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研究生:蔡椀宇
研究生(外文):Wan Yu Tsai
論文名稱:雙側偏癱腦性麻痺孩童之聽寫表現:從神經心理學觀點探討字屬性效應及錯誤類型
論文名稱(外文):Written spelling to dictation in children with diplegic cerebral palsy:the effects of character properties and analyses of error types from neuropsychological perspective
指導教授:孟令夫孟令夫引用關係
指導教授(外文):L. F. Meng
學位類別:碩士
校院名稱:長庚大學
系所名稱:職能治療學系
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:2016
畢業學年度:104
語文別:中文
論文頁數:198
中文關鍵詞:雙側偏癱腦性麻痺字屬性效應(繁體中文)錯誤類型聽寫字形產出字形拼寫神經心理模型
外文關鍵詞:cerebral palsy with diplegiathe effects of character properties(traditional Chinese)error typeswriting to dictationwritten productionorthographyneuropsychological model of spelling
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簡介:
由於雙側偏癱腦性麻痺孩童於各基礎功能皆可能受到影響,因此存在著 Roeltgen(2003)及Purcell、Shea與Rapp(2014)所提神經心理模型中各種歷程困難所導致的廣泛性寫字問題。而部份雙側偏癱腦性麻痺孩童之寫字錯誤類型與成人腦傷後寫特定屬性字困難的字形失寫症有所類似,例如寫形音不規則及低頻字容易出現同音別字、筆劃及部件添漏等錯誤,但文獻並未探討腦性麻痺孩童於特定屬性字之寫字表現。因此,本研究根據聽寫神經心理模型,調控字之屬性,以檢測腦麻孩童於聽寫字的整體表現,以及瞭解是否存在選擇性的屬性字效應及寫字錯誤類型。
方法:
本研究共招募16位雙側偏癱腦性麻痺孩童、30位一般發展孩童,除聽寫25個目標字(控制好字屬性中的規則性、筆劃、字頻),另亦評估聽寫相關之中央、周邊面向能力、神經學及神經心理功能等行為評估項目,除做為控制變項亦可於推導辯證追溯上游成因時作為佐證資料。並使用以下統計方式進行資料分析,(1)使用雙因子混合變異數分析(2 x 8)探討組別與屬性字對於寫字正確率之影響;(2)使用三因子混合變異數分析(2 x 8 x 19)瞭解組別、屬性字、錯誤類型對於寫字錯誤類型比例的影響;(3)使用曼惠特尼U檢定(Mann-Whitney U test)比較兩組孩童於人口學資料、控制變項、依變項(寫字正確率、反應時間、錯誤類型比例)之差異;(4)使用斯皮爾曼等級相關係數分析寫字正確率、反應時間、錯誤類型比例與控制變項之關係。
結果:
結果顯示,(1)組別x字屬性之變異數分析:腦性麻痺孩童所有屬性字正確率顯著低於一般孩童之情形,而未呈現與字形失寫症相同之字屬性效應。(2)組別x字屬性x錯誤類型之變異數分析:其常見錯誤類型如筆劃遺漏、添加之字屬性多為高規則、字頻高、筆劃多,與字型失寫症於無規則、字頻低出現筆劃部件錯誤、同音別字之情形亦有所差異。(3)兩組孩童於各錯誤類型比例之比較:筆劃部件相關錯誤類型總比例顯著高於一般發展孩童,多為筆劃遺漏或添加、部件遺漏或替代、部件及筆劃綜合的錯誤;另亦有同音形似多於一般發展孩童之情形。(4)寫字正確率與許多能力呈顯著相關,包括所有中央、周邊面向能力、觸識覺、手部操作、視知覺、注意力等;腦麻孩童常見之筆劃遺漏、筆劃與部件綜合的錯誤與動作能力、空間關係不佳有關,同音別字則與注意力有關。
討論與結論:
綜合上述結果可知,腦性麻痺孩童整體屬性字寫字表現皆弱於一般孩童,且即使是高規則、高頻字仍易出現筆劃部件相關錯誤,因此從中央歷程處理觀點來看並不支持其具有選擇性的字形處理問題。而前述筆劃部件相關錯誤之原因,除可能為中央歷程之字形處理困難,也可能源於語意連結字形或形素緩衝系統等缺陷。此外,腦麻孩童亦存在周邊系統及其他神經心理功能之缺陷,故整體能力不佳亦可能導致其出現筆劃部件相關錯誤較多之現象。因此,未來需進行更詳盡的推導辯證以追溯腦性麻痺孩童所呈現複雜寫字問題之上游成因。
Children with diplegic cerebral palsy have extensive writing problems derived from deficits in neuropsychological process of reading and writing regarding to their impaired functions caused by early brain injury (Purcell, Shea, & Rapp , 2014 ; Roeltgen, 2003). Some of them have the similar writing errors such as homophones, stroke/radical omission or addition with orthographic agraphia caused by acquired brain injury. Nevertheless, we still do not know if diplegic cerebral palsy have the same effects of character properties with orthographic agraphia in irregular and low frequency characters. According to neuropsychological models of reading and spelling, we designed a dictation task that modulated character properties (e.g. regularity, strokes, frequency, etc.) to evaluate the effects of character properties and analyze the error types in children with diplegic cerebral palsy, and compared with typically developing children.
