腦性麻痺孩童之書寫及相關視覺動作技巧表現

Abstract

前言: 進入一般學校的腦性麻痺孩童多被期望能完成學校的任務，包含書寫。雖然多數的腦性麻痺孩童有能力進行書寫，但他們仍有書寫困難，如:書寫速度慢和可讀性低。全面的評估書寫表現，包含書寫結果(handwriting product)、書寫過程(handwriting process)及相關的視覺動作技巧(visual motor skills)，能幫助我們更完整的了解腦性麻痺孩童的書寫表現及相關視覺動作技巧能力。然而，目前的研究多著重在書寫結果探討，關於腦性麻痺孩童的書寫表現與相關視覺動作技巧的研究仍較缺乏。 目的: 本研究目的為探討腦性麻痺孩童與一般發展孩童的書寫表現及相關視覺動作技巧之差異。此外，也探討兩組孩童各自書寫表現與相關視覺動作技巧之相關性。 方法: 本研究招募30位腦性麻痺孩童與30位年齡配對之一般發展孩童。每位受試者皆須完成平版化中文書寫測驗與平板化視覺動作技巧測驗。結果使用重複量數二因子變異數分析(two-way ANOVA, repeated measures)與獨立樣本T檢定分析兩組孩童的書寫表現與相關視覺動作技巧之差異。使用皮爾森相關分析兩組孩童各自書寫表現與視覺動作技巧之相關性。 結果: 腦性麻痺孩童的書寫正確率與字的可讀性(local legibility)包含位置，大小，角度及相似性皆低於一般發展孩童。兩組孩童在句子可讀性(global legibility)中的排列控制與大小控制參數中皆有顯著差異。然而，兩組孩童的書寫速度並無顯著差異。腦性麻痺孩童在書寫過程中，每一筆劃的速度比一般發展孩童快。腦性麻痺孩童的視覺動作技巧，不論是在仿畫或描畫表現皆低於一般發展孩童。對於腦性麻痺孩童，其視覺動作技巧的描畫測驗和字的可讀性中的角度及句子可讀性中的排列控制參數有顯著相關。但對於兩組孩童，其視覺動作技巧的仿畫測驗和書寫表現皆無顯著相關。 結論: 本研究全面探討腦性麻痺與一般發展孩童之書寫表現差異，腦性麻痺的書寫結果和視覺動作技巧表現低於一般發展孩童。描畫能力可能為影響腦性麻痺孩童書寫表現之重要因子。

Backgrounds: Children with cerebral palsy (CP) who attend to mainstream school are expected to finish the writing tasks in school. Although most of children with CP have the capacity to write, many of them still experience difficulties in handwriting such as slow writing speed and poor legibility. The comprehensive evaluation of handwriting performance including handwriting product and process and the related visual motor skills could provide more insight to understand the handwriting performance and the related factors of children with CP. However, current research mainly focused on handwriting product, while the understanding of handwriting performance and related visual motor skills of children with CP is still limited. Purposes: The aim of this study was to investigate the handwriting performance, visual motor skills between children with CP and typically developing children (TDC). In addition, relationship between handwriting performance and handwriting related visual motor skills in children with CP and those in TDC were also investigated. Methods: 30 children with CP and 30 age-matched TDC, aged 6 to 13 years, were recruited in the study. Each participant was asked to finish Tablet-based Chinese Handwriting Assessment and Tablet-based Visual Motor Skills Assessment. Two-way repeated-measures analysis of variance (ANOVA) and Independent-sample t test were used to analyze the handwriting performance and visual motor skills between two groups. Pearson product-moment correlation was used to analyze the relationship between the handwriting performance and visual motor skills in children with CP and those in TDC. Results: Children with CP performed lower accuracy and poorer local legibility (position, size, orientation and deformation) than those in TDC. Significant group differences were found in alignment control and size control of global legibility. However, there was no significant difference between groups in writing speed. There was a faster mean stroke velocity of handwriting process in children with CP than that in TDC. In addition, children with CP have poorer visual motor skills (tracking and copying) than those in TDC. Both orientation of local legibility and alignment control of global legibility are correlated to performance of tracking subtest in children with CP. No significant relationships between handwriting and copying performance were found in children with CP and in TDC. Conclusion: This study comprehensively assessed the handwriting performance including handwriting product and handwriting process in children with CP and in TDC. Children with CP performed poorer in handwriting product and visual motor skills compared to TDC. The tracking ability of visual motor skills may be an important factor of handwriting performance for CP children.