臺灣博碩士論文加值系統

研究背景與目的：移動任務為個體透過雙腳將身體從一地移動至另一地的動作。個體在執行移動任務時會透過下肢肢體內的動作，產生一個適當的協調模式，以完成所需的動作任務。過去的研究指出個體隨著年齡增加，其肌肉力量以及生理構造皆會改變，動作能力亦隨之增進，然而過去研究較少探討個體肢體協調的策略，肢體協調策略的年齡發展趨勢也不清楚。因此本研究主要的目的即為探討不同年齡層之間的正常發展兒童在執行行走、雙腳連續向前跳、單腳連續向前跳等移動任務時的下肢肢體內協調的策略差異，以及下肢肢體內協調能力之發展趨勢。方法：本研究共徵招60位正常發展兒童以及20位健康年輕成年人，其中正常發展兒童依照年齡分成4-6歲、7-9歲、10-12歲三組各20名；分別執行行走、雙腳連續向前跳、單腳連續向前跳等三項移動任務。本研究依據平面共變定律，採用主成份分析法分析下肢肢體內之協調能力、執行動作任務時之各關節仰角角度擺動幅度以及第一與第二主成份特徵值之比值。 結果：各組分別在執行行走、雙腳連續向前跳以及單腳連續向前跳動作任務時，各關節之仰角角度擺動幅度皆呈現相似的差異性：踝關節〉膝關節〉髖關節（p 〈 0.01）；而4-6歲兒童執行雙腳連續向前跳時，踝關節仰角角度擺動幅度顯著大於健康年輕成年人（p 〈 0.01），7-9歲兒童之踝關節仰角角度擺動幅度顯著亦大於健康年輕成年人（p = 0.34），透過線性比對分析發現，各組踝關節之仰角擺動幅度隨著年齡的增加，而顯著呈現出仰角擺動幅度下降的趨勢（p 〈 0.01）；而單腳連續向前跳方面，4-6歲之踝關節仰角角度擺動幅度顯著大於健康年輕成年人（p 〈 0.01），而7-9歲兒童之踝關節仰角角度擺動幅度亦顯著大於健康年輕成年人（p = 0.36），透過線性比對分析發現，各組踝關節之仰角擺動幅度隨著年齡的增加，而顯著呈現出仰角擺動幅度下降的趨勢（p 〈 0.01）；平面化指標結果顯示：個體呈現之平面化指標隨著年齡的增加，而有顯著增加的趨勢（p 〈 0.01），4-6歲兒童執行行走（p = 0.011）以及雙腳連續向前跳（p 〈 0.01）時，平面化指標顯著地低於健康年輕成年人，而4-6歲與7-9歲以及10-12歲兒童之間的差異未達統計顯著；於單腳連續向前跳任務中，受試者間呈現顯著的年齡發展趨勢：4-6歲的平面化指標顯著低於7-9歲（p = 0.016）、10-12歲（p 〈 0.01）以及健康年輕成年人（p 〈 0.01）；7-9歲也顯著的低於10-12歲（p 〈 0.01）以及健康年輕成年人（p 〈 0.01），而10-12歲與健康年輕成年人之間的差異未達統計顯著；第一與第二主成份特徵值之比值方面，顯示不同任務之間之特徵值比值有顯著差異：行走動作任務之特徵值比值顯著大於雙腳連續向前跳（p 〈 0.01）以及單腳連續向前跳（p 〈 0.01）。 結論：正常發展兒童於行走、雙腳連續向前跳以及單腳連續向前跳的移動任務所呈現之肢體內協調，皆隨著年齡的增加有成長的趨勢，大約於4-6歲時，即發展出成熟的行走及雙腳連續向前跳時的協調能力，而單腳連續向前跳屬於較困難的動作，因此此動作之協調能力發展較慢，需要之成熟年齡較長，大約至10-12歲之後才逐漸發展出與年輕成年人相當的協調能力；而個體執行不同移動任務時，又因使用不同的協調策略造成不同的下肢線性耦合程度，了解正常兒童肢體內協調之發展有助於臨床評估動作協調不良之兒童的問題，進一步針對兒童下肢之動作控制以及協調進行訓練，或許為一促進動作發展的好方法。

Background and Purpose: A mature locomotion is reflected as an ability of assembling and maintaining a series of proper spatial and temporal relationship of pelvis, thigh, shank and foot. It is well known that the muscle strength, limb length and limb stability increase with growth in childhood. However, the developmental pattern of intra-limb coordination of locomotion tasks and the possible differences in the strategy of intra-limb coordination of locomotion tasks in preschool children and children of school age are yet clear. The purpose of this study was to examine the developmental pattern of the intra-limb coordination in typically developing (TD) children while they were performing three locomotion tasks. Methods: A total of 60 TD children with 20 of each age group (4-6 years, 7-9 years and 10-12 years) and 20 healthy young adults participated in the study and performed three locomotion tasks in self-selected speed: walking, consecutive forward jumping and consecutive forward hopping. A six camera motion capture system was used to collect the kinematic data of the lower limbs. The planar co-variation principles and the principal component analysis were used to analyze each segment elevation angle, their contribution into a planarity configuration and their inter-dependency. Results: The differences of range of elevation angle among groups existed in jumping and hopping tasks. TD children of 4-6 years and 7-9 years had larger range ankle elevation