The study included 16 children with diplegic cerebral palsy and 30 typically developing children. In addition to the dictation task, extensive behavioral assessments were carried out to evaluate the central and peripheral processing abilities related to written spelling as well as neurological and neuropsychological functions for reasons of clear clinical reasoning. In regard to data analysis, (1) The two-way mixed-design ANOVA (2 x 8) was used to realize that how the groups and character properties influence writing accuracy. (2) The three-way mixed-design ANOVA (2 x 8 x 19) was used to measure the impact of groups, character properties, and error types on percentage of error types. (3) the Mann-Whitney U test was applied to test difference in demographic data, results of control variables and dependent variables (writing accuracy, reaction time, and percentage of error types) between two groups. (4) The Spearman's rank correlation coefficient was used to test the association between writing performances, percentage of error types and control variables.
The results reveal that (1) the effects of character properties in children with diplegia are not in common with orthographic agraphia. The writing accuracy of all character properties in children with diplegia are lower than typically developing children. (2) Their frequent error types such as stoke omission or addition have greater proportions in characters of regular, high frequency, and more strokes which differ from orthographic agraphia especially in irregular and low frequency words. (3) Children with diplegic cerebral palsy have more error types such as stroke omission and addition, radical omission and substitution, radical and stroke combined errors than typical developing children. Besides, the proportions of homographic homophones in diplegia are more than typical developing children. (4) A significant correlation was found between writing accuracy and many control variables in children with diplegia. Furthermore, there was a significant relationship between stroke/radical errors and motor abilities, spatial relations, and between homophones and attention in children with diplegia.
