閱讀障礙是一種與智力或聽力損傷無關的特殊學習障礙。這些孩童常常在拼音和解讀表現不佳，同時遭遇到字詞辨識準確性和流暢性的困難。特別是在辨識複雜的中文組字結構時，對於中文讀寫障礙孩童(CSCD)來說是一項極具挑戰的任務。中文讀寫障礙孩童的大細胞背側路徑(magnocellular-dorsal pathway)功能缺陷，影響他們在語言發展方面之視覺空間能力與視知覺穩定性等等。雖然視覺策略的使用和動作表現似乎存在潛在關聯，但對於讀寫障礙孩童的視覺傳遞路徑缺陷導致的動作控制缺陷證據有限。因此，本研究的主要目的是探討在台灣的國小讀寫障礙學生在不同視覺刺激條件下的姿勢控制調適關係。
考量視覺知覺能力和運動協調的潛在缺陷，本論文的第一個研究旨在比較中文讀寫障礙與非中文讀寫障礙孩童在視覺遮蔽時對姿勢控制的影響。本研究在觀察兩組在雙腳直立狀態下，張眼（EO）和閉眼（EC）時的壓力中心（COP）軌跡之前，使用兒童動作評估量表第二版（MABC-2）和視覺知覺技能測試第四版（TVPS-4）來進行動作與視知覺評估。結果顯示，在七個TVPS-4子量表中，兩組之間有六個呈現顯著差異（p < .001~ p = .045），並且在一個MABC-2類別中也有顯著差異（p = .012）。在張眼條件下，讀寫障礙學童的壓力中心軌跡在前後（AP）方向的均方根（RMS）值較非讀寫障礙學童高（p = .031）。然而，在兩個方向上，壓力中心軌跡的樣本熵（SampEn）沒有顯著差異（p > .05）。在閉眼條件下，兩組壓力中心軌跡的均方根和樣本熵亦無顯著差異（p > .05）。此外，前後方向的壓力中心軌跡均方根與TVPS-4的視覺主體背景區辨測試之間呈現負相關（r = -.391, p = .033）。這些跡象顯示，在張眼情況下中文讀寫障礙學童雖仰賴視覺線索卻難以維持平衡，而此對於姿勢搖晃大小與視覺主體背景區辨測試之間呈現負相關亦提供支持。
本論文的第二個研究旨在檢驗頻閃視覺（SV）對中文閱讀困難症兒童和典型發展兒童姿勢控制的影響。評估包括兒童動作評估量表第二版（MABC-2）和視覺知覺技能測試第四版（TVPS-4）。在頻閃視覺（視覺遮蔽50%）和完全視覺下，評估參與者在不穩定的軟墊上配戴頻閃眼鏡且雙腳直立60秒，紀錄姿勢晃動的情形。結果顯示，兩組之間在七個TVPS-4子量表中，均呈現顯著差異（p < .001~ p = .025），並且在一個MABC-2類別中也有顯著差異（p = .007）。姿勢量測顯示，頻閃視覺導致兩組的壓力中心軌跡的均方根（RMS）增加（p < .05）。值得注意的部分，中文讀寫障礙學童在前後方向上的壓力中心軌跡的平均頻率水平不受頻閃效應的影響（p = .581），而非閱讀困難的兒童在頻閃視覺下顯示出較低的平均頻率（p = .006）。在頻閃視覺下，MABC-2平衡子量表分數與壓力中心軌跡平均頻率呈負相關（r = -.492, p = .006）。TVPS-4中的視覺記憶（r = -.441, p = .015）和順序記憶（r = - .484, p = .007）子量表分數與前後方向上的壓力中心軌跡均方根呈負相關。由於感知偏差，在頻閃視覺效應下，中文讀寫障礙學童的嘗試姿勢反應修正不尋常地並未增加；此頻閃視覺下的姿勢振幅與識別姿勢運動能力所需的視覺記憶受損相關。
總結以上，由於視覺訊息處理的缺損，中文讀寫障礙學童似乎採用不同於非讀寫障礙同儕的姿勢控制策略。由於視覺前景和背景的干擾，讀寫障礙學童採用較少依賴視覺指引的姿勢控制，而造成在張眼情況下，姿勢穩定性較閉眼容易受到影響。此外，在閃頻視覺效應之下，中文讀寫障礙學童的姿勢不穩定提高，但修正不穩定姿勢的嘗試卻並未隨之提升。而相較於非讀寫障礙學童，中文讀寫障礙學童的平均頻率並未隨閃頻視覺效應有相應的姿勢反應而增加。此意謂視覺間歇性可能不適用於訓練中文讀寫障礙學童姿勢不穩定的改善，此與在閃頻效應下姿勢不確定性與視覺記憶受損有關，影響了對姿勢的運動識別能力。

Dyslexia is a specific learning disability that is not caused by intelligence or hearing impairments. It is characterized by difficulty with spelling, decoding, and accurate and fluent word recognition. Chinese-speaking children with dyslexia (CSCD) face specific challenges in identifying complex Chinese character configurations. The development of literacy skills in CSCD is influenced by visuospatial deficits and visual perceptual instability. These deficits can be attributed to dysfunction in the magnocellular-dorsal pathway, which is responsible for processing visual information quickly and accurately. There is a potential connection between visual strategy usage and motor performance. However, there is limited evidence regarding impaired postural control in CSCD who experience inferior visual processing. To address this research gap, the aim of this dissertation was to investigate the relationship between variations in visual stimuli and the adaptive postural control of CSCD at the elementary school level in Taiwan.