angle than young adults in both jumping (4-6 years vs. adults, p 〈 0.01; 7-9 years vs. adults, p = 0.034) and hopping (4-6 years vs. adults, p 〈 0.01; 7-9 years vs. adults, p = 0.036) tasks. With regards to the planarity index, the children of 4-6 years showed smaller index than young adults in walking and jumping tasks (walk, p = 0.011; jump, p 〈 0.01); Children with 4-6 years and of 7-9 years had smaller indices than young adults in hopping (4-6 years, p 〈 0.01; 7-9 years, p 〈 0.01), but there was not significant differences between children of 10-12 years and young adults in the hopping task. The differences among tasks in the ratio of λ1 to λ2 showed that the walking task had larger ratio compared to the jumping and hopping tasks (jump: p 〈 0.01; hop: p 〈 0.01). Conclusions: TD children at the age of 4-6 year may have already developed similar intra-limb coordination to adults in walking, jumping but not hopping until at the age of 10-12 year. However, younger children (4-6 years and 7-9 years) present inferior coordination in hopping with larger ankle elevation angle than elder participants (10-12 years TD and adults group). It may be due to the reason that younger children have insufficient muscle strength and joint stability over their distal limbs to accommodate the difficult locomotion task (hopping). Understanding the development of the intra-limb coordination of TD children may help with the evaluation of the motor strategy in children with motor coordination disorder.

目錄
中文摘要……………………………………………………………………………….I
英文摘要……………………………………………………………………………..III
致謝…………………………………………………………………………………...V
目錄…………………………………………………………………………………..VI
第一章　緒論………………………………………………………………………………1
1.1 移動任務………………………………………………………………………1
1.1.1 定義與重要性…………………………………………………………..…1
1.1.2 肢體內協調……………………………………………………………..…2
1.1.3 動態系統理論…………………………………………………………..…3
1.1.4 影響移動任務能力及表現之因素…………………………………..……4
1.2 移動任務能力及下肢動作協調之發展………………………………………6
1.3 肢體內協調分析方法…………………………………………………………8
1.3.1 平面共變定律……………………………………………………………8
1.3.2 平面共變定律之假說……………………………………………………11
1.3.3 主成份分析及共變角度之統計特色量化………………………………12
1.3.4 平面共變定律之結論……………………………………………………14
1.4 研究目的與假設……………………………………………………………15
1.4.1 研究目的…………………………………………………………………15
1.4.2 研究假設…………………………………………………………………15
第二章　研究方法……………………………………………………………………16
2.1 研究對象……………………………………………………………………16
2.1.1 正常發展兒童……………………………………………………………16
2.1.2 年輕成年人………………………………………………………………16
2.2 測驗工具 …………………………………………………………………17
2.2.1 兒童動作評估測驗－第二版……………………………………………17
2.2.2 畢保德圖畫詞彙測驗－修訂版…………………………………………18
2.3 實驗設備 …………………………………………………………………19
2.4 實驗流程 …………………………………………………………………21
2.5 實驗任務 …………………………………………………………………23
2.5.1 行走………………………………………………………………………24
2.5.2 雙腳連續向前跳…………………………………………………………24
2.5.3 單腳連續向前跳…………………………………………………………24
2.6 資料擷取與分析 …………………………………………………………25
2.6.1 運動學資料擷取…………………………………………………………25
2.6.2 資料分析…………………………………………………………………25
2.7 統計分析 …………………………………………………………………28
第三章　研究結果 ……………………………………………………………………29
3.1 基本資料及基本測試 ……………………………………………………29
3.2 髖關節、膝關節以及踝關節之仰角角度擺動幅度 ……………………31
