(3.236.222.124) 您好!臺灣時間:2021/05/19 10:46
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:::

: 
twitterline
研究生:徐琳雅
研究生(外文):Lin Ya Hsu
論文名稱:正常發展兒童與妥瑞症兒童之前置性姿勢調整的學習
論文名稱(外文):Acquisition of Anticipatory Postural Adjustments in Children with Typical Development and Tourette Syndrome
指導教授:劉文瑜劉文瑜引用關係
指導教授(外文):W. Y. Liu
學位類別:碩士
校院名稱:長庚大學
系所名稱:復健科學研究所
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:2008
畢業學年度:96
論文頁數:156
中文關鍵詞:妥瑞症當期學習平衡前置姿勢調整
外文關鍵詞:Tourette syndromewithin-session learningbalanceanticipatory postural adjustment
相關次數:
  • 被引用被引用:3
  • 點閱點閱:770
  • 評分評分:
  • 下載下載:64
  • 收藏至我的研究室書目清單書目收藏:2
背景與目的:前置性姿勢調整(anticipatory postural adjustment, APA)是姿勢控制中重要的一環,主要功能在於降低因自主動作所伴隨而來的姿勢干擾,增加姿勢穩定度或協助自主動作的產生,是一種經由學習而習得的姿態調整能力。妥瑞症(Tourette syndrome)是一種神經生物學上的疾病,好發於兒童時期,於18歲以前會被診斷。過去的研究中,顯示妥瑞症兒童的姿勢控制相較於正常發展兒童,在靜態平衡下的姿勢晃動(postural sway)較大且較快,顯示姿勢控制有異常存在。因此本研究的目的是描述並比較妥瑞症兒童與正常兒童的APA。方法:6位妥瑞症兒童以及6位正常發展兒童參與本研究。兩組的兒童皆接受為期1天、共75次在站立下密集練習伸手往前拿取一個正在移動的球的練習。實驗採用重複量測的設計,以肌電圖(electromyography, EMG)、壓力中心線(center of pressure, COP)的變化及運動學量測(kinematic measurements)評估APA能力。使用獨立t檢定與重複量數變異數分析比較兩組兒童APA表現差異。結果:妥瑞症兒童與正常發展兒童皆已出現基本APA的型態,如COPy向後移動。但兩組之間仍有顯著差異,包含妥瑞症兒童COPy向後移動的基本型態出現次數較少(p=0.03)、妥瑞症兒童姿勢調整動作之啟動較慢(p<0.001),以及伸手取物動作與COPy向後移動協調較差(p=0.02)。正常發展組兒童的APA在75次練習可以觀察,同側脛前肌先活化的使用更為一致(p<0.05),伸手取物動作與COPy向後移動姿勢控制的連結時間差變短(p=0.01),但妥瑞症兒童組則未觀察到經練習產生任何改變的趨勢。討論:本研究結果顯示以「站立下,伸手向前拿取移動中的球」的任務而言,妥瑞症兒童的APA能力明顯較正常發展兒童差。此外,正常兒童在75次的練習中可觀察到APA當期練習變化,妥瑞症兒童則無。因此,未來應更進一步探討妥瑞症兒童的動作控制、動作學習困難的導因和進程,與相關訓練模式之發展。
Background and Purpose: Anticipatory postural adjustment (APA) is a postural strategy that actively initiates movements to anticipate and counteract disturbances of balance in a feed-forward manner. It is acquired by learning from past experiences of execution. Tourette syndrome (TS) is a neurobiological disorder that usually has an onset in childhood and is diagnosed before the individual is 18 years of age. Previous studies indicated that children with TS demonstrated greater and faster postural sway during static standing compared to healthy controls. This suggested that children with TS might demonstrate some abnormality in postural control. The purpose of this study was to describe and compare the acquisition of APA in children with TS and those with typical development. Methods: Six children with TS and 6 children with healthy control participated in this study. Within 1 day, the children practiced the functional forward reach task with moving targets for 75 trials. We used the repeated-measures design with the control group in this study. APAs were evaluated by recording changes in electromyography (EMG), center of pressure (COP), and kinematic measurements. Independent t-test and repeated measure analysis of variance were used for comparison of the differences between the 2 groups. Results: Both the TS and control groups developed basic APA patterns, such as posterior shift of COPy. There were significant differences, including inconsistent posterior shifting of COPy (p = 0.03), late onset of APA (p < 0.001), and longer time delay between the onset of posterior shift of COPy and the initiation of hand movements (p = 0.02) in children with TS than the healthy control children. Following 75 trials, significantly consistent usage of the anterior tibialis during the APA period (p < 0.05) and shortening of the time delay between the onset of the posterior shift of COPy and the initiation of hand movements (p = 0.01) were observed only in the healthy control group, but not in the TS group. Discussion: The results of this study demonstrated that children with TS demonstrated worse APA than the healthy controls. In addition, the acquisition of APA was not observed in children with TS after 75 trials of practice. The reason and progress of the difficulties of motor control and motor learning of children with TS have to be discussed and related training models should be developed in further studies.
