跳到主要內容

臺灣博碩士論文加值系統

(44.192.20.240) 您好!臺灣時間:2024/02/24 23:27
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:羅鴻基
研究生(外文):Luo Hong-Ji
論文名稱:低危險早產兒及正常足月兒之行走達成年齡及可能影響之因子
論文名稱(外文):Age of Walking Attainment and Its Possible Influencing Factors in Low-Risk Preterm Infants and Normal Full-Term Infants
指導教授:鄭素芳鄭素芳引用關係
指導教授(外文):Jeng Suh-Fang
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:物理治療學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:97
中文關鍵詞:早產兒行走發展支撐跨步運動學測量影響因子
外文關鍵詞:prematuritywalking developmenttreadmill steppingkinematic analysisinfluencing factors
相關次數:
  • 被引用被引用:1
  • 點閱點閱:199
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
中文摘要
本研究之目的在於比較低危險早產兒及正常足月兒的行走達成年齡、藉由跑步機支撐跨步測試來瞭解低危險早產兒及正常足月兒自矯正年齡7個月至行走達成前之下肢動作發展、並探討可能影響行走達成之因子。受試嬰兒包括10位低危險早產兒及18位正常足月兒。所有嬰兒從矯正年齡7個月開始接受每兩個月一次的追蹤測量,直到嬰兒行走達成或達矯正年齡17個月即停止。測量的項目包括:跑步機支撐跨步運動學測量、生長與體格測量、皮下脂肪厚度測量、粗動作發展檢查、及認知發展檢查。結果發現兩組嬰兒之行走達成年齡並無明顯差異,至於7及9個月的各項檢查中,跑步機支撐跨步之運動學結果顯示,早產兒交替跨步數目較足月兒為高,且站立期時間較短。至於隨年齡之增加,所有嬰兒均以交替跨步為主要之動作型式,並呈現跨步頻率增加、髖關節彎曲角度增加、及膝關節彎曲尤拉角增加的趨勢。隨跑步機速度增加,所有嬰兒均呈現交替跨步頻率增加、跨步週期、站立期、及擺盪期時間減少、踝關節蹠屈角度減少、以及兩腳間之時間對稱性增加之現象。所有嬰兒各項發展在生長、體格、皮下脂肪厚度、全身脂肪含量百分比、阿爾伯塔動作分數與認知分數均無組別之差異,且均隨年齡增加而增加,唯7與9個月時早產兒的肩胛下皮下脂肪厚度較正常足月兒為薄。至於與行走達成相關之因子為7個月時之阿爾伯塔站姿分數、9個月阿爾伯塔站姿分數、及0.1m/s速度之左腳跨步週期時間。
在行走達成前一次及二次的各項檢查中,跑步機支撐跨步之運動學結果顯示,早產兒之跨步週期、站立期時間均較正常足月兒為短,其餘均無組別差異;隨著行走達成之接近,交替跨步百分比增加,其餘則無兩次測量間之差異;但隨速度之增加,所有嬰兒均呈現交替跨步頻率及其百分比增加,跨步週期、站立期時間及其百分比、及擺盪期時間減少、擺盪期百分比增加、踝關節蹠屈角度減少、以及兩腳間之時間對稱性會增加的現象。行走達成前一及二次兩組嬰兒在生長、體格、皮下脂肪厚度、全身脂肪含量百分比、阿爾伯塔動作分數與認知分數均無明顯差異,但隨年齡之增加,所有嬰兒均在以上測試呈現增加之趨勢。而與行走達成相關之因子有行走達成前第一、二次之阿爾伯塔站姿分數差值、與行走達成前第一、二次0.2m/s下肢著地時髖關節角度差值。
Abstract
The purpose of this study was to investigate the age of walking attainment, to examine the development of leg movement and to explore possible influencing factors of walking attainment in low-risk preterm infants and normal full-term infants. The subjects consisted of 10 low-risk preterm infants and 18 normal full-term infants who were born at National Taiwan University Hospital. Infants were prospectively followed at a two-month interval from 7 months of corrected age to walking attainment or until 17 months of corrected age. The assessments consisted of kinematic analysis of supported treadmill stepping movement, growth and anthropometric measures, skinfold measures, the Alberta Infant Motor Scale (AIMS), and the cognitive subscale of the Chinese Children Development Inventory (CCDI). The results showed comparable age of walking attainment among the preterm and term infants. Regarding the test results of 7 and 9 months, the preterm infants showed a higher frequency in alternate stepping and a shorter stance phase than the term infants. With increasing age, all infants exhibited an increasing number of alternate stepping, an increasing hip flexion and an increasing knee flexion Euler