3.2.1 行走………………………………………………………………………31
3.2.2 雙腳連續向前跳…………………………………………………………33
3.2.3 單腳連續向前跳…………………………………………………………36
3.3 平面化指標 ………………………………………………………………39
3.3.1 行走………………………………………………………………………39
3.3.2 雙腳連續向前跳…………………………………………………………39
3.3.3 單腳連續向前跳…………………………………………………………40
3.4 第一與第二主成份特徵值之比值 ………………………………………43
第四章　討論 …………………………………………………………………………44
4.1 髖關節、膝關節以及踝關節之仰角角度擺動幅度 ……………………45
4.1.1 行走………………………………………………………………………46
4.1.2 雙腳連續向前跳與單腳連續向前跳……………………………………46
4.2 平面化指標 ………………………………………………………………49
4.2.1 行走………………………………………………………………………50
4.2.2 雙腳連續向前跳…………………………………………………………50
4.2.3 單腳連續向前跳…………………………………………………………51
4.3 第一與第二主成份特徵值之比值 ………………………………………53
4.4 研究限制與未來研究方向之建議 ………………………………………54
第五章　結論與臨床意義 ……………………………………………………………55
第六章　參考文獻 ……………………………………………………………………56

 
表目錄
表一、受試者基本資料與基礎能力檢測結果………………………………………30
表二、雙腳連續向前跳時各組別間關節仰角角度擺動幅度之線性比對分析結果.35
表三、單腳連續向前跳時各組別間關節仰角角度擺動幅度之線性比對分析結果.38
表四、各組別間平面化指標之線性比對分析結果 ......................42

圖目錄
圖一、平面共變定律（Planar co-variation law）主要定義………………10
圖二、本研究反光球放置位置：雙側的下肢之25個骨突標的處 …………………20
圖三、實驗流程圖 ……………………………………………………………………22
圖四、實驗設置與動作任務 …………………………………………………………23
圖五、主成份分析後之特徵值 ………………………………………………………26
圖六、各關節仰角角度擺動幅度於行走動作任務週期之變化 ……………………32
圖七、行走動作任務之各關節仰角角度擺動幅度情形 ……………………………32
圖八、各關節仰角角度擺動幅於雙腳連續向前跳動作任務週期之變化 …………34
圖九、雙腳連續向前跳動作任務之各關節仰角角度擺動幅度情形 ………………34
圖十、雙腳連續向前跳時各關節仰角角度擺動幅度隨年齡增加之變化趨勢 ……35
圖十一、各關節仰角角度於雙腳連續向前跳動作任務週期之變化 ………………37
圖十二、單腳連續向前跳動作任務之各關節仰角角度擺動幅度情形 ……………37
圖十三、單腳連續向前跳時各關節仰角角度擺動幅度隨年齡增加之變化趨勢 …38
圖十四、不同年齡層受試者於不同動作任務時之平面化指標 ……………………41
圖十五、各組別間平面化指標隨年齡增加之變化趨勢 ……………………………42
圖十六、不同年齡層受試者於不同動作任務時之第一與第二主成份特徵值之比值43

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
American Psychiatric Association. (2010). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: Author.
Berger, W., Altenmueller, E., ＆ Dietz, V. (1984). Normal and impaired development of children's gait. Human Neurobiology, 3(3), 163-170.
Bianchi, L., Angelini, D., ＆ Lacquaniti, F. (1998). Individual characteristics of human walking mechanics. Pflügers Archiv - European Journal of Physiology, 436(3), 343-356.
Bianchi, L., Angelini, D., Orani, G. P., ＆ Lacquaniti, F. (1998). Kinematic coordination in human gait: relation to mechanical energy cost. Journal of Neurophysiology, 79(4), 2155-2170.
Borghese, N. A., Bianchi, L., ＆ Lacquaniti, F. (1996). Kinematic determinants of human locomotion. The Journal of Physiology, 494(Pt3), 863-879.
Brauer, S. G., Woollacott, M., ＆ Shumway-Cook, A. (2001). The interacting effects of cognitive demand and recovery of postural stability in balance-impaired elderly persons. The Journal of Gerontology, Series A: Biological Sciences and The Journal of Gerontology: Medical Sciences, 56(8), M489-496.
Brown, C., Bowser, B., ＆ Simpson, K. J. (2012). Movement variability during single leg jump landings in individuals with and without chronic ankle instability. Clinical Biomechanics (Bristol, Avon), 27(1), 52-63.
Cermak, S., ＆ Larkin, D. (2002). Developmental coordination disorder. Albany, NY: Delmar.