The first study in this dissertation aimed to compare the effects of visual occlusion on postural control between CSCD and non-dyslexic Chinese-speaking children, considering potentially impaired visual-perceptual capacity and movement coordination. Prior to examining the center of pressure (COP) trajectory during bilateral upright stance with eyes open (EO) and eyes closed (EC), the Movement Assessment Battery for Children 2nd Edition (MABC-2) and the Test of Visual-Perceptual Skills 4th Edition (TVPS-4) were used respectively to evaluate the motor and visual perceptual performances for both groups. The results indicated significant differences between the groups in six out of seven TVPS-4 subscales (p < .001~ p = .045) and one MABC-2 category (p = .012). In the EO condition, individuals with dyslexia showed a higher root mean square (RMS) value of COP in the anterior-posterior (AP) direction compared to non-dyslexic children (p = .031). However, there were no significant differences in the sample entropy (SampEn) of COP in either direction (p > .05). In the EC condition, there were no significant differences in COP RMS or SampEn between the groups (p > .05). Additionally, a negative correlation was observed between the RMS of COP in the AP direction and the visual figure-ground sub-score in TVPS-4 (r = - .391, p = .033). These scenarios indicated that CSCD children had difficulty maintaining balance when they relied on visual cues relative to EO condition, in support of significant negative correlations between the size of postural sway and the sub-score of visual figure-ground in TVPS-4.
The second study aimed to examine the effects of stroboscopic vision (SV) on postural control in children with CSCD and typically developed children. The assessments included the MABC-2 and TVPS-4. Participants performed a 60-second bipedal stance on a foam surface with stroboscopic glasses under two conditions: SV (50% visual occlusion) and full vision. The results indicated significant differences between the groups in all TVPS-4 subscales (p < .001~ p = .025) and one MABC-2 category (p = .007). The postural measures showed that SV led to an increased RMS of COP trajectories in the AP direction for both groups (p < .05). Notably, a high level of mean frequency (MF) of COP trajectory in the AP direction of the CSCD was unaffected by SV effect (p = .581), while the non-dyslexic children demonstrated an enhanced lower MF under SV (p = .006). Under SV, the MABC-2 balance sub-score was negatively correlated with COP MF (r = -.492, p = .006). The TVPS-4 sub-scores of visual memory (r = -.441, p = .015) and sequential memory (r = - .484, p = .007) were negatively correlated with COP RMS in the AP direction. These findings suggest that postural corrective attempts in CSCD is atypically not potentiated with SV effect due to perceptual bias. Stance destabilization under SV is associated with impairments in posture-based movement recognition related to visual memory.
In summary, CSCD exhibit a distinct postural strategy compared to non-dyslexic children due to impaired visual processing. With the interference of the visual figure-ground performance, the CSCD adhere less to visual cues for postural regulation, resulting in greater postural instability under EO conditions compared to EC conditions. Furthermore, higher postural instability with uncorrected attempts in children with CSCD persists regardless of the SV effect. In contrast to non-dyslexic children, the findings indicate that CSCD did not show an increase in mean frequency of postural responses with the SV effect. This suggests that visual intermittency did not contribute to motor explorations during postural training in an unsteady stance for this population. Stance destabilization in CSCD under SV is associated with impaired visual memory in recognizing posture-based movements.

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