節律動作介入計畫之於學齡前自閉症類群障礙兒童的效益

Effectiveness of Rhythmic Motor Intervention Program in Preschool-Aged Children with Autism Spectrum Disorder

謝禮年(Li-Nian Xie)

指導教授 ： 吳晏慈

國立臺灣大學/醫學院/物理治療學研究所/碩士(2021年)

https://doi.org/10.6342/NTU202104289

摘要

自閉症類群障礙(簡稱自閉症)的核心症狀為社會互動與語言溝通的障礙、及侷限重複的動作、行為或興趣。過去的文獻指出，自閉症兒童的動作發展異常出現於早期的嬰幼兒階段，並可能持續至學齡期階段，其動作障礙表現於靜動態的姿勢控制穩定性不足、多重肢體間的協調性低、動作模仿及人際同步性技巧差。近期文獻指出以音樂節律的引導策略，有助於提高自閉症兒童的社交互動能力、口語及非口語溝通能力，及社交適應能力。然而極少研究探討結合音樂節律與動作協調訓練於自閉症兒童的效益。目前現有研究發現音樂節律動作介入有助於改善學齡期自閉症兒童的動作協調能力、增加人際同步性的持續時間，以及較少的動作模仿錯誤次數。然而，此介入模式應用於臺灣學齡前自閉症兒童的效益仍未知。因此，本研究的目的為：(1)發展臺灣學齡前自閉症兒童的節律動作介入計畫，並且探討執行介入計畫的可行性；(2)探討介入計畫對於自閉症兒童的動作技巧、社會溝通、適應行為等多發展面向的效益。
本研究為準實驗研究設計，共14位年齡介於41至91個月且確診為自閉症的兒童參加節律動作介入組，另有9位與介入組在年齡、性別及認知能力配對之自閉症兒童參與控制組，介入組兒童持續接受8週，每週1次60分鐘的節律動作訓練課程，父母其中一人共同參與，並協助在家執行每週2次的居家訓練。本研究探討之介入效益包括兒童在動作發展與協調能力、社會溝通技能、與適應行為發展。受試兒童在介入前之基準期與介入完成後分別接受皮巴迪動作發展量表第二版、兒童動作ABC評量表第二版的動作評估、穆林早期學習量表之接受與表達語言次量表的評估；以及由父母填寫社會反應量表第二版、與文蘭適應行為量表之問卷。同時，研究分析兒童動作模仿與人際同步技能在訓練過程中的變化。最後在介入完成時，以介入組家長所填寫的滿意度問卷結果做為介入計畫的可行性指標。此研究使用威爾卡森符號檢定分析介入組兒童在介入前後的各項發展指標的改變；另以曼惠特尼U檢定分析介入及控制組兒童在各療效指標上是否有組間差異。
研究結果顯示，共11位介入組兒童完成節律動作介入計畫，在完成介入計畫後，兒童在皮巴迪動作發展量表第二版中的靜態控制、動態位移和視覺動作整合分量表的分數顯著提高，並在兒童動作ABC評量表第二版之丟接技巧、平衡技巧分量表，以及整體動作技巧的百分位等級顯著上升。此外，介入組兒童在介入後的動作模仿的錯誤率顯著的降低、且其人際同步的時間顯著升高。此外，自閉症兒童的社會溝通能力，其社會反應量表第二版問卷之社會意識的分量表有顯著下降的分數。同時，相較於控制組兒童，介入組兒童在介入後的動作、社會溝通、以及適應行為表現呈現較佳的趨勢。整體而言，超過70%參與介入組兒童的家長，對此計畫所設計之訓練內容、時程安排、以及參與介入後之效益表示滿意。本研究結果初步顯示節律動作介入計畫對於臺灣學齡前自閉症兒童的多項發展有助益，可提供臨床實作上的初步介入模式之參考。然而，對於不同認知能力的自閉症兒童，此介入模式仍需在對其注意力、重複行為特徵、或理解指令困難等問題，調整適合個案個別化的訓練內容。未來的研究方向建議可再針對不同認知程度的自閉症兒童探討不同介入強度的節律動作介入計畫之效益。

