- 學位論文
鞋墊對動作發展遲緩兒童在平衡表現的影響
The Influences of Shoe Inserts on Balance Performance in Motor Development Delayed Children
摘要
背景與目的：過去有研究者探討動作發展遲緩的兒童的扁平足發生率比一般正常兒童高，而扁平足除了有骨骼結構排列不正常外，周邊肌肉及韌帶也較一般人不穩定，亦有可能是造成動作發展遲緩的因子之一。臨床有許多醫師建議有扁平足的動作發展遲緩兒童穿著足弓鞋墊來矯正其足部結構，並配合臨床治療師的訓練及協助其動作穩定達到輔助效果，但是過去未曾有研究探討鞋墊的介入前後對動作發展遲緩兒童在平衡表現的影響，因此希望藉由本研究結果來探討動作發展遲緩的兒童穿著鞋墊前後，在平衡功能的表現是否有差異性。方法：本研究招募3歲至6歲11個月的動作發展遲緩的兒童共36名(19名男性，17名女性)。每位受試者在實驗前皆會接受足印採集及身體基本資料測量，之後進行未穿著足弓鞋墊及穿著足弓鞋墊時的平衡測試(Movement ABC第二版)。實驗結束後，會依照CSI將受試者分成扁平足組與正常足弓組、BMI指數分成體重正常組及體重過重組、Beighton score分成韌帶正常組及韌帶鬆弛組，以及將平衡功能各項目細分成穿著鞋墊前、後的比較。統計方式以成對樣本T檢定分析: (1)穿著鞋墊前、後的平衡功能差異。(2)穿著鞋墊前、後單足站立分數的改變量與CSI之相關性。(3)BMI與Beighton score對於平衡功能改變量的影響。結果：在平衡表現中，鞋墊介入後對全體受試者、扁平足受試者在右側單腳站立、左側單腳站立、踮腳尖走4.5公尺直線、跳躍、平衡總分及平衡百分位數均出現顯著差異。另外將單腳站立測試中給予CSI分組，僅發現足弓的差異在受試者穿著鞋墊有顯著差異。在Beighton score的分組方式中，平衡總分有受到Beighton score的影響。結論：本研究發現鞋墊對動作發展遲緩的兒童在平衡表現上有影響，尤其在扁平足的孩童有顯著差異。另外我們發現足弓差異、Beighton score可能是影響平衡表現的因子，若要增加該族群孩童的平衡表現，除了使用鞋墊協助外，也可以配合穿著鞋墊進行相關的下肢訓練，增加孩童動作及平衡的協調性，進而促進孩童的動作發展。而在本研究中也印證了過去研究的結果，在發展遲緩的孩童中，扁平足的比例也相對較高，另外男性在扁平足的比例也是呈現較多人數的狀態。
並列摘要
Background: Some researchers in the past to explore the incidence of flatfoot in children with motor development is higher than normal development children. People with flat feet usual has abnormal bone structure and unstable muscle and ligaments than the average person, there may be a factor to cause motor development delay in their childhood. There are many clinical physicians have recommended that developmental delay child with flatfoot to wear inserts in able to correct their foot structure, and clinical therapist with lower extremity training can help them to achieve better balance performance. But we had never found the study which use the shoe inserts wear or not, and operation the balance performance in the children with motor development delay at the past. Purpose: The aim of this study, we desire to explore the balance influence of shoe inserts in children with motor development delay. Methods: A total of thirty-six subjects with motor development delay whose age between 3 to 6 years 11 months old was recruited. There has nineteen male and seventeen female and each subject would receive the test of balance performance with and without wearing the shoe inserts. Those subject would accept the experiment of footprints collected at the beginning of the study. In this study, we choose the balance performance test at Movement ABC Second Edition in our study. At the end of the test, we use Chippaux-Smiark index (CSI) to determine the arch status from footprints. And use BMI to divided into normal weight and overweight groups, and use Beighton score to divide into normal ligament and laxity ligament group, and balance performance of each project was divided into wearing inserts and without inserts. We use pair-t test analysis to identify the difference between wearing inserts or not, and identify the significant factor from the change score of one-leg standing test between CSI differences, and identify the difference groups of BMI and Beighton score which were the factor to influence the balance performance. Result: In the balance performance, we found that whole of participants and the participants with flatfoot had a significant difference at right-leg standing, left-leg standing, walking heels raised, jumping on mat, balance standard score, balance percentile after wearing inserts. In this research, we found that foot arch groups separate by CSI in one-leg standing test has a significant diffidence on wearing inserts. And almost all of balance test, we found that only the total of balance score has a significant difference on Beighton score, which may be a factor in the balance of performance. Conclusion: Our study found that wearing shoe inserts would affect the balance performance of children with motor development delay, especially in the children with flatfoot, has a significant differences. It seems that wearing shoe inserts may make them better. We also found that the arch differences, Beighton score may be a factor in the balance of performance. If we want to increase the balance of performance of motor development delay children, the shoe inserts may be an assistance with lower extremity training to increase the balance performance and motor development. In this study, we found the same result with prior study. Motor developmental delay children are more like to have flatfoot than normal children. And males are more likely to have flatfoot than females.