動作技巧方案對於發展性協調障礙兒童之協調、平衡、自我效能以及日常生活參與之成效

背景：發展協調障礙(Developmental Coordination Disorder, DCD)是兒童常見動作問題。身體協調及平衡是動作技巧之基礎。過去探討DCD兒童介入成效的研究限制主要為：一、迄今，尚無針對DCD兒童之平衡與身體協調之具實證基礎的動作技巧方案。二、少有研究探討DCD兒童的動作協調與平衡問題的改善是否會影響日常生活參與，且有研究方法上的限制。目的：（1）發展一套針對DCD兒童的身體協調和平衡之動作技巧方案，（2）探討動作技巧方案對DCD兒童身體協調和平衡之成效、對日常生活參與及兒童自我效能的影響，以了解訓練成效是否可類化至一般日常活動當中。研究方法：本研究分為兩階段，第一階段為發展動作技巧方案，研究者透過回顧文獻、專家會議與田野測試，發展適合DCD兒童之動作技巧方案；第二階段驗證動作技巧方案之成效，即使用發展協調障礙問卷、動作評估測驗篩選符合之DCD兒童。本研究招募37位國小一到四年級符合DCD診斷之兒童，依家長可配合的時間，分為實驗組與控制組；實驗組除了傳統職能治療課程外，接受為期8周之動作技巧方案，控制組僅接受傳統職能治療課程。8周介入前後，二組DCD兒童以一對一方式接受前後測，再於訓練方案結束後兩個月及後四個月進行追蹤評估。成效評量包括三方面：（1）以布魯茵克斯-歐西瑞斯基動作量表第二版(Bruninks-Oseretsky Test of Motor Proficiency-2, BOT-2)評量平衡及協調功能。（2）以自我效能及目標設定系統量表(Perceived Efficacy and Goal Setting system, PEGS)評量自我效能。（3）以文蘭適應行為量表(Vineland Adaptive Behavior Scale–Chinese version, VABS-C)中的粗動作次量表，及加拿大職能表現測驗(Canadian Occupational Performance Measure；COPM)評量日常生活參與。資料分析：以SPSS Statistics 25版(Spss, 2017)軟體進行資料分析。以描述性統計分析兩組人口學特性（兒童年齡、性別、診斷、接受OT治療期間）。以Wilcoxon signed-rank test檢驗實驗組接受動作技巧方案是否有進步、控制組前後測是否有改變。此外，以Mann-Whitney U test分析兩組在成效評量之前後測改變量的組間差異，顯著水準α設定為0.05。結果：以Wilcoxon signed-rank test 檢定發現，BOT-2之雙側協調次量表中，實驗組後測分數比前測高(p<.05)，顯示有治療效果，介入後兩個月追蹤評估分數較後測低(p>.05)，顯示治療效果消退，介入後四個月追蹤評估分數比後測低(p>.05)，顯示治療效果消退; 控制組後測分數也比前測高 (p<.05)，顯示傳統治療有效。BOT-2平衡次量表中，實驗組後測比前測高(p<.05)，顯示有治療效果，介入後兩個月追蹤評估分數較後測低(p<.05)，顯示治療效果消退，介入後四個月追蹤評估分數比後測低(p<.05)，顯示治療效果消退。相反地，控制組在前測和後測相比沒有進步(p>.05)。BOT-2身體協調組合(body coordination composite)中，實驗組後測分數比前測高(p<.05)，顯示有治療效果，介入後兩個月追蹤評估分數較後測低(p<.05)，顯示治療效果消退，介入後四個月追蹤評估分數比後測低(p>.05)，顯示治療效果消退; 控制組後測分數比前測高 (p<.05)，顯示傳統治療有效。以Mann Whitney U檢定發現，兩組在BOT-2 雙側協調次量表測得之前後測改變量分數無顯著差異 (p>.05)。以Wilcoxon signed-rank test 檢定發現，自我效能及目標設定系統量表-兒童版中，實驗組後測分數比前測高(p<.05) ，表示有治療效果，介入2個月後追蹤測驗分數與後測比較結果，顯示治療效果維持(p>.05)。介入4個月後追蹤測驗分數與後測比較結果，顯示治療效果維持(p>.05); 控制組在後測沒有進步(p>.05)。自我效能及目標設定系統量表-照顧者版中，實驗組後測分數比前測高(p<.05)，顯示有治療效果，介入2個月後追蹤測驗分數與後測比較結果，顯示治療效果維持(p>.05)。介入4個月後追蹤測驗分數與後測比較結果，顯示治療效果消退(p<.05); 控制組在後測沒有進步(p>.05)。以Mann Whitney U檢定發現，兩組在PEGSC、PEGSCG測得之前後測改變量分數無顯著差異 (p>.05)。以Wilcoxon signed-rank test 檢定發現，加拿大職能表現量表-表現次量表中，實驗組後測分數比前測高(p<.05)，顯示有治療效果，介入2個月後追蹤測驗分數與後測比較結果，顯示治療效果維持(p>.05)。介入4個月後追蹤測驗分數與後測比較結果，顯示治療效果維持(p<.05); 控制組後測分數比前測高(p<.05) ，顯示有傳統治療有效果。加拿大職能表現量表-滿意度次量表中，實驗組後測分數比前測高(p<.05)，顯示有治療效果，介入2個月後追蹤測驗分數與後測比較結果，顯示治療效果維持(p>.05)。介入4個月後追蹤測驗分數與後測比較結果，顯示治療效果維持(p>.05); 控制組後測分數比前測高(p<.05) ，顯示有傳統治療有效果。以Mann Whitney U檢定發現，兩組在PEGSC、PEGSCG測得之前後測改變量分數無顯著差異 (p>.05)。以Wilcoxon signed-rank test 檢定發現，VABS中，實驗組後測分數不比前測高(p>.05)，顯示沒有治療效果，介入2個月後追蹤測驗分數與後測比較結果，顯示沒有治療效果 (p>.05)，介入4個月後追蹤測驗分數與後測比較結果，顯示沒有治療效果(p>.05); 控制組後測分數不比前測高(p>.05)。以Mann Whitney U檢定發現，兩組在VABS測得之前後測改變量分數無顯著差異 (p>.05)。結論：本研究結果提供6-10歲DCD兒童的針對平衡及協調之動作技巧方案之實證基礎，結果顯示動作技巧方案可改善DCD兒童的平衡及協調、自我效能，以及日常生活參與，介入成效與傳統職能治療一樣。未來將有助於臨床工作者介入方案及學校適應體育課程的設計。

