臺灣博碩士論文加值系統

發展性協調障礙(Developmental Coordination Disorder, DCD)兒童的視覺處理缺損是影響其動作控制的障礙因素之一，然而目前針對DCD兒童的視知覺表現之相關研究尚未充分，因此本研究以客觀量性的實驗設計來探討DCD兒童與典型發展兒童在視知覺表現的差異。
本研究採方便取樣，招募31位DCD兒童，年齡介於5至8歲（平均年齡6.47歲）及35名典型發展兒童（平均年齡6.43歲），以眼動儀和動作分析系統比較兩組兒童在下列測驗的表現：1. 眼球動作控制測驗（含平順追視、掃視及反掃視），2. 電腦化泰迪熊刪除測驗（視覺搜尋能力），3. 功能性按鍵任務（視覺搜尋及眼手動作連結能力）。
研究結果發現DCD兒童的基礎眼球動作控制與典型發展兒童能力相近，並無顯著的缺損。但在高階的視知覺認知能力上，相對於典型發展兒童，DCD兒童缺乏有組織的搜尋策略，泰迪熊刪除測驗表現明顯較差：所花時間較長、凝視點較多、視覺搜尋品質亦較低。在功能性按鍵任務中，DCD兒童不論是手部還是眼球動作的移動時間皆顯著較典型發展兒童長，且隨著動作階段增加，DCD兒童眼、手起始與結束的連結程度越低。
整體而言，DCD兒童在基礎眼球動作控制上沒有顯著的缺損，在較複雜的視覺搜尋及合併動作的眼手連結任務中表現明顯較差；然兒童日常生活活動大多為複雜的視知覺任務，因此DCD兒童的視知覺缺損，勢必影響其日常適應表現。因此建議臨床治療師在分析DCD兒童的問題時，應將視知覺能力對動作控制的影響納入考量。

Although the underlying causes of Developmental Coordination Disorder (DCD) remain unclear. Visual perceptual disorder was one of the possible accounts to explain movement clumsiness in children with DCD. Data related to the visual performance of children with DCD, however, have been conflicting and rare. The aim of this study was to explore and compare the visual perceptual performances in children with DCD and typically developing (TD) children.
This study used a convenience sample of children, aged between 5 and 8 years, divided into two groups: DCD (n = 31, Mean age = 6.47) and TD (n = 35, Mean age = 6.43). Eye tracker and motion analysis systems were used to compare their visual perceptual performance in the following tests: 1. oculomotor control tasks (smooth pursuit, saccade and anti-saccade), 2. Computerized Teddy Bear Cancellation Test (visual scanning ability), 3. three calculator buttons pressing task (visual scanning and eye-hand coupling performance).
Children with DCD and TD children performed similarly in the oculomotor control tests, which are fundamental skills of visual perception, but showed significant impaired performance in complex visual perceptual tasks, such as visual scanning and eye-hand coupling. Children with DCD lacked of organized searching strategy, so they demonstrated longer completion time, more fixation points and lower visual scanning quality. In the 3 calculator buttons pressing task, children with DCD showed longer hand movement time and eye movement time. Furthermore, eye-hand coupling in children with DCD was decreased as the task demands were increased.
In summary, our data suggested that children with DCD had no impairment in the fundamental oculomotor control skills, but showed significantly deficits in the visual cognitive level of skills, such as visual searching and eye-hand coupling abilities. Most of the daily activities are complex visual-motor tasks, so the impairment of visual cognition do had significant impacts on the visual adaptive performances. Our findings suggested that clinicians should concern the influence of visual impairments on the motor performance in children with DCD.

