.
Tomchek, S. D. (2001). Assessment of individuals with an Autism Spectrum Disorder utilizing a sensorimotor approach. In R. A. Huebner (Ed.), Autism: A sensorimotor approach to management. (pp. 103-138). Austin, TX: ProEd.
Tyldesley, B., & Grieve, J. I. (2002). Motor control. In B. Tyldesley & J. I. Grieve (Eds.), Muscles, nerves and movement in human occupation. (3rd ed., pp. 193-204). Oxford, England: Blackwell Science.
von Hofsten, C., & Ronnqvist, L. (1988). Preparation for grasping an object: a developmental study. Journal of Experimental Psychology: Human Perception & Performance, 14(4), 610-621.
Wu, C., Trombly, C. A., Lin, K., & Tickle-Degnen, L. (2000). A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability. Archives of Physical Medicine and Rehabilitation, 81(1), 95-101.
Zoia, S., Pezzetta, E., Blason, L., Scabar, A., Carrozzi, M., Bulgheroni, M., et al. (2006). A comparison of the reach-to-grasp movement between children and adults: a kinematic study. Developmental neuropsychology, 30(2), 719-738.
中文參考文獻
行政院內政部。（民96）。統計年報—身心障礙人數按成因分。民國96年6月24日摘自網路資料http://www.moi.gov.tw/stat/。
陸莉與劉鴻香。（民86）。拜瑞-布坦尼卡視覺-動作統整發展測驗：指導手冊。台北市：心理出版社。
陸莉與劉鴻香。（民87）。修訂畢保德圖畫詞彙測驗：指導手冊。台北市：心理出版社。