angle. With increasing treadmill speed, all infants showed an increasing number of alternate stepping, a decreasing stride cycle duration, stance and swing phase, a decreasing ankle plantarflexion and an increasing temporal symmetry of both legs. In addition, the groups were comparable in growth, skinfold, the AIMS score, and the cognitive scores in follow-up period. With increasing age, all infants showed an increase in growth, skinfold, the AIMS score, and the cognitive score. Furthermore, the AIMS standing scores at 7 and 9 months, and the stride cycle duration were found to significantly correlate with walking attainment.
Comparison of the test results of the last and the second last trial prior to walking attainment showed no group and trial differences in all kinematic variables of treadmill stepping movement. With increasing treadmill speed, all infants demonstrated an increasing number of alternate stepping, a decreasing stride cycle duration, stance and swing phase, and a decreasing ankle plantarflexion. In addition, the groups were comparable in growth, anthropometry, skinfold, the AIMS score, and the cognitive scores in follow-up period. Yet, all infants showed an increase in all these measures with increasing age. Furthermore, the difference of the AIMS standing scores and the difference of hip angle at foot strike between the last and the second last trials were found to significantly correlate with walking attainment.
目 錄
目錄………………………………………………………………….………i
表次………………………………………………………………….………iii
圖次………………………………………………………………….………vi
中文摘要…………………………………………………………….………vii
英文摘要…………………………………………………………….………ix
本文
第一章、前言……………………………………………………….………1
第一節:研究背景……………………………………………….………1
第二節:研究目的及假說……………………………………….………4
第二章、文獻回顧……………………………………………….………5
第一節:早產兒的發展………………………………………….………6
第二節:行走功能的重要性…………………………………….………7
第三節:早產兒與正常足月兒之行走達成年齡與步態的比較.………8
第四節:早產兒與正常足月兒下肢動作發展的研究………….………9
第五節:影響行走動作達成的因素…………………………….………15
第三章、研究方法……………………………………………….………19
第一節:受試嬰兒……………………………………………….………19
第二節:實驗步驟……………………………………………….………19
第三節:統計分析……………………………………………….………27
第四章、結果…………………………………………………….………29
第一節:受試嬰兒……………………………………………….………29
第二節:行走達成年齡………………………………………….………29
第三節:嬰兒於矯正年齡在七個月及九個月之各項測量結果.………30
第四節:嬰兒行走達成前一次及二次測試之各項結果……….………34
第五節:影響行走達成之因子………………………………….………37
第五章、討論…………………………………………………….………40
第六章、結論…………………………………………………….………45
參考文獻………………………………………………………….………47
表………………………………………………………………….………57
圖………………………………………………………………….………87
附錄……………………………………………………………….………89
附錄一:同意書………………………………………………….………89
附錄二:醫學倫理委員會審核通過證明……………………….………92
附錄三:受試嬰兒基本資料表………………………………….………93
附錄四:阿爾伯塔嬰兒動作量表……………………………….………95
附錄五:學齡前兒童行為發展量表(認知理解部分)題目….………97
參考文獻
1. Abdel-Aziz YI, Karara HM. Direct linear transformation from computer coordinate into object space coordinate in closed-range photography. ASP Photogrammetry, Falls Church. 1971, pp.1-18.
