腦性麻痺與典型兒童手側化發展研究

Studies of Handedness Development in Cerebral Palsied and Typically Developed Children

孟令夫(LingFu Meng)

指導教授 ： 林幸台 ； 林克忠

國立臺灣師範大學/教育學院/特殊教育學系/博士(1999年)

摘要

本研究探討腦性麻痺與典型兒童的手側化發展特質，共分成三個子研究進行，分別為（1）以建構效度為主的「手側化量表」信效度研究，（2）比較腦性麻痺與典型兒童手側化表現與發展趨勢，以及（3）以實驗研究探討情境脈絡效應（物品位置與規格效應）對手側化表現的影響。
在子研究一中，研究者發展出手側化量表，並建立滿意的表面效度、「前-後測信度」、內在一致性、與「父母 「兒童一致性」，並藉由專家檢核方式建立內容效度。建構效度部份則由研究者分別採用介於4歲至12歲從小班到小六共九個年級的385, 728, 以及744位樣本進行兩階段探索性因素分析與一階段的驗證性因素分析（共三階段），並確認手側化量表具有兩種因素成分，分別為因素一的「多步驟/複雜」活動與因素二的「單步驟/簡單」活動。
子研究二分析101位腦性麻痺與801位典型兒童（介於4歲至12歲從小班到小六等共九個年級）的資料。兩組兒童於從事因素一活動時的側化商數以及使用右手的頻率均顯著比從事因素二活動時高，這樣的結果反映出活動特質不同會影響手側化表現。腦性麻痺組的側化商數與使用右手的人數頻率比典型兒童低，反映出早期腦傷可能導致非典型的偏側化表現。在典型兒童中，四歲組與五歲組（小班與中班）有比較多的非右手使用者，而且他們的側化商數也比其他從6歲到12歲等七組兒童低，因此六歲大班階段於手側化從不穩定到穩定發展歷程中是重要的關鍵期，社會壓力於此可能扮演重要的角色。
子研究三以手側化的近代觀點設計實驗研究，以探討物品「規格效應」與「位置效應」對於非側化手使用次數的影響，樣本包括32位腦性麻痺與26位典型兒童參與本研究。所有的樣本均需執行推球到桌前紙箱中的動作，每位分別經歷位於三種不同位置兩種規格共六種的推球情境，三種位置為非慣用手的對側、中間、以及同側，兩種規格是指排球與棒球。每位個案重複此六種情境三次，因此每人均推球十八次。二因子變異數分析的結果發現位置與規格效應沒有交互作用，但是不同位置影響非慣用手的使用次數，規格則未產生影響。因此情境脈絡效應（尤其是位置效應）可以被調控作為治療或教學上的因子以誘發腦傷者使用他們的不利手。
本論文獲至以下三點結論：（1）有兩個因素的手側化量表具備好的信效度，（2）活動特質、腦傷、以及社會壓力等因子對於手側化表現具有關鍵的影響力，（3）建議未來可以深入分析情境脈絡效應（包括活動特質與物品位置），作為協助動作不利孩子的策略之一。

關鍵字

信度與效度 ； 動作不對稱（動作偏側化） ； 情境脈絡效應 ； 腦傷 ； 兒童發展 ； 因素分析 ； 慣用手（側化手）

並列摘要

This study (with three sub-studies) examined the issue based on traditional and contemporary perspectives of handedness development. They are "a reliability and validity study of the handedness inventory (mainly focusing on construct validity)", "handedness development: a comparison of cerebral palsied and typically developed children", and "the effects of object position and size on manual asymmetries in cerebral palsied and typically developed children".
In sub-study I, the handedness inventory was developed. The inventory demonstrated satisfactory surface validity, test-retest reliability, internal consistency (Cronbach α), and parent-child agreement. Content validity was established by the use of expert panel and construct validity was studied by using two-stage exploratory factor analysis and one-stage confirmatory factor analysis with 385, 728, and 744 subjects (ages ranging from 4- to 12-years) respectively. Two factors were identified finally: sequenced/complex tasks (factor 1) and non-sequenced/simple tasks (factor 2).
In sub-study II, 101 data from cerebral palsies and 801 typical children with ages from 4- to 12-years were analyzed. The higher laterality quotient and the frequency of right handedness were found on factor I activities than on factor II activities for both groups. The results indicated significant effects for different tasks in manual preference. Cerebral palsies' laterality quotient and frequency of right handedness were significantly lower than typical children; the association between early brain injuries and atypical lateral preference was strong. Four and five-old-years are more non-right handed and lower scored than other groups in typical children. It was also noted that there was no difference in handedness performance among other 7 groups from 6- to 12-old-years. The year in the senior class of kindergartens (6-year-old) was the most critical period in the process of establishing stable hand preference; social stress was important to substantiate this phenomenon.
In sub-study III, an experimental study of handedness based on contemporary view was conducted to examine the size and position effects on the use of non-preferred hand in 32 cerebral palsies and 26 typical children. The subjects were asked to execute upper extremity movements 18 times; they pushed balls forward into a box. Two kinds of different ball size (volleyball and baseball) with three different positions (contralateral, middle and ipsilateral sides relative to the non-preferred hand) were experienced by each subject (2×3 = 6 different pushing situations) ; six situations were repeated 3 times (6×3 = 18). Results of two-way ANOVA (2×3) suggested that no interaction existed between position and size effects in both groups. However, the differences in object position did influence the use of non-preferred hand and the object size did not demonstrate the same effect in cerebral palsies and typical children. Context effects, especially the position effect, can be manipulated as a therapeutic and educational strategy to facilitate the use of impaired hand for the children with cerebral palsy.
In summaries, the handedness inventory demonstrated good reliability and validity and included two factors. Task property, brain damage, and social stress might influence manual asymmetries. Context variables including task property and object position can be analyzed and utilized to help the children with motor deficiency.

並列關鍵字

reliability and validity ； motor asymmetries (movement lateralization or manual asymmetries ) ； contextual effects(context effects) ； brain lesions (brain damage, brain injuries) ； child development (children development) ； factor analysis ； preferent hand(dominant hand, preferred hand)

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