Cheron, G., Bouillot, E., Dan, B., Bengoetxea, A., Draye, J. P., ＆ Lacquaniti, F. (2001). Development of a kinematic coordination pattern in toddler locomotion: planar covariation. Experimental Brain Research, 137(3-4), 455-466.
Clark, J. E., ＆ Whitall, J. (1989). Development of posture and gait across the life span. Columbia, SC: University of South Carolina Press.
Deconinck, F. J., De Clercq, D., Savelsbergh, G. J., Van Coster, R., Oostra, A., Dewitte, G., ＆ Lenoir, M. (2006). Differences in gait between children with and without developmental coordination disorder. Motor Control, 10(2), 125-142.
Dejnabadi, H., Jolles, B. M., ＆ Aminian, K. (2008). A new approach for quantitative analysis of inter-joint coordination during gait. IEEE Transactions on Biomedical Engineering, 55(2 Pt 1), 755-764.
Dobson, V., ＆ Teller, D. Y. (1978). Visual acuity in human infants: a review and comparison of behavioral and electrophysiological studies. Vision Research, 18(11), 1469-1483.
Dominici, N., Ivanenko, Y. P., Cappellini, G., Zampagni, M. L., ＆ Lacquaniti, F. (2010). Kinematic strategies in newly walking toddlers stepping over different support surfaces. Journal of Neurophysiology, 103(3), 1673-1684.
Duysens, J., ＆ Van de Crommert, H. W. (1998). Neural control of locomotion; The central pattern generator from cats to humans. Gait ＆ Posture, 7(2), 131-141.
Foch, E., ＆ Milner, C. E. (2012). Lower extremity joint position sense in runners with and without a history of knee overuse injury. Gait ＆ Posture. doi: 10.1016/ j.gaitpost.2012.05.011.
Folio, M. R., ＆ Fewell, R. R. (2000). Peabody Developmental Motor Scales Examiner’s Manual (2nd ed.). Austin, TX: Pro-Ed.
Gabbard, C. P. (1996). Lifelong motor development (2nd ed.). Dubuque, IA: Brown ＆ Benchmark.
Ghanem, I., ＆ Seringe, R. (1995). Comparison of evaluation methods of the results of congenital clubfoot treatment. Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 81(7), 615-621.
Haddad, J. M., van Emmerik, R. E., Wheat, J. S., Hamill, J., ＆ Snapp-Childs, W. (2010). Relative phase coordination analysis in the assessment of dynamic gait symmetry. Journal of Applied Biomechanics, 26(1), 109-113.
Hallemans, A., ＆ Aerts, P. (2009). Effects of visual deprivation on intra-limb coordination during walking in children and adults. Experimental Brain Research, 198(1), 95-106.
Haywood, K., ＆ Getchell, N. (2005). Life Span Motor Development (4th ed.). Champaign, IL: Human Kinetics.
Haywood, K. ＆ Getchell, N. (2009). Life Span Motor Development (5th ed.). Champaign, IL: Human Kinetics.
Henderson, S. E., Sugden, D. A., ＆ Barnett, A. L. (2007). Movement assessment battery for children-2 second edition [Movement ABC-2]. London, UK: The Psychological Corporation.
Holm, I., Tveter, A. T., Fredriksen, P. M., ＆ Vollestad, N. (2009). A normative sample of gait and hopping on one leg parameters in children 7-12 years of age. Gait ＆ Posture, 29(2), 317-321.
Ivanenko, Y. P., Cappellini, G., Dominici, N., Poppele, R. E., ＆ Lacquaniti, F. (2007). Modular control of limb movements during human locomotion. The Journal of Neuroscience, 27(41), 11149-11161.
Ivanenko, Y. P., d'Avella, A., Poppele, R. E., ＆ Lacquaniti, F. (2008). On the origin of planar covariation of elevation angles during human locomotion. Journal of Neurophysiology, 99(4), 1890-1898.
Jolliffe, I. T. (2002). Principal component analysis. New York, NY: Springer.
Krasovsky, T., ＆ Levin, M. F. (2010). Review: toward a better understanding of coordination in healthy and poststroke gait. Neurorehabilitation and Neural Repair, 24(3), 213-224.
Kugler, P. N., ＆ Turvey, M. T. (1987). Information, natural law, and the sev-assembly of rhythmic movement. Hillsdale, NJ: Erlbaum.
Miller, R. H., Chang, R., Baird, J. L., Van Emmerik, R. E., ＆ Hamill, J. (2010). Variability in kinematic coupling assessed by vector coding and continuous relative phase. Journal of Biomechanics, 43(13), 2554-2560.