目 錄
指導教授推薦書………………………………………………………...Ⅲ
口試委員審定書………………………………………………………...Ⅳ
授權書…………………………………………………………………...Ⅴ
誌謝……………………………………………………………………...Ⅵ
中文摘要...................................................................................................Ⅷ
英文摘要………………………………………………………………...Ⅹ
目錄………………………………………………………………...…ⅩⅡ
圖目錄………………………………………………………………...ⅩⅥ
表目錄………………………………………………………………...ⅩⅦ
第一章 前言…………………………………………………………….1
1.1研究背景….…………………………………………….………….1
1.2研究目的及假說……………………………………………….…..5
1.3名詞定義…………………………………………….……………..6
第二章 文獻回顧……………………………………………….………9
2.1 妥瑞症…………………………………………….……………….9
2.1.1妥瑞症的相關檢查,評估與診斷……………………………10
2.1.2妥瑞症的預後………………………………………………...17
2.2影響兒童前置性姿勢調整的因子………………...………….......19
2.2.1 個體的差異對前置性姿勢調整的影響…………...…..........19
2.2.2 學習的影響..............................................................................22
2.3妥瑞症病灶在於前置性姿勢調整的角色……………………….24
2.3.1 大腦基底核在於前置性姿勢調整的角色………….............24
2.3.2 小腦在於前置性姿勢調整的角色..........................................26
第三章 研究方法……………………………………………….……..31
3.1 受試兒童……………………………………….……….………..31
3.2 實驗儀器…………………………………………………..……..33
3.2.1 評估活動儀器…………………………………...….……….33
3.2.2 評估記錄儀器……………………………………………….33
3.3 實驗步驟…………………………………………….…………...35
3.3.1 臨床評估測試……………………………………….………35
3.3.2 前置性姿勢調整評估測試………………………………….36
3.4 資料處理與分析…........…………………………………………39
3.4.1 運動學分析……………...………………………….……….39
3.4.2 表面肌電訊號圖分析………...……………………………..40
3.4.3 壓力中心與動力學(Kinetic)分析………...……………..….41
3.5 統計分析…………………………………………….…………...43
第四章 研究結果……………………………………………….……..51
4.1 妥瑞症兒童與正常發展兒童的動作表現.……….……………..51
4.1.1自主伸手取物動作………...………………….……………..51
4.1.2前置性姿勢調整………...………………………….………..52
4.2 正常發展兒童經由當期學習前置性姿勢控制的變化……..…..59
4.3 妥瑞症兒童經由當期學習前置性姿勢控制的變化………..…..62
4.4 妥瑞症兒童與正常發展兒童前置性姿勢調整之當期學習差異65
第五章 討論………...…………………………………..……………..88
5.1 妥瑞症兒童與正常發展兒童的前置性姿勢調整差異…..……..88
5.2 正常發展兒童前置性姿勢調整之當期學習變化………………94
5.3 妥瑞症兒童前置性姿勢調整之當期學習變化………..........…..97
5.4 研究限制………..........................………………………………100
5.5 臨床意義………...…………………........………...……………102
第六章 結論………...…………………………………..……………105
參考文獻……………………………………………….………………106
附錄…………………………………………………………………….......
