姿勢控制成熟度對於5到7個月嬰兒姿勢控制和精細動作關聯性的影響

Abstract

前言：動作發展是孩童發展重要的發展項目之一，尤其於孩童的早期發展，姿勢控制和精細動作的關係性是常被臨床和研究探討的一個主題。在動作發展理論當中，神經系統選擇理論(neuronal group selection theory, NGST)是最能解釋姿勢控制和精細動作關聯性為何會下降的重要理論，過去研究也發現姿勢控制的成熟度是影響姿勢控制和精細動作關聯性下降的重要因素之一，因此，本研究目的在探討姿勢控制的成熟度如何影響姿勢控制和精細動作相關性，並同時探討社會因子(social factors)會如何影響此相關性。 方法：研究對象招募滿5~7個月的健康孩童，以亞伯達嬰幼兒量表 (Alberta Infant Motor Scale) 來評量孩童軀幹控制的表現，再以皮巴迪動作評估量表 (Peabody Developmental Motor Scales II) 和嬰兒姿勢和精細動作評估量表 (Posture and Fine Motor Assessment of Infants) 的精細動作次分項來評量孩童精細動作表現。社會因子以親子互動時間、母親教育程度和職業等級來做代表分析。此研究使用亞伯達嬰幼兒量表的50百分等級將受試者分成姿勢控制較不成熟組和姿勢控制較成熟組。資料分析使用皮爾森相關分析 (Pearson’s correlation) 來檢測姿勢控制和精細動作的相關性，再以線性迴歸分析精細動作的預測因子。 結果：本研究的樣本共有58名受試者。姿勢控制和精細動作的相關係數在姿勢控制較不成熟的組別(r=.57, .52, p<0.05) 略高於姿勢控制較成熟組 (r=.39, .41, p<0.1)。線性回歸的結果顯示在兩組中，精細動作皆無法被社會因子所預測。 討論：本研究發現姿勢控制較不成熟的孩童，其姿勢控制和精細動作的相關性略高於姿勢控制較成熟的孩童。然而，因為測量親子互動時間的準確性和母親教育程度的變異性過小，精細動作無法有效被社會因子所預測。 結論：本研究發現姿勢控制的成熟度對於姿勢控制和精細動作的相關性有影響，建議未來研究在採用親子互動作為社會因子時應考量質性的測量方式，且家中的環境(如：玩具多寡、性質，平常玩耍的環境)也須被同時考量進去。本研究結果可提供未來在研究或臨床上面對動作發展遲緩孩童的一個參考基礎和方向。

Introduction: Motor development is one of the most important parts in a child’s early development. In the clinics, therapists always assume that postural control has been related with fine motor skills when dealing with motor issues. Among the motor developmental theories, the neuronal group selection theory could explain the reason why the relationship between postural control and fine motor skills decreased with the maturation of the postural control in infant before 1 year old. However, previous studies finding the decreased relationship between postural control and fine motor skills had three main limitations: (1) the insufficient evaluating items of postural control and fine motor skills; (2) only the use of center of pressure (COP) and the electromyography (EMG) technique to investigate the relationship; (3) the insufficient sample sizes. Besides, the social factors would be considered to influence the relationship between postural control and fine motor skills. Objectives: The aims of this study were to investigate: (1) the influence of the maturation of postural control in the relationship between postural control and fine motor skills in infants at 5-7 month age; (2) whether fine motor skills would be more predictable by the social factors such as the parent-child interaction, maternal education and occupational level in infants with more mature postural control than that in infants with less mature postural control. Methods: This study recruited participants from day-care centers and baby-care websites in north Taiwan. The postural control would be measured by the Alberta Infant Motor Scale (AIMS). Fine motor skills would be measured by the Peabody Developmental Motor Scales II (PDMS-2) and the Posture and Fine Motor Assessment of Infants (PFMAI). Social factors included in this study contained the parent-child interaction, maternal education and the parent’s occupational level. The scores of AIMS would be used to divide infants into two groups (infants with more mature postural control and infants with less mature postural control). Results: A total of 58 infants were examined at 5-7 months. The correlation coefficients between postural control and fine motor skills in infants with less mature postural control (r=.57 between the AIMS and the PDMS, and r=.52 between the AIMS and the PFMAI, p<0.05) were higher than that in infants with more mature postural control (r=.39 between the AIMS and the PDMS, and r=.41 between the AIMS and the PFMAI, p<0.1). The regression models showed that the social factors (parent-child interaction, maternal education and occupational level) could not predict fine motor skills in both groups. Discussion: The finding that the relationship between postural control and fine motor skills in infants with less mature postural control was higher than that in the infants with more mature postural control could be proven in this study. However, the social factors (parent-child interaction, maternal education and occupational level) could not predict fine motor skills due to the measure of parent-child interaction and small variation of educational level of participants’ parents. Conclusion: Further studies need to measure the quality of parent-child interaction instead of the quantity and focus on environmental factors (e.g. adequate toys) which might also have influence on the fine motor skills. The relationship between postural control and fine motor skills in infants with less mature postural control could provide implications when investigating and threating infants with motor delay.