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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
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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
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