關鍵字

發展性協調障礙；平衡；協調；自我效能；參與；動作技巧方案

並列摘要

Background and purpose: Children with developmental coordination disorder (DCD) are characterized with motor coordination problems, leading to limitations in participation in daily activities, academic activities, and play. Coordination and balance are fundamental to motor skills. Reviewing previous studies shows that there is still no evidence-based motor skill training program specifically for coordination and balance of children with DCD. Further, only few intervention studies examined whether improved motor skills would improve participation. Thus, the purpose of this study is to develop a motor skill training program for coordination and balance for children with DCD and to examine the effect of the program on coordination, balance, self-efficacy, and participation in daily activities. Methods: The study has two phases – Phase I: the development phase and Phase II: the validation phase. In Phase I, a motor skill training program was developed through literature review, consultation with experts, and a field test. The training program was based on Mach drill and yoga, consisting of five individual tasks and two group activities. In Phase II, the effectiveness of the program was investigated. Thirty-seven children whose MABC-2 percentage scored below 15% were recruited. They were then assigned to either an experimental group (EG) or a control group (CG) according to parents’ choice based on their availability. EG received an 8-week motor skill training program, two sessions a week, 30 minutes for each session in addition to their regular occupational therapy. CG received regular occupational therapy only. Result: Wilcoxon signed-rank test showed significantly improvement in the post-test score of BOT-2 bilateral coordination subscale (p<.05) for both groups. Furthermore, the improvement of BOT-2 bilateral coordination subscale was maintained at the 2-month and 4-month follow-ups (p>.05) respectively for the experimental group. For BOT-2 balance subscale, the post-test score was significantly higher than the pre-test score (p<.05) in EG only. However, the training effect on balance was not maintained at the 2-month and the 4-month follow-ups (p>.05). Regarding BOT-2 body coordination composite, significant improvement was noted in the post-test score (p<.05) for both groups. The training effect on body coordination was not maintained at the 2-month, but was maintained at the 4-month follow-up(p>.05) in EG. No group difference was noted in the change scores of BOT-2 bilateral coordination subscale, balance subscale and body coordination composite. In regard to self-efficacy, significant improvement was noted in the post-test scores of both children and caregiver versions of Perceived Efficacy and Goal Setting System (PEGS-C and PEGS-CG) (p<.05) in EG. Furthermore, the training effect on child rating of efficacy was maintained at the 2-month and 4-month follow-ups (p>.05). The effect on self-efficacy rated by caregivers was maintained at the 2-month follow-up, not at 4-month follow-up (p<.05). No group difference was noted in the change scores of PEGS -C and PEGS-CG. For performance in daily activities measured by Canadian Occupational Performance Measure (COPM) – performance subscale, significant improvement in the post-test score (p<.05) for both groups was noted. The training effect was maintained at the 2-month and 4-month follow-ups. For satisfaction of performance, significant improvement was noted in the post-test score of COPM– satisfaction subscale (p<.05) for both groups. For the EG, the improvement of COPM – satisfaction subscale was maintained at the 2-month and 4-month follow-ups (p>.05). No group difference was noted in the change score of both performance subscale and satisfaction subscale of COPM. For Vineland Adaptive Behavior Scale–Chinese version (VABS-C)- gross motor subscale, no improvement was noted in the post-test score for both groups. No group difference was noted in the change score of VABS-C. Conclusion: This study provides empirical evidence for a motor skill training program on balance and coordination for 6-10-year- old children with DCD. The results show that the motor skill training program can improve balance, coordination, self-efficacy, and performance on daily activities in children with DCD with similar effectiveness as traditional occupational therapy. This study provides an alternative evidence-based intervention program for clinicians and educators when serving children with DCD.

並列關鍵字

developmental coordination disorder ； coordination ； balance ； self-efficacy ； participation ； motor skill training program

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動作技巧方案對於發展性協調障礙兒童之協調、平衡、自我效能以及日常生活參與之成效

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