探討下身穩定度與不同書寫工具對腦性麻痺學童書寫姿勢的影響

The Effect of Lower Body Stabilization and Different Writing Tools on Writing Posture in Children with Cerebral Palsy

俞雨春(Yu-Chun Yu) ； 連悅如(Yueh-Ju Lien) ； 朱彥穎(Yan-Ying Ju) ； 程欣儀(Kathy Hsin-Yi Cheng)

《職能治療學會雜誌》 31卷1期 (2013/06) Pp. 94-110

https://doi.org/10.6594/JTOTA.2013.31(1).05

摘要

腦性麻痺學童因異常肌肉張力而影響書寫時之身體姿勢，進而影響學習及動作靈活度。本篇目的在探討提供下半身穩定的椅子及搭配使用不同書寫工具對腦性麻痺學童在書寫時身體姿勢的影響。本研究比較腦性麻痺學童下半身固定與否（固定／未固定）及使用不同書寫工具（一般筆／限制高度筆／異軸筆）時之書寫生物力學參數。受試者進行描繪阿基米德螺旋迷宮，並使用肌電圖，電子量角器及照相標記法以蒐集生物力學參數。統計使用重複測量二因子變異數分析分析下半身固定與否及不同書寫工具對以上參數造成的影響。研究結果顯示，不同筆的使用對身體角度變化，如肩部水平傾斜角度、頭部水平傾斜角度及軀幹側傾角度變化參數上呈現統計顯著差異。在固定下半身的椅子使用部分，發現軀幹側傾角度、軀幹前傾角度、視線角度均有顯著差異。筆與椅的交互作用亦對部分參數有顯著影響。上肢之肌電訊號則無明顯差異。本研究結果可提供針對腦性麻痺學童進行書寫時的生物力學方面之參考。本研究結果亦指出下肢固定及使用雙軸設計的筆可以有效改善書寫姿勢的問題，其概念與應用可以做為輔具筆設計及改良的參考。未來也可在其他有書寫姿勢問題的特殊需求學童做進一步的探討及應用。

關鍵字

腦性麻痺 ； 生物力學 ； 書寫 ； 姿勢 ； 異軸筆

並列摘要

Failure to attain proper writing biomechanics in children with cerebral palsy often leads to problems such as soreness, kyphosis, easy fatigue and myopia. These problems inevitably impact on children's learning and academic success. The aims of this study were to investigate the influence of lower body stabilization and pen design on writing biomechanics in children with cerebral palsy. Fourteen children with cerebral palsy were included. Two different ways of lower body fixation and three different pen designs were evaluated in this study. Electromyography, electrogoniometer and photography were used to investigate handwriting biomechanics. Two-way repeated measures ANOVA was used for statistically analysis. No significant difference was noted in EMG in either variable. Significant differences were found in pens for variables including shoulder horizontal inclination, head horizontal inclination, and trunk slant angle. As for the effects on chair, significant differences were found in trunk tilt inclination, visual focus-vertical and trunk forward inclination angle, indicating a chair which provided proper positioning was effective in improving writing posture. Biaxial pen and positioning chair could improve writing posture effectively, but not the upper extremity muscle exertion. Current results may provide guidelines for parents, teachers and clinicians information regarding the selection of writing tools and proper sitting supports. The rationale of biaxial pen design also provides information regarding the design of assistive writing devices. Future application studies can be conducted in disabled children with poor handwriting posture.

並列關鍵字

Cerebral palsy ； Biomechanics ； Handwriting ； Posture ； Biaxial pen