In summary, the overall spelling performances in children with diplegic cerebral palsy are worse than typical developing children. Meanwhile, the properties of characters which are much easier still appear stroke/radical errors frequently. The aforementioned phenomenon did not support that children with diplegic cerebral palsy have specific orthographic processing problems. Their writing errors may result from disrupted access from semantics to orthographic system, deficits in orthographic system and graphemic buffer, or lower overall capacities related to written spelling. More evaluations related to dictation tasks should be applied to confirm the underlying writing problems in children with diplegia in the future. Consequently, there were no specific effects of character properties accompanied with writing errors.
目 錄
指導教授推薦書
口試委員審定書
致謝.....iii
中文摘要.....iv
英文摘要.....vi
目錄.....ix
圖目錄.....xiv
表目錄.....xv
第一章 緒論.....1
第一節、研究緣起及目的.....1
第二節、重要名詞釋義.....4
壹、雙側偏癱腦性麻痺.....4
貳、中央及周邊處理歷程.....4
參、字形失寫症.....4
肆、選擇性字屬性效應及選擇性錯誤類型.....5
伍、筆劃部件相關錯誤類型.....5
第二章 文獻回顧.....7
第一節、書寫障礙定義、特徵.....7
壹、文獻中對於書寫障礙的定義.....7
貳、書寫障礙於不同分類系統中的定義.....7
第二節、書寫障礙類型.....9
壹、依聽寫神經心理模型提出之亞型進行分類.....9
貳、依語言及非語言能力的分類模式.....15
參、依書寫錯誤類型進行分類.....18
第三節、腦性麻痺孩童的腦傷型態及其影響的功能.....19
壹、單側偏癱腦性麻痺之常見腦傷型態.....19
貳、雙側偏癱腦性麻痺之常見腦傷型態.....20
第四節、影響腦麻孩童書寫表現之因素.....24
壹、感覺.....24
貳、動作計畫.....25
參、視知覺.....25
肆、視動整合.....26
伍、認知相關能力.....27
第五節、腦性麻痺孩童寫字表現、特質及與腦傷之關係.....30
壹、腦性麻痺孩童於聽寫時的寫字表現及特質.....30
貳、腦性麻痺孩童腦傷區域與寫字特質之關係.....31
參、小結.....32
第六節、聽寫的認知神經心理機制.....40
壹、拼音文字的聽寫理論模型.....40
貳、中文字的聽寫理論模型.....44
第七節、聽/讀寫能力之神經心理評估方式.....48
壹、各式書寫評估方式.....48
貳、讀寫認知歷程評估方式.....49
參、同音別字寫字困難孩童之評估方式.....51
肆、本研究之評估架構及方式.....52
第三章 研究目的及待答問題.....54
第一節、研究目的.....54
第二節、待答問題及假說.....54
第四章 研究方法.....56
第一節、研究架構與變項定義.....56
壹、研究架構.....56
貳、變項定義.....57
第二節、研究方法與設計.....58
第三節、研究對象.....59
壹、納入條件.....60
貳、排除條件.....60
參、樣本數大小.....60
第四節、研究工具與施測方法.....61
壹、初篩過程及同意書、問卷填寫.....61
貳、控制變項之評估工具與施測方式.....61
參、依變項之評估工具與施測方式.....68
第五節、資料分析.....76
壹、描述性統計.....76
貳、推論性統計.....76
第五章 研究結果.....77
第一節、基本人口學資料.....77
第二節、寫字相關能力(控制變項)於兩組之比較.....79
第三節、寫字表現於兩組之比較.....82
壹、整體寫字表現比較.....82
貳、組別及字屬性對於寫字正確率之影響.....82
第四節、寫字錯誤類型於兩組之比較.....87
壹、排除正確寫字類型之比較.....87
貳、含正確寫字類型之比較.....87
參、組別、字屬性、錯誤類型對於寫字錯誤類型比例之影響.....90
第五節、寫字表現及錯誤類型與寫字相關能力(控制變項)之關係.....101
壹、寫字表現與寫字相關能力(控制變項)之關係.....101
貳、寫字錯誤類型與寫字相關能力(控制變項)之關係.....105
第六章 討論.....116
第一節、寫字相關能力(控制變項)兩組比較結果探討.....116
壹、兩組孩童達顯著差異之項目及原因探討.....116
貳、兩組孩童未達顯著差異之項目及原因探討.....118
第二節、字屬性影響寫字表現效應之探討.....121
壹、兩組孩童整體寫字表現比較.....121
貳、兩組孩童於各屬性字正確率之比較.....121
參、腦麻孩童組內各屬性字正確率之比較.....122
肆、一般孩童組內各屬性字正確率之比較.....122
第三節、腦性麻痺孩童寫字錯誤類型探討.....123
壹、整體結果討論.....123
貳、組別及屬性對錯誤類型比例會造成影響之錯誤類型探討.....123