2. Allen MC, Alexander GR. Gross motor milestones in preterm infants: correction for degree of prematurity. J Pediatr 1990;116:955-959.
3. Allen MC, Alexander GR. Screening for cerebral palsy in preterm infants: delay criteria for motor milestone attainment. J of Perinatol 1994;15:190-193.
4. Allen MC, Jones MD. Medical complications of permaturity. Obstet Gynecol 1986;67:427-437.
5. Allen MC. Developmental outcome and followup of the small for gestional age infant. Semin in Perinatol 1984;8:123-156.
6. Astbury J, Orgill AA, Bajuk, et al. Determinants of developmental performance of very low birthweight survivors at one and two years of age. Dev Med Child Neurol 1983;25:709-716.
7. Bartlett D, Piper MC. Neurodevelopment of preterm infants through the first year of life: implications for physical therapy and occupational therapists. Phys Occup Ther Pediatr 1993;12:37-55.
8. Behrmen RE, Vaughan III VC. Nelson Textbook of Pediatrics. USA:WB Saunders Co, 1979
9. Bendersky M, Lewis M. Environmental risk, biological risk, and developmental outcome. Dev Psychol 1994;30:484-494.
10. Chen SJ, Guo NW, Wang PF, et al. Outcome for very low birth-weight infants. Acta Paed Sin 1989;30:30-39.
11. Chen TJ, Chen SH, Lee KS. The need for neonatal intensive care in taiwan: historical perspectives. Acta Paed Sin 1990:31:1-10.
12. Cioni G, Duchini F, Milianti B, et al. Differences and Variations in the Patterns of Early Independent Walking. Early Hum Dev 1993;35:193-205.
13. Cioni G, Prechtl HFR. Preterm and early posttrem motor behavior in low-risk premature infants. Early Hum Dev 1990;23:159-191.
14. Clark JE, Phillips SJ. The step cycle organization of infant walkers. J Motor Behav 1987;19:421-433.
15. Davis DW, Thelen E, Keck J. Treadmill Stepping in Infants Born Prematurity. Early Hum Dev 1994;39:211-223.
16. De Groot L, de Groot CJ, Hopkins B. An instrument to measure independent walking: there differences between preterm and fullterm infants? J Child Neurol 1997;12:37-41.
17. Drillen CM. Abnormal neurologic sign in the first year of life in low birth weight infants; possible prognostic significance. Dev Med Child Neurol 1972;14:575-584.
18. Droit S, Boldrini A, Ciono G. Rhythmical Leg Kicking in Low-Risk and Brain-Damaged Preterm Infants. Early Hum Dev 1996;44:201-213.
19. Findlay S, Lui K. Sensorimotor profiles in very low birth weight infants at four months adjusted age: specific deficits and possible implications. Phys & Occup Ther Pediatr 1991;11:13-26.
20. Forssberg H. A Neural Control Model for Human Locomotion Development: Implication for Therapy. In: Forssberg H, Hirschfeld H,ed. Movement Disorders in Children. Med Sport Sci 1991;36:174-181
21. Forssberg H. Ontogeny of Human Locomotor Control I. Infants Stepping, Supported Locomotion and Transition to Independent Locomotion. Experimental Brain Research 1985;57:480-493.
22. Geerdink JJ, Hopkin B, Beek WJ, et al. The Organization of Leg Movements in Preterm and Full-Term Infants After Term Age. Dev Psychobiol 1996;29(4):335-351.
23. Gibson EJ. Exploratory behavior in the development of perceiving, acting, and the acquiring of knowledge. Ann Rev Psychol 1988;39:1-41.
24. Goldson E. Bronchopulmonary dysplasia. Pediatrics 1990;19:13-18.
25. Gorga D, Stern FM, Ross G. Trends in neuromotor behavior of preterm and fullterm infants in the first year of life: a preliminary report. Dev Med Child Neurol 1985;27:756-766.
