自閉症兒童的姿勢控制與接球技能

Postural Control and Interceptive Skills in Children with Autism Spectrum Disorder

蘇琬淳(Wan-Chun Su)

指導教授 ： 陳麗秋

國立臺灣大學/醫學院/物理治療學研究所/碩士(2015年)

https://doi.org/10.6342/NTU.2015.01299

摘要

自閉症類群疾患是一種影響社會互動以及行為功能的神經發展疾患。研究指出有很高比例的自閉症兒童伴隨有動作的問題，這些問題可能是由於他們在動作計劃以及動作控制過程中無法有效地整合知覺與動作所導致的。接球是兒童很重要的活動之一，需要整合視覺、姿勢和手部動作才能準確地完成。雖然過去研究發現自閉症兒童在姿勢控制和接球技能的缺失，但尚沒有研究探討自閉症兒童在動作中協調兩者的能力。本篇研究的目的是要檢查自閉症兒童在接球過程中手部動作以及姿勢控制的知覺動作整合能力和一般發展兒童有何不同，並探討不同的姿勢控制難度以及額外的視覺提示會如何影響兒童的接球表現。本研究共徵召了15位自閉症兒童以及15位年齡及性別對照的一般發展兒童。實驗任務是請兒童在站姿下用雙手接住由軌道上滾下來的球。實驗中共有三個軌道，分別指向兒童的前方、左前方，以及右前方，以提供接球時不同的姿勢控制難度。此外，一半比例的接球測試中會有箭頭符號預先指出球的方向。上述的六種測試狀況各測試15球，總共有90次測試，區分為三個測試段落，不同的視覺提示狀態和軌道方向會以同樣的比例隨機分布在每個段落的接球測試中。本實驗使用超音波動作捕捉系統、力板以及高速攝影機紀錄兒童在接球過程中的手部動作、身體重心改變以及行為表現。為了瞭解兒童的動作計畫能力，本研究分析了手部和重心位移的起始時間以及預期性姿勢控制的重心移動幅度和時間；兒童的動作控制能力則會以手部動作和重心位移的幅度、速度與加速度來分析動作的品質。統計分析採用三維重複測驗的變異數分析比較二組兒童在不同姿勢控制難度以及不同視覺提示下的接球表現。研究結果發現自閉症兒童有較差的接球能力，特別是在接由兩邊滾落的球，他們展現出更低的接球成功率。在動作計劃部分，自閉症兒童有較高的比例選擇不去使用視覺提示來計劃自己的手部動作。相較於一般發展的兒童，他們也展現出較少且較延遲的預期性姿勢控制。至於動作控制的部分，自閉症兒童的手部動作較不流暢，且有較差的動作準確性。姿勢控制難度以及視覺提示都會影響到自閉症和一般發展兒童的接球動作表現，然而，自閉症兒童無法和一般發展兒童一樣調整他們的預期性姿勢控制以適應姿勢控制的困難程度和視覺提示的狀態。我們的研究結果顯示自閉症兒童的接球問題可能是由於他們的動作計劃以及動作控制過程中無法有效地整合知覺與動作所導致的。在提供自閉症兒童臨床介入時需要強調各動作部位間的整合能力，並加強他們根據不同任務需求和知覺訊息調節動作的能力。

關鍵字

自閉症 ； 知覺動作整合 ； 接球 ； 姿勢控制 ； 攔截技巧

並列摘要

Autism Spectrum Disorder (ASD) represents a group of neurodevelopmental disorders characterized by social communication deficits and restricted behaviors. Although not being considered as the core symptoms, a growing body of evidence confirms common motor deficits in children with ASD. Research suggests that motor deficits associated with ASD result from impaired sensory-motor integration in planning and control of the movements. Catching is a fundamental motor skill in many school and life activities and requires coordination between vision, posture, and arm movements. Although postural control and ball catching have been shown impaired in children with ASD, none has investigated how they are integrated. The purpose of this study was, using ball catching as a window, to investigate the sensory-motor integration processes in children with and without ASD. Fifteen children with ASD and 15 age- and gender-matched children with typical development were included in this study. In the experiment, children were required to catch a foam ball rolling down a ramp with two hands in standing position. There were 3 ramps, each directing to the child’s front at the center, 35° left, and 35° right to impose different postural demands for catching. Fifty percent of the trials were presented with a visual pre-cue, an arrow indicating the direction of the ball. Fifteen trials were tested for each of the 6 conditions. A total of 90 trials were arranged in 3 blocks, with ball directions and visual pre-cue conditions randomized within each block. An ultrasound-based motion capture system, a pressure plate, and a high speed camera were used to record children’s arm movements, postural adjustments and catching behaviors. Time to initiate primary movements of posture and arm, as well as the spatial and temporal measures of anticipatory postural adjustments were analyzed to assess motor planning processes. Amplitude, velocity and acceleration of the arm movements and postural adjustments were analyzed to assess the quality of motor control. Repeated measures 3-way ANOVAs were conducted to analyze the effects of group, ball direction, and visual cue condition on children’s catching performance. The results showed that children with ASD had difficulties catching the balls, especially those from the lateral directions. For motor planning processes, children with ASD, compared to TD peers, more frequently chose not to use visual information to guild their arm movements during catching and demonstrated less and delayed anticipatory postural adjustments. For motor control processes, children with ASD demonstrated arm movements with decreased smoothness and accuracy. Postural demands and visual pre-cues applied similar influence on most catching behaviors, except for the anticipatory postural adjustments, of both TD and ASD children. Children with ASD failed to alter their anticipatory postural adjustments to adapt to increase of postural demands and changes of visual cues. Our results suggest that motor difficulties related to ASD may lie in the sensory-motor integration in planning and control of movements. Based on our findings, clinical interventions for children with ASD should focus on the integration between motor components and its adaptation to task demands and sensory information.

並列關鍵字

Autism Spectrum Disorder ； Sensory-Motor Integration ； Catching ； Posture ； Interceptive Skill

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