附錄一 基本資料表格及實驗紀錄表…………………………….114
附錄二 受試者同意書…………………………………………….120
附錄三 耶魯tic總嚴重度量表(Yale Global tic Severity Scale)….129
附錄四 人體試驗同意書………………………………………….133
附錄五 妥瑞症與正常發展兒童比較結果表………………….134
附錄六 過去文獻與本研究比較討論表………………………….137
附錄七 合併其他共病症之受試兒童基本資料………………….139


圖 目 錄
圖2-1 CINAHL, Medline電子資料庫文獻搜尋……...…...…………...28
圖2-2 文獻搜尋結果………………………………………..……….....29
圖2-3 國際功能分類系統-妥瑞症兒童…………………..………….30
圖3-1 實驗設置………………………………………………………...45
圖3-2 TS01與Control01單一個案在五段落間COPy移動情形比較...46
圖3-3 TS01與Control01單一個案在五段落間APA onset latency改變比較...…………………………………………………………………....47
圖3-4 TS01與Control01單一個案在五段落間APA time delay改變比較...……………………………………………………………….……...48
圖4-1 比較TS與Control group time delay改變………………………56
圖4-2 Control group 5段落中COPy向後移動time delay改變情形...…….68
圖4-3 TS group 5段落中COPy向後移動time delay改變情形…...………69
圖5-1 TS group年齡與COPy起始延緩時間關係圖...……..……………103


表 目 錄
表3-1 受試兒童基本資料………………………..…………………...49
表3-2 受試兒童基本資料-妥瑞症兒童……………………………...50
表4-1空間參數-APA最佳時間內型態表現…………………………...57
表4-2量性參數-肌肉的iEMG值…………….………………………...58
表4-3正常發展兒童在五段落間姿勢調整動作空間參數表現之比較70
表4-4正常發展兒童在五段落間APA最佳時間內空間參數表現之比較.………………………………………………………………………..71
表4-5正常發展兒童在五段落間姿勢調整動作時間參數表現之比較72
表4-6正常發展兒童在五段落間姿勢調整動作下肢各肌肉APA iEMG表現之比較…………………………………………………...…….…...73
表4-7正常發展兒童五段落間伸手取物動作與姿勢調整動作之間協調之比較..………………………………………………………………….75
表4-8妥瑞症兒童五段落間姿勢調整動作空間參數表現之比較…....76
表4-9妥瑞症兒童APA最佳時間內空間參數表現之比較…................77
表4-10妥瑞症兒童姿勢調整動作時間參數表現之比較…………......78
表4-11妥瑞症兒童姿勢調整動作下肢各肌肉APA iEMG表現之比較………………...………………………………………………….…...79
表4-12妥瑞症兒童伸手取物動作與姿勢調整動作之間協調表現之比較…………...……………………………………………………………81
表4-13兩組兒童在五段落間姿勢調整動作空間參數上學習之比較..82
表4-14兩組兒童五段落間APA最佳時間空間參數之比較…...……...83
表4-15兩組兒童在五段落間姿勢調整動作時間參數之比較……......84
表4-16兩組兒童在五段落間姿勢調整動作調整動作下肢各肌肉APA iEMG值之比較……………..…………………………………….........85
表4-17兩組兒童在五段落間伸手取物動作與姿勢調整動作之間協調表現之比較……………..……………..………………………………...87
表5-1 妥瑞症兒童、帕金森氏症病患、小腦損傷患者與正常發展兒童APA差異……………………………….……………………………...104
1. Albin RL, Mink JW. Recent advances in Tourette syndrome research. TRENDS in Neurosciences 29(3): 175-182, 2006.
2. Aruin AS, Almeida GL. A coactivation strategy in anticipatory postural adjustments in persons with Down syndrome. Motor Control 1:178-191, 1997.
3. Aruin AS, Neyman I, and Nicholas JJ et al., Are there deficits in anticipatory postural adjustments in Parkinson’s disease? NeuroReport 7: 1794-1796, 1996.
4. Aruin AS. The organization of anticipatory postural adjustments. J ournal of Automatic Control 12:31-37, 2002.
5. Aruin AS, Shiratori T. Anticipatory postural adjustment while sitting: The effects of different leg supports. Experimental Brain Research 151: 46-53, 2003.
6. Assaiante C, Woollacott M, and Amblard B. Development of postural adjustment during gait initiation: kinematic and EMG analysis. Journal of Motor Behavior 32: 211-226, 2000.
7. Bax M, Goldstein M, and Rosenbaum P et al., Proposed definition and classification of cerebral palsy. Developmental Medicine Child Neurology 47:571-576, 2005.
8. Bloch MH, Peterson BS, and Scahill L et al., Adulthood outcome of tic and obsessive-compulsive symptom severity in children with Tourette syndrome. Arch Pediatric Adolescence Medicine 160: 65-69, 2007.
9. Bloch MH, Sukhodolsky DG, and Leckman JF et al., Fine-motor skill deficits in childhood predict adulthood tic severity and global psychosocial functioning in Tourette’s syndrome. Journal of Child Psychology and Psychiatry 47(6): 551-559, 2006.
10. Carter JH. Tics through Tourette's syndrome. Journal of Neuroscience Nursing 23(3): 145-147, 1991.
11. Chappell PB. and McSwiggan-Hardin MT. Videotape tic counts in the assessment of Tourette's syndrome: stability, reliability, and validity. Journal of the American Academy of Child & Adolescent Psychiatry 33(3): 386-393, 1994.