26. Hadders-Algra M, Brogren E, Katz-Salamon, et al. Periventricular leucomalacia and preterm birth have different detrimental effects on postural adjustments. Brain 1999;122:727-740.
27. Hagberg B, Hagberg G, Zetterstrom R. Decreasing perinatal mortality- increase in cerebral palsy morbidity. Acta Paediatr Scand 1989;78:664-670.
28. Heine K, Pakuh PA, Vonnegut KJ, et al. Concurrent validities od the Alberta Infant Motor Scale(AIMS) and the Bayley Scales of Infant Development second deition(BSID-II) in high risk infants (Abstract). Ped Phys Ther 1997;9:205 .
29. Hempel MS. Neurological development during toddling age in normal cgildren and children at risk of developmental disorders. Early Hum Dev 1993;34:47-57.
30. Heriza CB. Comparison of Leg Movements in Preterm Infants at Term with Healthy Full-Term Infants. Phys Ther 1988;68(11):1687-1693.
31. Heriza CB. Implications of a dynamical system approach to understanding infant kicking behavior. Phys Ther 1987;67:1877-1880.
32. Heriza CB. Motor Development: Traditional and Contemporary Theories. In: Lister MJ,ed. Contemporary Management of Motor Control Problems: Proceedings of the II Step Conference. Alexandria VA: Fundation for Phys Ther, 1991;99-126.
33. Heriza CB. Organization of Leg Movements in Preterm Infants. Phys Ther 1988;68(9):1340-1346.
34. Hsieh TT, Hsu JJ, Chen CJ et al. Analysis of birth weight and gestional age in Taiwan. J Formos Med Assoc. 1991;90:382-387
35. Jeng SF, Tsou Yau KI, Chen LC, et al. Alberta Infant Motor Scale: Reliability and Validity When Used on Preterm Infants in Taiwan. Phys Ther 2000;80(2):168-178.
36. Jeng SF, Yau KI & Liao HF et al. Prognostic factors for walking attainment in very low-birthweight preterm infants. Early Hum Dev. 2000;59(3):159-73.
37. Jensen JL, Thelen E, Schneider, et al. Adaptive Dynamics of the Leg Movement Pattern of Human Infants: III Age-Related Differences in Limb Control. J Motor Behav 1995;27(4):366-374.
38. Johnson A, Goddard O, Ashurst H. Is late walking a marker of morbidity? Arch Dis Child 1990;65:486-488.
39. Kamm k, Thelen E, Jensen JL. A dynamical systems approach to motor development. Phys Ther 1990;70:763-775
40. Kang MJ, Lee CH, Wei HY. A study of Chinese newborn infants with low birth weight. Acta Paed Sin 1975;16:193-204
41. Kao HA, Chiang CT. The classification of newborn infants and neonatal survival rate. Acta Paed Sin 1975;16:137-141
42. Largo RH, Pfister D, Molinari L, et al. Significance of prenatal, perinatal and postnatal factros in the development of AGA perterm infants at five to seven yeas. Dev Med Child Neurol 1989;31:440-456.
43. Lewis M, Bendersky M. Cognitive and motor difference among low birth weight infants: impact of intraventricular hemorrhage, medical risk, and social class. Pediatrics 1989;83:187-192.
44. Liao HF, Lee SC, Soong WT, et al. Mental and neuromotor outcomes of children with psychomotor retardation. JOPTA 1996;21:121-130.
45. Liao MF, Liang IS, Tsao LY, et al. Perinatal and neonatal mortality- a 5-year survey in Changhua Christian Hospital. Acta Paed Sin 1985;26:150-156.
46. Low JA, Galbraith RS, Muir DW, et al. The contribution of fetal-newborn complications to motor and cognitive deficits. Dev Med Child Neurol 1985;27:578-587.
47. Majnemer A, Brownstein A, Kadanoff R, et al. A comparison of neurobehavioral performance of healthy term and low-risk preterm infants at term. Dev Med Child Neurol 1992;34:417-424.
