電腦化視-動-整合測驗

Abstract

前言: 「視知覺動作能力（VPMS）」涵括了視知覺、手眼協調、視動整合的能力。 VPMS失能，往往對學齡兒童的職能表現與功能性技巧造成負面的影響，因此兒童職能治療師時常需要針對學齡兒童的VMPS困難進行測驗、評估。 因此治療師與老師需要有效測驗，以供治療對象篩選、設立治療計劃，乃至於監控進步成效。 近年來隨著數位科技日新月異的進步，過去紙本化VPMS測驗在施測與記分上的諸多劣勢亦逐漸被彰顯。隨著科技進步，電腦化的復健模式於近十年內蓬勃進展，藉由電腦化的測驗工具，兒童ＶＰＭＳ評估有了更俱效率的方法。因此本研究發展一基於電腦的兒童VPMS評估工具。本研究的目的如下: 1) 設計與發展VPMICA， 2)對VPMICA進行效度驗證。（藉由比對Beery VMI， TVPS-3 and DTVP-2 eye-hand coordination subtest結果，同時效度）， 3) 對VPMICA進行信度驗證4) 檢視VPMICA對兒童書寫困難的區別效度。 方法:為評估同時效度， 43名參與並完成下列四項評估：VPMICA， Beery VMI， TVPS-3 and DTVP-2 eye-hand coordination subtest。為評估再測信度， 43名參與者中有15名需在兩週後再進行一次VPMICA。為評估區別效度，對 26 名有書寫困難的兒童完成VPMICA. 信度使用ICC係數 (intraclass correlation coefficients) 做前後測的分析。The用皮爾森相關分析 (Pearson’s correlation) 來檢與測Beery VMI， TVPS-3 and DTVP-2之收斂效度。 結果: 本研究的樣本共有69名受試者。結果顯示VPMICA在三個分測驗皆有高度的再測信度(VD = .933; VM = .803; FC = .982; FG = .990; VC = .985; Circle = .997; Pentagon = .993; Star = .999; VMI =.997). 在收斂效度的部分VPMICA的三個分測驗分別與TPVS-3，DTVP-2 ，VMI有顯著的中度相關 (VD r = .611， n = 43， p < .01; VM r = .446， n = 43， p < .01; SR r = .312， n = 43， p < .05; FC r = .526， n = 43， p < .05; FG r = .406， n = 43， p < .01; VC r = .646， n = 43， p < .01; circle r = -.600， n = 43， p < .01; pentagon r = -.744， n = 43， p < .01; star r = -.708， n = 43， p < .01 VMI raw score r = .641， n = 43， p < .01; VMI standard score r = .760， n = 43， p < .01; VMI scaled scores r = .778， n = 43， p < .01)。 最後本研究也發現正常發展孩童和書寫困難孩童的VPMICA 的分數有顯著的差異。 結論 ：本研究的結果證明VPMICA是一個具備信效度的評估工具，可以精準的測量到孩童VPMS 的能力。本研究結果支持未來在研究或臨床上面學校老師與職能治療師等可以選用此工具來評估及監測書寫困難孩童的VPMS 能力。

Background & Literature Review: The visual-perceptual-motor skills (VPMS) serve as an umbrella term encompassing visual-perceptual, eye hand coordination, and visual motor integration skills. Since dysfunction or difficulties in VPMS in school-aged children can negatively impact a child’s occupational performance and functional skills, pediatric occupational therapists often need to assess and treat school-aged children with difficulties in VPMS. It is important, therefore, for therapists and educators to use tests that possess sound measurement properties in order to monitor progress, plan treatments and to determine eligibility for therapeutic services. However rapid digital technology developed in the recent years, it is striking that most of the assessment tools assessing VPMS in children is still mostly paper-based which may be prone to several disadvantages due to manual administering and scoring. Fortunately, due to the advance of technology, the application of computerized methods in rehabilitation has expanded in recent decades and could be a solution to better and quicker assessment of children’s VPMS. Objective: We aim to develop a computer based VPMS assessment tool for children. The objectives of this study are the following: 1) To design and develop the VPMICA, 2) To validate the VPMICA by assessing the concurrent validity with Beery VMI, TVPS-3 and DTVP-2 eye-hand coordination subtest, 3) To examine the test-retest reliability of the VPMICA and 4) To examine the discriminate validity of the VPMICA on children with handwriting difficulties. Methods: To assess the concurrent validity, 43 participants were recruited and completed 4 assessments: VPMICA, Beery VMI, TVPS-3 and DTVP-2 eye-hand coordination subtest. To assess the test-retest reliability, 15 out of the 43 participants recruited earlier were asked to complete the VPMICA two weeks after. To assess the discriminant validity, 26 children with handwriting difficulties were recruited to complete the VPMICA. Data Analysis: The IBM SPSS 22.0 was used to perform the statistical analysis. First descriptive statistics were calculated to characterize the performance of the participants. Then, the test-retest reliability of the VPMICA was assessed using test-retest correlation between scores in trial 1 and trial 2 using the intraclass correlation coefficients (ICC). The convergent validity of the Computer-Based Assessment of Visual Motor Integration for Children with Beery VMI, TVPS-3 and DTVP-2 subtest were estimated with Pearson correlations. The discriminant validity was computed using the scores of children with handwriting difficulties. Results: The VPMICA exhibited high reliability (VD = .933; VM = .803; FC = .982; FG = .990; VC = .985) in VP subtests, high reliability (Circle = .997; Pentagon = .993; Star = .999) in EHC subtests and high reliability in VMI (.997). Significant moderate correlations were found between VPMICA VP subtest scores and TVPS-3 scaled scores in the entire sample except the spatial relationship subtest (VD r = .611, n = 43, p < .01; VM r = .446, n = 43, p < .01; SR r = .312, n = 43, p < .05; FC r = .526, n = 43, p < .05; FG r = .406, n = 43, p < .01; VC r = .646, n = 43, p < .01). Significant moderate correlations were found between VPMICA EHC subtest scores and DTVP-2 eye-hand coordination subtest standard scores in the entire sample (circle r = -.600, n = 43, p < .01; pentagon r = -.744, n = 43, p < .01; star r = -.708, n = 43, p < .01). Significant moderate correlation was found between VPMICA VMI subtest scores and VMI scale scores in the entire sample (VMI raw score r = .641, n = 43, p < .01; VMI standard score r = .760, n = 43, p < .01; VMI scaled scores r = .778, n = 43, p < .01). And significant differences were found on the scores VPMICA VP, VMI and EHC subtests between typically developed children and children with handwriting difficulties. Conclusion: The preliminary results indicate that the VPMICA is a valid tool that accurately assesses VPMS in children with handwriting difficulties and Teachers and occupational therapist can also use this assessment tool to evaluate and monitor children’s VPMS. In addition to its demonstrated reliability and validity, the VPMICA is cost effective and relatively easy to administer. These factors support the use of VPMICA in assessing VPMS in children.