Missiuna, C., ＆ Pollock, N. (1995). Beyond the norms: Need for multiple sources of data in the assessment of children. Physical ＆ Occupational Therapy in Pediatrics, 15(4), 57-74.
Mitchell, D., Davis, B., ＆ Lopez, R. (2002). Teaching fundamental gymnastics skills. Champaign, IL: Human Kinetics.
Oberg, T., Karsznia, A., ＆ Oberg, K. (1994). Joint angle parameters in gait: reference data for normal subjects, 10-79 years of age. Journal of Rehabilitation Research and Development, 31(3), 199-213.
Okamoto, T., ＆ Kumamoto, M. (1972). Electromyographic study of the learning process of walking in infants. Electromyography and Clinical Neurophysiology, 12(2), 149-158.
Parker, H. E., Larkin, D., ＆ Ackland, T. R. (1993). Stability and change in children's skill. Psychological Research, 55(2), 182-189.
Paroczai, R., ＆ Kocsis, L. (2006). Analysis of human walking and running parameters as a function of speed. Technology and Health Care, 14(4-5), 251-260.
Perry, S.B. (1998). Clinical implications of a dynamic systems theory. Neurology Report, 22 (1), 4-10.
Raynor, A. J. (2001). Strength, power, and coactivation in children with developmental coordination disorder. Developmental Medicine and Child Neurology, 43(10), 676-684.
Rink, J. E., Hall, T. J., ＆ Williams, L. H. (2010). Schoolwide physical activity: A comprehensive guide to designing and conducting programs. Champaign, IL: Human Kinetics.
Rose,J., ＆ Gamble J. G (2005).Human Walking (3rd ed.). Philadelphia, PA:Lippincott Williams ＆ Wilkins
Stansfield, B. W., Hillman, S. J., Hazlewood, M. E., ＆ Robb, J. E. (2006). Regression analysis of gait parameters with speed in normal children walking at self-selected speeds. Gait ＆ Posture, 23(3), 288-294.
Schoner, G., ＆ Kelso, J. A. (1988). Dynamic pattern generation in behavioral and neural systems. Science, 239(4847), 1513-1520.
Shetreat-Klein, M., Shinnar, S., ＆ Rapin, I. (2012). Abnormalities of joint mobility and gait in children with autism spectrum disorders. Brain Dev. doi: 10.1016/ j.braindev.2012.02.005
Shumway-Cook, A., ＆ Woollacott, M. H. (1985). The growth of stability: postural control from a development perspective. Journal of Motor Behavior, 17(2), 131-147.
Shumway-Cook, A., ＆ Woollacott, M. H. (2000). Attentional demands and postural control: the effect of sensory context. The Journal of Gerontology, Series A: Biological Sciences and The Journal of Gerontology: Medical Sciences., 55(1), M10-16.
Staszkiewicz, R., Chwala, W., Forczek, W., ＆ Laska, J. (2012). Influence of surface on kinematic gait parameters and lower extremity joints mobility. Acta of Bioengineering and Biomechanics, 14(1), 75-82.
Thelen, E., ＆ Ulrich, B. D. (1991). Hidden skills: a dynamic systems analysis of treadmill stepping during the first year. Monographs of the Society for Research in Child Development, 56(1), 1-98; discussion 99-104.
Tveter, A. T., ＆ Holm, I. (2010). Influence of thigh muscle strength and balance on hop length in one-legged hopping in children aged 7-12 years. Gait ＆ Posture, 32(2), 259-262.
Woollacott, M. H., ＆ Jensen, J. L. (1996). Posture and locomotion. In: H. Heuer ＆ S. Keele (Eds.), Handbook of Perception and Action (pp. 333-403). London: Academic Press.
Zwicker, J. G., Missiuna, C., ＆ Boyd, L. A. (2009). Neural correlates of developmental coordination disorder: a review of hypotheses. Journal of Child Neurology, 24(10), 1273-1281.
成戎珠（1994）。動作發展新理論－動力系統理論之介紹。中華民國物理治療學會雜誌，（19-1），88-98。
陳正昌、程炳林、陳新豐、劉子鍵（2005）。多變量分析方法－統計軟體應用（第四版）。台北市：五南出版社。
陳順宇（2005）。多變量分析（第四版）。臺北市：華泰文化事業股份有限公司。
陸莉、劉鴻香（2005）。畢保德圖畫詞彙測驗－指導手冊（再版）。台北市：心理出版社。
廖華芳（2011）。小兒物理治療學－三版。台北市：禾楓書局有限公司。