48. Martin-Ancel A, Garcia-Alix A, Gaya F, et al. Multiple organ involvement in perinatal asphyxia. J Pediatr 1995;127:786-793.
49. McCormick AQ. Retinopathy of prematurity. Curr Probl Pediatr 1977;7:1-28
50. McGraw MB. The neuromuscular maturation of human infant. New York: Hafner, 1945 .
51. Nelligan G, Prudhan D. Norms for standard developmental mile-stone by sex, social class and place in the family. Dev Med Child Neurol 1969;11:413-4422.
52. Orstein M, Ohlsson A, Edmonds J, et al. Neonatal follow-up of very low birthweight/ extreme low birthweight infants to school age: a critical overview. Acta Paediatr Scand 1991;80:741-748.
53. Papile LA, Burstein J, Burstein R, et al. Incidence and evolution of subependymal and intraventriculau hemorrhage: a study of infants with birth weights less than 1500 gm. J Pediatr 1978;82:529-534.
54. Piper MC, Darrah J. Motor assessment of the developing infants Philidelphia: W.B. Saunders Co, 1994
55. Reed ES. Changing thories of postural development. In: Wollacott MH, Shumway-Cook A, ed. Development of postural and gait across the lifespan. Columbia, SC: University of South Carolina Press, 1989
56. Rosner BA. Fundamentals of biostatistics. 4th ed. Belmont : Wadsworth Publishing Co, 1995
57. Saigal S, Szatmari P, Rosenbaum P, et al. Cognitive abilities and school performance of extremely low birth weight children and matched term control children at age 8 years: a regional study. J Pediatr 1991;118:751-760.
58. Scholz JP. Dynamic pattern theory- some implications for therapeutics. Phys Ther 1990;70:827-843.
59. Selfe J. Validity and reliability of measurements taken by the Peak 5 motion analysis system. J Med Eng Tech 1998;22:220-225.
60. Sheahan MS, Brockway NF. The High Risk Infants. In: Tecklin JS, ed. Pediatric Physical Therapy. Philadelphia: JB Lippincott Co, 1994:56-88.
61. Sheng HP, Muthappa PB, Wong WW, et al. Pitfalls of body fat assessments in premature infants by anthrropometry. Biol Neonats 1993;64:279-286.
62. Shumway-Cook A, Woolacott MH. Motor Control-Theory and Practical Applications. Baltimore, Maryland: Williams & Wilkins,,1995, pp.239-314
63. Silva PA, McGee R, Williams S. The predictive significance of slow walking and slow talking: a report from the Dunedin Multidisciplinary Child Development Study. Brit J Disord of Commun 1982;17:133-139.
64. Skidmore MD, Rivers A, Hack M. Increased risk cerebral palsy among very low weight infants with chronic lung disease. Dev Med Child Neurol 1990;32:325-332.
65. Stout JL. Gait: development and analysis. In: Campbell SK,ed. Physical therapy for children ,Philadelphia:WB Saunders Co, 1995
66. Teng RJ, Yau KIT, Lu CP et al. The neonatal morbidity and mortality of low birth weight neonates. Acta Paed Sin 1992;33:167-175
67. Thelen E, Bradshaw G, Ward JA. Spontaneous Kicking in Month-Old Infants: Manifestation of a Human Central Locomotor Program. Behav Neural Biol 1981;32:45-53.
68. Thelen E, Cooke DW. Relationship Between Newborn Stepping and Later Walking: A New Interpretation. Dev Med Child Neurol 1987;29:380-393.
69. Thelen E, Fisher DM. Newborn Stepping: An explanation for a Disappearing Reflex .Dev Psychobiol 1982;18(5):760-755.
70. Thelen E, Fisher DM. The Organization of Spontaneous Leg Movements in Newborn Infants. J Motor Behav 1983;15(4):353-377.
71. Thelen E, Johnson RR, Fisher DM. Shifting patterns of bilateral coordination and lateral dominance in the leg movement of young infants. Dev Psychobiol 1983;16:29-46.