12. Dickstein R, Shefi S, and Marcovitz E et al., Anticipatory postural adjustment in selected trunk muscles in post stroke hemiparetic patients. Arch Physical Medicine Rehabilitation. 85(2):261-267, 2004.
13. Elble RJ, Leffler K. Pushing and pulling with the upper extremities while standing: the effects of mild Alzheimer dementia and Parkinson's disease. Movement Disorder. 15(2):255-268, 2000.
14. Elstner K, Selai CE, and Trimble MR et al., Quality of life(QOL) of patients with Gilles de la Tourette’s Syndrome. Actu Psychiatry Scandinavia. 103:52-59,2001.
15. Franjoine MR, Gunther JS. Pediatric Balance Scale: A modified version of the Berg Balance Scale for the school-age child with mild to moderate motor impairment. Pediatric physical therapy 15:114–128, 2003.
16. Frank JS, Earl M. Coordination of posture and movement. Physical Therapy. 70:855-863, 1990.
17. Geuze RH. Postural control in children with developmental coordination disorder. Neural Plastisity. 12(2-3):183-196, 2005.
18. Goetz CG, Kompoliti K. Rating scales and quantitative assessment of tics. Advances in Neurology. 85: 31-42, 2001.
19. Haas G, Diener HC, and Rapp H et al. Development of feedback and feedforward control of upright stance. Developmental Medicine & Child Neurology. 31: 481-488, 1989.
20. Hadders-Algra M. The neuronal group selection theory: promising principles for understanding and treating developmental motor disorders. Developmental Medicine & Child Neurology. 42: 707-715, 2000.
21. Hadders-Algra M, Brogren E, Forssberg H. Ontogeny of postural adjustments during sitting in infancy: variation, selection and modulation. Journal of Physiology. 493: 273-288, 1996a.
22. Hadders-Algra M, Brogren E, Forssberg H. Training affects the development of postural adjustments in sitting infants. Journal of Physiology. 493: 289-298, 1996b.
23. Himle MB, Chang S. Establishing the feasibility of direct observation in the assessment of tics in children with chronic tic disorders. Journal of Applied Behavior Analysis. 39(4): 429-40, 2006.
24. Jacobs JV, Horak FB. Cortical control of postural responses. Journal of Neural Transmision. 114: 1339–1348, 2007.
25. Kenji D, Complementary roles of basal ganglia and cerebellum in learing and motor control. Current Opinion in Neurobiology. 10:732-739, 2000.
26. Kompoliti K, Goetz CG. Tourette syndrome. Clinical rating and quantitative assessment of tics. Neurologic Clinics. 15(2): 239-254, 1997.
27. Latash ML, Aruin AS, and Neyman I et al., Anticipatory postural adjustments during self inflicted and predictable perturbations in Parkinson's disease. Journal of Neurology, Neurosurgery & Psychiatry. 58:326-34, 1995.
28. Latash ML, Krishnamoorthy V, and Scholz JP et al., Postural synergies and their development. Neural Plastisity. 12(2-3): 119-130, 2005.
29. Leckman JF, Riddle MA and Hardin MT et al., The Yale Global Tic Severity Scale: Initial testing of a clinician-rated scale of tic severity. Journal of the American Academy of Child and Adolescent Psychiatry. 28 : 566-573, 1989.
30. Leckman JF. Tourette’s syndrome. 360:1577-1586, 2002.
31. Lemay M, Termoz N, and Lesperance P et al., Postural control anomalies in children with Tourette syndrome. Experimental Brain Research. 179(3):525-530, 2007.
32. Liu WY. Anticipatory postural adjustments in children with cerebral palsy and children with typical development during forward reach tasks in standing, Ph.D dissertation. MCP Hahnemann University, 2001.
33. Liu WY. Zaino CA. and McCoy SW. Anticipatory postural adjustments in children with cerebral palsy and children with typical development. Pediatric Physical Therapy. 19(3):188-95, 2007.
34. Luft RA, Buitrago MM. Stages of Motor Skill Learning. Molecular Neurobiology. 32(3):205-216, 2005.
35. Massion J. Movement, posture and equilibrium: interaction and coordination. Progress in Neurobiology. 38: 35-56, 1992.
36. Minshew NJ, Sung K, and Jones BL et al., Underdevelopment of the postural control system in autism. Neurology. 63 (11):2056-2061, 2004.