目錄
第一章、緒論 1
第一節、研究動機與重要性 1
第二節、研究目的 3
第二章、文獻回顧 4
第一節、視知覺簡介 4
第二節、發展性協調障礙兒童及其視知覺問題 6
一、發展性協調障礙兒童簡介 6
二、DCD兒童的視知覺問題 8
三、DCD兒童的視覺-動作連結 12
第三節、研究目的及假設 16
第三章、研究方法 18
第一節、研究參與者 18
第二節、研究工具 19
一、篩檢測驗 19
二、眼球追蹤系統 21
三、動作分析系統 23
四、眼球動作控制測驗 24
五、泰迪熊刪除測驗 26
六、功能性按鍵任務 28
第三節、研究程序 29
第四節、資料收集與分析 31
一、基本資料 31
二、眼球動作控制測驗之眼球運動資料 31
三、泰迪熊刪除測驗之眼球運動資料 32
四、功能性按鍵任務之視覺搜尋眼球運動及眼手連結測驗資料 33
五、資料分析 37
第四章、結果 38
第一節、基本人口學資料 38
第二節、眼球動作控制能力 39
一、平順追視 39
二、掃視 39
三、反掃視 39
第三節、泰迪熊刪除測驗之視覺掃描與眼球運動表現 41
一、視覺掃描表現 41
二、眼球運動表現 41
第四節、功能性按鍵任務 43
一、手部動作數據分析 43
二、眼球動作數據分析 45
三、眼手連結數據分析 47
第五章、討論 48
第一節、兩組兒童眼球動作控制能力的差異 48
一、平順追視 48
二、掃視 50
三、反掃視 51
第二節、兩組兒童在泰迪熊刪除測驗表現的差異 53
第三節、兩組兒童功能性按鍵任務表現的差異性 55
一、手部動作 55
二、眼球動作 56
三、眼手連結 58
第四節、綜合討論 61
第五節、研究限制與未來研究方向 63
一、研究限制 63
二、未來研究方向 63
第六章、結論 65
第七章、參考文獻 67

吳武典、胡心慈、蔡崇建、王振德、林幸台、郭靜姿（民95）。托尼非語文智力
　　　測驗（再版）：指導手冊。台北市：心理出版社。
陸莉、劉鴻香（民87）。畢保德圖畫詞彙測驗（修訂版）：指導手冊。台北市：
　心理出版社。
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision. Washington, DC.
Biancotto, M., Skabar, A., Bulgheroni, M., Carrozzi, M., ＆ Zoia, S. (2011). Neuromotor deficits in developmental coordination disorder: Evidence from a reach-to-grasp task. Research in Developmental Disabilities, 32(4), 1293-1300.
Bonifacci, P. (2004). Children with low motor ability have lower visual-motor integration ability but unaffected perceptual skills. Human Movement Science, 23(2), 157-168. doi: DOI: 10.1016/j.humov.2004.08.002
Brown, L., Sherbenou, R. J., ＆ Johnsen, S. K. (1997). Test of nonverbal intelligence-3 (TONI-3). Austin, TX: Pro-Ed.
Chang, S.-H., ＆ Yu, N.-Y. (2010). Characterization of motor control in handwriting difficulties in children with or without developmental coordination disorder. Developmental Medicine ＆ Child Neurology, 52(3), 244-250. doi: 10.1111/j.1469-8749.2009.03478.x
Crawford, S. G., ＆ Dewey, D. (2008). Co-occurring disorders: A possible key to visual perceptual deficits in children with developmental coordination disorder? Human Movement Science, 27(1), 154-169. doi: doi: 10.1016/j.humov.2007.09.002
Doré-Mazars, K., Vergilino-Perez, D., Lemoine, C., ＆ Bucci, M. P. (2011). Adaptation of reactive saccades in normal children. Investigative Ophthalmology ＆ Visual Science, 52(7), 4813-4818.
Dunn, L. M. (1981). Manual for the Peabody Picture Vocabulary Test-Revised. Circle Pines, MN: American Guidance Service.
Fukushima, J., Tanaka, S., Williams, J. D., ＆ Fukushima, K. (2005). Voluntary control of saccadic and smooth-pursuit eye movements in children with learning disorders. Brain and Development, 27(8), 579-588.
Gardner, M. F. (1996). Test of Visual-perceptual Skills (Non-Motor)－Revised. San Francisco: Psychological and Educational Publication.
Geldmacher, D. S., ＆ Hills, E. C. (1997). Effect of stimulus number, target-to-distractor ratio, and motor speed on visual spatial search quality following traumatic brain injury. Brain Injury, 11(1), 59-66.
Henderson, S. E., Sugden, D. A., ＆ Barnett, A. L. (2007). Movement assessment battery for children-2 second edition. London, UK: The Psychological Corporation.
Hyde, C., ＆ Wilson, P. H. (2011). Dissecting online control in Developmental Coordination Disorder: A kinematic analysis of double-step reaching. Brain and Cognition, In Press, Corrected Proof. doi: doi: 10.1016/j.bandc.2010.12.004
Ingster-Moati, I., Vaivre-Douret, L., Bui Quoc, E., Albuisson, E., Dufier, J.-L., ＆ Golse, B. (2009). Vertical and horizontal smooth pursuit eye movements in children: A neuro-developmental study. European Journal of Paediatric Neurology, 13(4), 362-366. doi: 10.1016/j.ejpn.2008.07.003
Irving, E. L., González, E. G., Lillakas, L., Wareham, J., ＆ McCarthy, T. (2011). Effect of stimulus type on the eye movements of children. Investigative Ophthalmology ＆ Visual Science, 52(2), 658-664.