72. Thelen E, Kelso JAS, Fougel A. Self-organizing systems and infant motor development. Developmental Review 1987;7:39-65.
73. Thelen E, Smith LB. Dynamic Principles of Development: Reinterpreting Learning to Walk. In: Thelen E, Smith LB, ed. A Dynamic Systems Approach to the Developmental of Cognition and Action. London: The MIT Press, 1994
74. Thelen E, Ulrich BD. Hidden Skill: A Dynamic Systems Analysis of Treadmill Stepping During the First Year. Monographs of the Society for Research in Child Development 1991.
75. Thelen E. Development of Locomotion from a Dynamic Systems Approsch. In: Forssberg H, Hirschfeld H, ed. Movement Disorders in Children. Med Sport Sci 1992;36:169-173.
76. Thelen E. Developmental Origins of Motor Coordination: Leg Movements in Human Infants .Dev Psychobiol 1985;18:1-22.
77. Thelen E. Neural Control of Innate Behavior. In: Forssberg H, Hirschfeld H,ed. Movement Disorders in Children. Med Sport Sci 1992;36:169-168.
78. Thelen E. Treadmill-elicited stepping in seven-month-old infants. Child Dev 1986;57:1498-1506.
79. Touwen BCL. Neurological development in infancy. London, SIMP Heinemann, 1976.
80. Tsou Yau KI. Assessment of neonatal body composition from arm circumference and skinfold thickness measurements. Acta Paed Sin 1987;28:157-163.
81. Ulrich BD, Jensen JL, Thelen E, et al. Adaptive dynamics of the leg movement patterns of human infants: II Treadmill stepping in infants and adults. J Motor Behav 1994;26:313-324.
82. Ulrich BD, Ulrich DA, Collier DH, et al. Developmental shifts in the ability of infants with down syndrome to produce treadmill steps. Phys Ther 1995;75:14-23.
83. Ulrich BD, Ulrich DA, Collier DH. Alternating stepping patterns: hidden abilities of 11-month-old infants with down syndrome. Dev Med Child Neurol 1992;34:233-239.
84. Vaal J, van Soest AJ. Spontaneous kicking behavior in infants: age-related dffects of unilateral weighting. Dev Psychobiol 2000;36:111-122
85. van der Heide JC. Kinematic and qualitative analysis of lower-extremity movements in preterm infants with brain lesions. Phys Ther 1999;79:546-557
86. Vohr BR, Garcia CT. Neurodevelopmental and school performance of very low birth-weight infants: a seven year longitudinal study. Pediatrics 1985;76:345-350.
87. Volpe JJ. Brain Injury in the Premature Infants: Current Concepts of Pathologenesis and Prevention. Biol Neonate 1992;62:231-242.
88. Weiner AS, Long T, DeGangi G, et al. Sensory processing of infants born prematurely or with regulatory disorders. Phys Occup Ther Pediatr 1996;16:1-17.
89. Weststrate JA, Deurenberg P. Body composition in children: Proposal for a model for calculating body fat percentage from total body density or skinfold-thickness measurements. Am Clin Nutr 1989;50:1104-1115.
90. Wilhelm IJ. The neurological suspect neonate. In: Campbell SK,ed. Pediatric Neurologic Physical Therapy. 2nd ed. New York:Churchill Livingstone Inc, 1991.
91. Pang MYC, Yang JF. The initiation of the swing phase in human infant stepping: importance of hip position and leg loading. J of Physiol. 2000;528:389-404.
92. Zatsiorsky, V.M., Kinematics of Human Motion, Champaign:Human Kinetics, Leeds, 1998.
93. Zelazo PR. ''Waslking'' in newborn. Science 1972;176:314-315.
94. 徐澄清、蘇喜、蕭淑貞等人:學齡前兒童發展量表之修訂及初步常模之建立。中兒醫誌:第十九卷142-156頁,1978年。
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top