背景和目的：平衡控制對於所有直立活動十分重要，其會受到環境與任務所影響。過去研究指出成人站在高處時，會增加生理覺醒(physiological arousal)，並改變姿勢。此外，成人動作的時間與振幅也會因為站在高處執行而有所不同。由於感覺、認知、動作發展的不成熟，且各方面經驗不足，兒童平衡控制與成人並不相同，且更為依賴視覺以維持平衡。日常生活中，兒童需要在高處站立或從事一些活動，但有關他們站在高處平衡控制的資訊卻是缺少的。本研究目的為檢視高度、面對樓梯方向和視覺輸入是如何影響正常發展兒童的足底壓力中心(COP)位移。並觀察兒童站在不同高度的階梯往前伸取的動作時間與動作幅度是否與站在地面時相同 。
方法：本研究招募5～15歲兒童，分為5～9歲、10～12歲與13～15歲三組，三組分別為16人、13人、13人。參與兒童被要求站立在地面、樓梯第三階與樓梯第五階執行兩項任務。使用可攜式測力板測量COP。第一項任務為靜止站立20秒，每一階會有四種狀況，(1)張眼並面對上樓方向、(2)張眼並面對下樓方向、(3)閉眼並面對上樓方向、(4)閉眼並面對下樓方向。以四因子變異數分析（組間：年齡；組內：高度、視覺和面對方向）COP的移動總距離、搖晃區域、位移均方根、速度均方根與平均功率頻率；第二項任務為往前伸取130％手長距離的目標物，每一階會有兩種狀況，(1)面對上樓方向、(2)面對下樓方向。以三因子變異數分析（組間：年齡；組內：高度和面對方向）COP起始潛伏時間、預期性控制持續時間、最大往後位移與時距，並分析COP在動作期間的往前位移、速度、加速度最大值與最大值發生時距。
結果：結果顯示，靜態站立在高處時，兒童前後向身體搖晃振幅降低，頻率增加。在缺乏視覺訊息的狀況下，兒童COP移動總距離、搖晃區域、振幅、頻率與速度均方根皆增加。相較於面對下樓方向，面對上樓方向的前後向搖晃速度較大。隨著年齡漸長，兒童身體搖晃的移動總距離、搖晃區域、振幅與速度皆降低。在各因子的交互作用方面，視覺與站立高度對前後向搖晃速度呈邊緣顯著，張眼站在不同高度時，前後向速度並無差異，但閉眼時，第五階之前後向速度顯著大於第三階與地面。面對方向與高度對左右向搖晃頻率也有交互作用，面對上樓方向時，站在第五階之左右向平均功率頻率顯著大於站在地面。面對下樓方向時，高度並未對左右向搖晃頻率有所影響。在往前伸取的任務中，階梯高度對COP最大往前位移有所影響，站在第五階的COP最大往前位移顯著小於在地面與第三階。此外，年齡層較小的兒童，在伸取時，COP起始潛伏時間會較晚、最大往前位移與速度較大。
討論：正常發展兒童站在第五階時，身體前後向搖晃頻率增加、振幅降低，與過去成人站在高處之研究結果相符。在閉眼時，兒童身體搖晃程度增加，顯示在缺乏視覺資訊時，其身體穩定度降低。面對方向不同所造成身體搖晃速度不同的原因可能是高度知覺的影響。年齡層較小的兒童，其身體搖晃振幅與速度都較年長兒童大，表示隨著年齡增長，兒童的平衡控制逐漸變好。視覺與高度對於搖晃速度的交互作用，暗示著視覺可以協助個體站在高處維持靜態平衡。高度對於往前伸取距離的影響，可能肇因於伸取策略之改變，顯示站立高度也會影響動態平衡。
結論：五～十五歲兒童在面對高處時的靜態平衡改變已相似於成人，身體搖晃振幅降低，頻率提高。在高處往前伸取時，兒童的動作策略也有所改變，COP最大往前位移會降低。本研究也再度證明，視覺對於兒童維持靜態站立平衡的重要性，且隨著年齡的增長，身體搖晃會越趨於穩定。

Background and Purposes: Balance control is essential to all upright activities, and it is influenced by environment and tasks. Previous research indicated adults would increase physiological arousal and caused posture changes while standing on heights. Also, adults would alter the movement duration and amplitude while executing a dynamic activity on higher surfaces. Children’s balance control is different from adults’ due to immature sensory, cognitive and motor development, and insufficient experiences. Besides, children rely more on vision to maintain balance. Occasionally, children need to stand and engage activities on higher surfaces, but the information about their balance control is lacking. The purposes of this study are (1) to investigate how height, facing direction and visual input affect body sway of the children with typical development in static standing, and (2) to investigate if forward reaching in terms of movement time and amplitude was affected by heights and facing direction in the children with typical development.