Irving, E. L., Steinbach, M. J., Lillakas, L., Babu, R. J., ＆ Hutchings, N. (2006). Horizontal saccade dynamics across the human life span. Investigative Ophthalmology ＆ Visual Science, 47(6), 2478-2484.
Irving, E. L., Tajik-Parvinchi, D. J., Lillakas, L., González, E. G., ＆ Steinbach, M. J. (2009). Mixed pro and antisaccade performance in children and adults. Brain Research, 1255(0), 67-74.
Klein, C., Rauh, R., ＆ Biscaldi, M. (2011). Patterns of change in ocular motor development. Experimental Brain Research, 210(1), 33-44. doi: 10.1007/s00221-011-2601-7
Kuhn, G., Tewson, L., Morpurgo, L., Freebody, S. F., Musil, A. S., ＆ Leekam, S. R. (2011). Developmental changes in the control of saccadic eye movements in response to directional eye gaze and arrows. The Quarterly journal of experimental psychology, 64(10), 1919-1929.
Lahuis, B. E., Van Engeland, H., Cahn, W., Caspers, E., Van der Geest, J. N., Van der Gaag, R. J., ＆ Kemner, C. (2009). Smooth pursuit eye movement (SPEM) in patients with multiple complex developmental disorder (MCDD), a subtype of the pervasive developmental disorder. World Journal of Biological Psychiatry, 10(4_3), 905-912.
Land, M. F. (1999). The roles of vision and eye movements in the control of activities of daily living. Perception, 28(11), 1311.
Land, M. F. (2001). In what ways do eye movements contribute to everyday activities? Vision Research, 41(25-26), 3559.
Land, M. F. (2006). Eye movements and the control of actions in everyday life. Progress in Retinal and Eye Research, 25(3), 296-324. doi: 10.1016/j.preteyeres.2006.01.002
Land, M. F. (2009). Vision, eye movements, and natural behavior. . Visual Neuroscience, 26, 51-62. doi: 10.1017/S0952523808080899
Langaas, T., Mon-Williams, M., Wann, J., Pascal, E., ＆ Thompson, C. (1998). Eye movements, prematurity and developmental co-ordination disorder. Vision Research, 38(12), 1817-1826. doi: 10.1016/s0042-6989(97)00399-4
Laurent-Vannier, A., Chevignard, M., Pradat-Diehl, P., Abada, G., ＆ De Agostini, M. (2006). Assessment of unilateral spatial neglect in children using the Teddy Bear Cancellation Test. Developmental Medicine ＆ Child Neurology, 48(2), 120-125. doi: 10.1017/s0012162206000260
Laurent-Vannier, A., Pradat-Diehl, P., Chevignard, M., Abada, G., ＆ De Agostini, M. (2003). Spatial and motor neglect in children. Neurology, 60(2), 202-207.
Maria Pia, B., ＆ Marine, V. (2009). Normal Speed and Accuracy of Saccade and Vergence Eye Movements in Dyslexic Reader Children. Journal of Ophthalmology, 2009.
May-Benson, T. A., Ingolia, P., ＆ Koomar., J. (2002). Daily Living Skills and Developmental Coordination Disorder. In S. A., Cermak ＆ D. Larkin. (Eds.), Developmental coordination disorder. Albany: NY :Delmar Thomson Learning.
Mezzalira, R., Neves, L. C., Maudonnet, O. A. Q., Bilécki, M. M. C., ＆ Ávila, F. G. (2005). Oculomotricity in childhood: is the normal range the same as in adults? Revista Brasileira de Otorrinolaringologia, 71(5), 680-685.
Mon-Williams, M. A., Wann, J. P., ＆ Pascal, E. (1999). Visual–proprioceptive mapping in children with developmental coordination disorder. Developmental Medicine ＆ Child Neurology, 41(4), 247-254. doi: 10.1111/j.1469-8749.1999.tb00592.x
Newsham, D., Knox, P. C., ＆ Cooke, R. W. I. (2007). Oculomotor control in children who were born very prematurely. Investigative Ophthalmology ＆ Visual Science, 48(6), 2595-2601.
O'Brien, V., Cermak, S. A., ＆ Murray, E. (1988). The relationship between visual-perceptual motor abilities and clumsiness in children with and without learning disabilities. American Journal of Occupational Therapy, 42(6), 359-363.
Parush, S., Yochman, A., Cohen, D., ＆ Gershon, E. (1998). Relation of visual perception and visual-motor integration for clumsy children. Perceptual ＆ Motor Skills, 86(1), 291-295.