關鍵字

自閉症類群障礙 ； 動作 ； 介入 ； 節律 ； 音樂 ； 學齡前期

並列摘要

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social interaction and communication and the presence of repetitive and restricted behaviors/interests. Previous literature revealed that atypical motor development and motor coordination problems such as poor posture control and multi-limbs coordination, poor imitation of movements, and interpersonal synchrony could be observed in young children with ASD. Recent literature reported the training strategy using rhythms of music could help to improve the social interaction skills, verbal and non-verbal communication skills, and social adaptive behavior in children with ASD. However, few studies have explored the effects of motor coordination training combined with rhythms of music in school-aged children with ASD, and there is a lack of early motor intervention studies for preschool children with ASD. Recent studies reported that rhythmic motor intervention (RMI) for school-aged children with ASD could improve not only motor coordination but also abilities in interpersonal synchrony and imitation. However, the effect of RMI on preschool-aged children with ASD was still unclear; and there was a need to develop a cultural-adapted RMI program for Taiwanese children with ASD. Therefore, the purposes of this study were: (1) to develop an RMI program and explore its feasibility for the training of preschool-aged Taiwanese children with ASD; (2) to explore the effects of the RMI program on motor skills and coordination, socio-communication and language, and adaptive behavioral developments.
This study conducted a quasi-experimental research design. Fourteen children aged between 42 and 96 months who were diagnosed with ASD were recruited into the RMI group, and 9 children with ASD match with age, sex, and cognitive levels were allocated into the control group. Children in the RMI group received an 8-week intervention with 1 session per week, 60 minutes per session. Outcome measurements at baseline and post-intervention involved motor skills and coordination, social communication and language, and adaptive behaviors in children with ASD. Outcomes of Peabody Developmental Motor Scales, Second Edition (PDMS-2) and Movement Assessment Battery for Children, Second Edition (MABC-2) assessment were used as motor skills outcome, and Expressive Language and Receptive Language Scales of Mullen Scale of Early Learning (MSEL), Social Responsiveness Scale, Second Edition (SRS-2) and Vineland Adaptive Behavior Scale (VABS), were implemented for the participating children as outcomes of language, social communication, and behaviors. In addition, imitation skills and interpersonal synchrony of children with ASD were analyzed using video-recorded at the early and late intervention sessions. Finally, parents in the RMI group filled in a satisfaction questionnaire as the assessment of the feasibility of RMI program. The Wilcoxon signed-rank test was carried out to examine changes in child’s developmental outcomes from baseline to post-intervention within the RMI group, and Mann-Whitney U Test was used to examine the group differences for changes of outcomes.
After completing the intervention program, children with ASD revealed significant improvements of increased motor scores of Stationary, Locomotion, and Visual-motor Integration subscale in PDMS-2, increased percentile ranks of overall motor coordination performance in MABC-2, decreased error rates of motor imitation, increased in-synchrony movement, and improved scores of Social Awareness subscale in SRS-2. Trends of improvement in Objects manipulation and Grasping subscale of PDMS-2, and total score of SRS-2, and overall score of VABS were seen in children of RMI group. Overall, more than 70 % of parents of children with ASD who have received RMI program were satisfied with the training content, schedule, and self-perceived benefits from the intervention. The study showed that the RMI program was effective on the developments of Taiwanese preschool-aged children with ASD, and provide a preliminary model for future research and clinical practice. However, for children with different cognition levels, it is necessary to modify the training contents and schedule according to their problems such as insufficient attention, severe stereotypic behaviors, lack of eye contact, or difficulty in understanding instruction. It is suggested that further studies could further develop a modified RMI program for children with ASD with various cognition levels and explore its effectiveness.

並列關鍵字

Autism spectrum disorder ； motor ； intervention ； rhythm ； music ； preschool-aged

參考文獻

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