參、其他錯誤類型於兩組孩童之差異探討.....124
肆、小結.....126
第四節、寫字表現與寫字相關能力(控制變項)關係之探討.....127
壹、寫字正確率與控制變項關係之探討.....127
貳、反應時間與控制變項關係之探討.....129
第五節、寫字錯誤類型與寫字相關能力(控制變項)關係之探討.....130
壹、筆劃部件相關錯誤類型與控制變項之關係.....130
貳、音似別字及音異形異別字錯誤類型與控制變項之關係.....131
參、同音別字錯誤類型與控制變項之關係.....131
肆、空白及其他錯誤類型與控制變項之關係.....132
第六節、排除寫字相關能力影響後兩組孩童寫字表現之探討.....132
第七章 研究限制與未來方向.....134
壹、增進評估內容之細膩度.....134
貳、腦影像學資料較為缺乏.....135
參、研究對象及研究工具選擇之限制.....135
第八章 結論與臨床運用建議.....136
參考文獻.....138
附錄.....151
附錄一、基本資料暨寫字表現調查表.....151
附錄二、記錄格式.....155
附錄三、雙側偏癱腦性麻痺孩童之基本資料.....166
附錄四、一般孩童之基本資料.....167
附錄五、兩組孩童寫字錯誤類型比例於各類字屬性、不同錯誤類型之描述統計.....168
附錄六、臨床試驗同意證明書.....171
附錄七、臨床試驗變更案同意證明書(一).....174
附錄八、臨床試驗變更案同意證明書(二).....177
附錄九、拜瑞─布坦尼卡 視覺─動作統整發展測驗使用同意書.....180


圖目錄
圖2-2-1 書寫與口語拼音之解剖神經心理模型.....11
圖2-6-1 閱讀與拼字之功能性模型.....42
圖2-6-2 中文閱讀及聽寫功能性模型.....44
圖2-6-3 語言處理歷程之認知成份架構圖.....45
圖2-6-4 中文聽寫認知處理模型.....47
圖4-1-1 研究架構.....56
圖4-4-1 聽寫測驗施測流程圖.....73
圖4-4-2 研究步驟流程圖.....75
圖6-1-1 閱讀與拼字之功能性模型之路徑a、路徑b示意圖.....119
圖6-1-2 腦麻孩童滑鼠游標移動軌跡 (左至右) ─ 右手操作.....120
圖6-1-3 腦麻孩童滑鼠游標移動軌跡 (右至左) ─ 右手操作.....120


表目錄
表2-3-1 單側、雙側偏癱腦性麻痺腦傷型態分類及其影響之功能.....22
表2-5-1 腦性麻痺孩童寫字相關能力、寫字表現文獻摘要整理.....34
表2-6-1 拼音文字拼字/閱讀模型之比較.....43
表2-7-1 讀寫歷程評估方式、檢視之系統/路徑及缺損之行為表現.....50
表2-7-2 本研究之評估架構及選用之評估測驗.....53
表4-1-1 依變項與自變項之概念型及操作型定義.....57
表4-4-1 聽寫測驗挑選之目標字及其屬性分類......70
表4-4-2 不同屬性字中其他變因之統計檢定結果.....72
表4-4-3 寫字錯誤類型分類.....74
表5-1-1 雙側偏癱腦性麻痺孩童與一般孩童之人口學資料比較.....78
表5-1-2 腦性麻痺孩童於粗大動作功能及徒手能力分類系統中之障礙程度情形.....78
表5-2-1 雙側偏癱與一般孩童控制變項評估結果之比較.....80
表5-3-1 兩組孩童寫字表現比較-使用Mann-Whitney U test.....82
表5-3-2 兩組孩童各屬性字寫字正確率之描述性統計.....83
表5-3-3 Mauchly球形檢定.....85
表5-3-4 組別、字屬性在寫字正確率上之變異數分析摘要表.....85
表5-3-5 組別、字屬性在寫字正確率上之單純主效果分析.....86
表5-4-1 雙側偏癱與一般孩童寫字錯誤類型比例之比較.....88
表5-4-2 組別、屬性、錯誤類型在錯誤類型比例上之三因子混合變異數分析摘要表.....90
表5-4-3 組別×屬性」在寫字錯誤類型比例上之「單純交互作用」.....92
表5-4-4 組別、屬性、錯誤類型在錯誤類型比例上之單純單純主效果分析(屬性).....97
表5-4-5 組別、屬性、錯誤類型在錯誤類型比例上之單純單純主效果分析(組別).....98
表5-5-1 腦性麻痺孩童控制變項與寫字表現之相關分析.....103
表5-5-2 一般孩童控制變項與寫字表現之相關分析.....104
表5-5-3 腦麻孩童寫字錯誤類型比例(含正確類型)與聽寫所需之中央、週邊面向能力之相關分析.....109
表5-5-4 腦麻孩童寫字錯誤類型(含正確類型)與其它神經學、神經心理功能之相關分析─感覺、手功能項目.....110
表5-5-5 腦麻孩童寫字錯誤類型(含正確類型)與其它神經學、神經心理功能之相關分析─動作控制、動作計劃能力項目.....111
表5-5-6 腦麻孩童寫字錯誤類型(含正確類型)與其它神經學、神經心理功能之相關分析─視知覺、基礎認知能力項目.....112
表5-5-7 一般孩童寫字錯誤類型比例(含正確類型)與聽寫所需之中央、週邊面向能力之相關分析.....113
表5-5-8 一般孩童寫字錯誤類型(含正確類型)與其它神經學、神經心理功能之相關分析─感覺、手功能、動作控制項目.....114
表5-5-9 一般孩童寫字錯誤類型(含正確類型)與其它神經學、神經心理功能之相關分析─動作計畫、視知覺、基礎認知能力項目.....115

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