Piek, J. P., ＆ Dyck, M. J. (2004). Sensory-motor deficits in children with developmental coordination disorder, attention deficit hyperactivity disorder and autistic disorder. Human Movement Science, 23(3-4), 475-488.
Pitcher, T. M., Piek, J. P., ＆ Hay, D. A. (2003). Fine and gross motor ability in males with ADHD. Developmental Medicine ＆ Child Neurology, 45(8), 525-535. doi: 10.1111/j.1469-8749.2003.tb00952.x
Quintana, L. A. (2002). Assessing abilities and capacities: Vision, visual perception, and praxis. In C. A. Trombly ＆ M. V. Radomski (Eds.), Occupational therapy for physical dysfunction (5 ed.). Baltimore: Maryland: Lippincott Williams ＆ Wilkins.
Rösblad, B. (1994). Repetitive goal-directed arm movements in children with developmental coordination disorders: role of visual information. Adapted Physical Activity Quarterly, 11(2), 190-202..
Rütsche, A., Baumann, A., Jiang, X., ＆ Mojon, D. (2006). Development of visual pursuit in the first 6 years of life. Graefe's Archive for Clinical and Experimental Ophthalmology, 244(11), 1406-1411. doi: 10.1007/s00417-005-0248-4
Ross, R. G., Radant, A. D., ＆ Hommer, D. W. (1993). A Developmental Study of Smooth Pursuit Eye Movements in Normal Children from 7 to 15 Years of Age. Journal of the American Academy of Child ＆ Adolescent Psychiatry, 32(4), 783-791. doi: 10.1097/00004583-199307000-00012
Rostoft, M. S. (2004). Developmental co-ordination disorder: different perspectives on the understanding of motor control and co-ordination. Advances in Physiotherapy, 6(1), 11.
Rousseaux, M., Beis, J., Pradat-Diehl, P., Martin, Y., Bartolomeo, P., Bernati, T., . . . Marchal, F. (2001). Presenting a battery for assessing spatial neglect. Norms and effects of age, educational level, sex, hand and laterality. Revue neurologique, 157(11 Pt 1), 1385.
Salman, M., Sharpe, J., Lillakas, L., Dennis, M., ＆ Steinbach, M. (2006). Smooth pursuit eye movements in children. Experimental Brain Research, 169(1), 139-143. doi: 10.1007/s00221-005-0292-7
Schneck, C. M. (2005). Visual perception. In A. S. A. J. Case-Smith, ＆ P. Pratt (Ed.), Occupational therapy for children (5 ed., pp. 412-448). St. Louis: Mosby.
Schoemaker, M. M., van der Wees, M., Flapper, B., Verheij-Jansen, N., Scholten-Jaegers, S., ＆ Geuze, R. H. (2001). Perceptual skills of children with developmental coordination disorder. Human Movement Science, 20(1-2), 111-133. doi: Doi: 10.1016/s0167-9457(01)00031-8
Sellers, J. S. (1995). Clumsiness. Physical and Occupational Therapy in Pediatrics, 15(4), 39.
Tsai, C.-L. (2008). Relationship of Visual Perceptual Deficit and Motor Impairment in Children with Developmental Coordination Disorder. Perceptual ＆ Motor Skills, 107(2), 457.
Tseng, M. H., ＆ Murray, E. A. (1994). Differences in Perceptual-Motor Measures in Children with Good and Poor Handwriting. Occupational Therapy Journal of Research, 14(1), 19-36.
Warren, M. (1993). A hierarchical model for evaluation and treatment of visual perceptual dysfunction in adult acquired brain injury, Part 2. American Journal of Occupational Therapy, 47(1), 55-66.
Wilmut, K., Brown, J. H., ＆ Wann, J. P. (2007). Attention disengagement in children with Developmental Coordination Disorder. Disability and Rehabilitation, 29(1), 47-55.
Wilmut, K., Wann, J. P., ＆ Brown, J. H. (2006). Problems in the coupling of eye and hand in the sequential movements of children with Developmental Coordination Disorder. Child: Care, Health and Development, 32(6), 665-678. doi: 10.1111/j.1365-2214.2006.00678.x
Wilson, P. H., ＆ McKenzie, B. E. (1998). Information Processing Deficits Associated with Developmental Coordination Disorder: A Meta-analysis of Research Findings. Journal of Child Psychology and Psychiatry, 39(6), 829-840. doi: 10.1111/1469-7610.00384
Zoia, S., Barnett, A., Wilson, P., ＆ Hill, E. (2006). Developmental Coordination Disorder: current issues. Child: Care, Health and Development, 32(6), 613-618. doi: 10.1111/j.1365-2214.2006.00697.x