早產兒和足月兒的體能活動量、動作技巧表現及家庭環境

Physical Activity, Motor Competence and Environmental Affordance in Preterm and Full-term Young Children

趙盈瑄(Ying-Hsuan Chao)

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.2015.01434

摘要

身體活動量對於兒童的發展扮演很重要的角色,包括動作、認知功能及情緒
表現等,同時也能促進健康與避免慢性疾病的發生。早產兒童是有發展問題的高 危險族群,所以了解早產對於兒童活動量參與的影響也成為重要的討論議題。隨 著身體活動量逐漸受到重視,許多西方國家紛紛提出兒童活動量參與的建議綱要, 針對學齡與學齡前兒童的活動量參與提出最低需求,臺灣也針對學齡兒童提出身 體活動量參與指標與倡導計畫,但對於學齡前兒童則未予相同重視。本篇研究的 目的要探討學齡前早產及足月兒在二歲半至三歲半時活動量隨著發展改變的差異 及其受到家庭環境或動作發展的影響。受試者包括 18 位早產兒以及 20 位健康足 月兒,受試兒童在兩歲半、三歲及三歲半接受動作發展以及身體活動量評估,並 請家長填寫家庭環境問卷。動作發展評估使用皮巴迪動作發展量表第二版 (Peabody Developmental Motor Scales, Second Edition)。身體活動量使用加 速規客觀記錄孩童連續七天身體的活動量,並將活動量分級為靜態、輕度、中度 及強度活動量,計算孩童在各活動量分級的參與時間及百分比。家庭環境將使用 動作發展-家庭環境之行動機會訊息量表(Affordance in the Home Environment for Motor Development- Chinese version)評估家庭室內及戶外活動空間、家庭 活動及玩具種類。統計分析使用重複測試的二因子變異數分析比較足月及早產兒 兩組在三個年齡時身體活動量與動作發展的差異,並使用相關統計分析三個年齡 層兒童身體活動量與動作表現及家庭環境的關係,最後使用回歸分析探討兩歲半 時的動作表現及家庭環境是否可以預測三歲半時兒童的活動量。研究結果顯示足 月兒在靜態、輕度及總活動量的時間都高於早產兒,此外,隨著年紀發展只有強 度的活動量隨著年紀增加而有顯著的增加。活動量在兩歲半及三歲半時與家庭環 境因子中刺激的變化呈負相關。在活動量及動作發展的關係,結果顯示兩歲半及 三歲時兒童的活動量與移位技巧有正相關。三歲半時兒童的中度及強度的活動量 與精細動作的手眼協調技巧及精細動作的發展商數呈負相關。在早期動作技巧及 家庭環境預測活動量的部分,2.5 歲兒童家庭環境刺激的變化結合移位技巧的表現, 才能顯著的預測三歲半中度至強度的活動量,其他則未達到顯著意義。我們的研 究發現早產兒的活動量在學齡前低於足月兒童。在學齡前階段,兒童的動作發展 與家庭環境與活動量參與有相關,這樣的相關會隨著年紀改變而改變。為了增加 兒童的活動參與,家長要多鼓勵兒童從事與中強度活動量相關技巧的活動並減少 過度保護對兒童的活動持正面鼓勵的態度。

關鍵字

身體活動量 ； 動作發展 ； 家庭環境 ； 早產

並列摘要

Physical activity (PA) plays an important role in child development, including motor, cognitive functioning and emotional well-being. Children born preterm are at high risk for motor deficits. It is important of knowing the impact of preterm birth on children’s PA participation in early developmental period. The aims of this study were to describe and compare the developmental trajectories of PA behavior in preterm and full-term children from 2.5 to 3.5 years of age and to investigate the relationship among motor competence, home environmental affordance, and PA participation in early preschool period. We recruited 18 preterm and 20 full-term children from National Taiwan University Hospital. Children’s PA behaviors, motor development and home environmental affordance were assessed at age 2.5, 3 and 3.5 years of age. Children’s PA was measured using accelarometry (ActiGraph GT3X+) for 7 consecutive days. PA behaviors were classified into different intensity level. Time and percent time spending in various levels of PA were calculated. Children’s motor competency was assessed using the Peabody Developmental Motor Scales, Second Edition (PDMS-2) for gross and fine motor skills. Children’s home environment was assessed using the Affordance in the Home Environment for Motor Development- Chinese version (AHEMD-C) for inside space, outside space, variety of stimulation, gross motor toys and fine motor toys. Using repeated measures of 2-way ANOVA, we investigate the difference of PA performance and motor competence between two group (preterm and full-term) and three ages (2.5, 3 and 3.5 years). Correlation analyses were used to investigate the relationship between young children’s PA levels, motor competence and home affordance. Multiple regression analyses were used to investigate the possible predicting factors including motor competence and home affordance in 2.5 years of age to predict children’s MVPA at 3.5 years of age. Our results revealed that preterm children, comparing to full-term peers, spent less time in light PA and total PA. Only vigorous PA showed significant age-related differences. In 2.5 and 3.5 years of age, children’s PA participation was negatively correlated with variety of stimulation of home affordance. For the relationship between motor competence and PA, the results showed that children’s PA participation were positively correlated with their locomotion skills in 2.5 nd 3 years of age. In 3.5 years, children’s MVPA participation was negatively correlated
with visual motor integration and fine motor quotient. In addition, to combine children’s motor competence and home affordance together to predict children’s 3.5 years MVPA participation showed significant prediction. 2.5 years children’s motor competence and home affordance including locomotion and variety of stimulation could predict 3.5 years children’s MVPA. Our findings suggest that in early developmental period, preterm children’s PA participation were less than full-term children. Children’s motor competence and home affordance in preschool period were associated with PA participation, and the relationship changes with age. Children with better motor competence and less home affordance in early years would have more high intensity PA participation in later years. In order to increase children’s participation in PA, parents need to encourage children to engage in locomotion activities in young preschool period and to have a positive attitude, less protective to support children to participate in PA.

並列關鍵字

Physical Activity ； Motor Development ； Home Environment ； Preterm

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