37. Nashner LM, Shumway-Cook A, Marin O. Stance postural control in select groups of children with cerebral palsy: Deficits in sensory organization and muscular coordination. Experimental Brain Research. 49: 393-409, 1983.
38. Nolan EE, Gadow KD. Observations and ratings of tics in school settings. Journal of Abnormal Child Psychology. 22(5): 579-93, 1994.
39. Paulignan Y, Dufosse N, and Hugon M et al., Acquisitino of co-ordination between posture and movement in a bimanual task. Experimental Brain Research. 77: 337-348, 1989.
40. Peterson BS, Leckman JF. The temporal dynamics of tics in Gilles de la Tourette syndrome. Biological Psychiatry. 44(12): 1337-1348, 1998.
41. Riach CL, Hayes KC. Anticipatory postural control in children. Journal of Motor Behavior. 22: 250-266, 1990.
42. Robertson MM, Banerjee S. The Tourette syndrome diagnostic confidence index: development and clinical associations. Neurology. 53(9): 2108-2112, 1999.
43. Saccomani L, Fabiana V, and Barisione M et al., Tourette syndrome and chronic tics in a sample of children and adolescents. Brain & Development. 27:349-352, 2005.
44. Schmidt RA. Motor control and learning:A Behavioral Emphasis, 2nd Edition. p.73, 343-348, 1988.
45. Schmitz C, Martin N, and Assaiante C. Buliding anticipatory postural adjustment during childhood: a kinematic and electromyography analysis of unloading in children from 4 to 8 years of age. Experimental Brain Research. 142:354-364, 2002.
46. Shumway-Cook A, Hutchinson S, and Kartin D et al., Effect of balance training on recovery of stability in children with cerebral palsy. Developmental Medicine & Child Neurology. 45:591-602, 2003.
47. Shumway-Cook A, Woollacott MH. Motor control: Theory and practice application (2nd Edition). Lippincott, Wilkins & Williams, New York, 2001.
48. Singer HS. Tourette’s syndrome: from behaviour to biology. Lancet Neurol. 4: 149-159, 2005.
49. Stern E, Silbersweig DA, and Chee KY et al., A Functional Neuroanatomy of Tics in Tourette Syndrome. Arch GenePsychiatry. 57: 741-748, 2000.
50. Storch EA, Murphy TK. Reliability and validity of the Yale Global Tic Severity Scale. Psychological Assessment. 17(4): 486-491, 2005.
51. Thelen E. Motor development: a new synthesis. American Psycologist. 50: 79-95, 1995.
52. Thelen E, Spencer JP. Postural control during reaching in young infants: a dynamic system approach. Neuroscience & Biobehavioral . 22: 507-514, 1998.
53. Timmann D, Horak FB. Perturbed step initiation in cerebellar subjects: 1. Modifications of postural responses. Experimental Brain Research. 119:73-84, 1998.
54. Timmann D, Horak FB. Perturbed step initiation in cerebellar subjects: 2. Modification of anticipatory postural adjustments Experimental Brain Research. 141:110–120, 2001.
55. van Donkelaar P, Stein JF, and Passingham RE et al., Neuronal activity in the primate motor thalamus during visually triggered and internally generated limb movements. Journal of Neurophysiology. 82: 934-945, 1999.
56. Viallet F, Massion J, and Massarino R et al., Performance of a bimanual load-lifting task by Parkinsonian patients. Journal of Neurology, Neurosurgery, and Psychiatry. 50: 1274-1283, 1987.
57. Walkup JT, Rosenberg LA. The validity of instruments measuring tic severity in Tourette's syndrome. Journal of the American Academy of Child & Adolescent Psychiatry. 31(3): 472-7, 1992.
58. Zinner SH. Tourette syndrome in infancy and early childhood. Infant & Young Children. 4: 353-370, 2006.
59. 王煇雄,郭夢菲。又抖又叫-鬥陣妥瑞症。台北:新迪圖書;1999。
60. 胡名霞。動作控制與動作學習。台北:金名圖書;2003。
61. 張蕙如。大量練習平衡訓練對於腦性麻痺兒童前置姿勢調整的影響。長庚大學復健科學研究所。碩士論文;2006
62. 林子崴。自主動作之感覺經驗對預期性姿勢調控習得過程之影響。長庚大學復健科學研究所。碩士論文;2005
63. 徐琳雅、劉文瑜、連恆裕、黃美涓、鄧復旦、陳嘉玲。腦性麻痺及正常發展兒童之前置性姿勢調整的動作學習。2006年中華民國物理治療學會第五十四屆學術論文研討會(摘要)。
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top