Methods: Children aged 5~15 years were recruited for the study, they are divided into three groups: 5~9 years old, 10~12 years old and 13~15 years old. Sixteen, thirteen and thirteen participants were included in each group, respectively. Center of pressure (COP) were measured by a portable force plate. The participants were asked to stand on ground, the3rd and 5th step of a five-step staircase to execute following two tasks. First, maintaining static standing for 20 seconds in four conditions in random order: (1) facing ascending direction with eyes open; (2) facing descending direction with eyes open; (3) facing ascending direction with eyes closed; (4) facing descending direction with eyes closed. A four-way MANOVA with one between (age) and three within (height, vision and facing direction) variables was employed to verify differences in total path length, sway area, root mean square (RMS) of COP displacement, RMS of COP velocity, and mean power frequency (MPF) of COP. The second task was forward reaching: reaching the target hung in front of the individual. The target distance was 130% arm length of the participant. There were two conditions in this task: (1) facing ascending direction; (2) facing descending direction. A three-way MANOVA with one between (age) and two within (height and facing direction) variables was used to analyze differences in COP onset latency, anticipatory control duration, peak backward displacement and interval, peak forward displacement and interval, peak forward velocity and interval, and peak forward acceleration and interval.
Results: The results indicated that body sway amplitude decreased and frequency increased in the participants while quietly standing on higher surfaces. Total path length, sway area, RMS of COP displacement, RMS of COP velocity and MPF of COP significantly increased in eyes closed condition. Sway velocity in antero-posterior direction is greater when facing ascending direction than facing descending direction. Total path length , sway area, RMS of COP displacement and velocity decreased with age. Vision and height had marginally significant interaction on sway velocity in antero-posterior direction. In eye-open condition, height had no main effect on sway velocity in antero-posterior direction. But when vision is absent, sway velocity in antero-posterior direction increased as standing on highest level. Direction and height also had interaction on sway frequency in medio-lateral direction. No height effect was found on the variables when facing descending direction. But when facing ascending direction, sway frequency in medio-lateral direction on the 5th step was higher than that on the ground. In forward reaching task, staircase height had main effect on COP peak forward displacement, while it was shorter while on the 5th step than the 3rd step and ground. Besides, onset latency and peak forward displacement and velocity of COP were greater in younger children than older children.
Discussion: When children with typical development stand on the 5th step, the frequency of body sway increased and the amplitude of body sway decreased. This result was consistent with adults’ results reported by previous researches. In eye-close condition, children increased the extent of body sway, demonstrated that their body stability decreased when lacked visual information. Due to height perception, sway velocity was affected by facing direction. Amplitude and velocity of body sway were greater in younger children than older children, it represented that balance control of children with typical development becomes better with age. Interaction effect of vision and height on sway velocity implied that vision could assist individual to maintain static balance while on heights. COP peak forward displacement of COP decreased indicated that movement strategy also altered while forward reaching on heights.
Conclusion: The findings in COP parameters indicated that children may change their static and dynamic balance control while standing on higher surfaces. The results also support previous literatures that vision plays an important role in balance control of children, and the body sway becomes stabilized with age.

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葉純志、莊義利、蔡益堅、吳秀英(2007)。我國0-12歲兒童非致死性就醫事故傷害分析之研究。2005年「國民健康訪問暨藥物濫用」結果報告 。