發展協調障礙孩童視知覺與視覺動作統合特性之探討

Visual Perception and Visual-motor Integration in Children with Developmental Coordination Disorder

研究目的：比較發展協調障礙（DCD）孩童與典型發展孩童在視知覺（無動作參與）（TVPS-R）及視覺動作統合（有動作參與）（VMI）測驗之表現差異，並分析兩種知覺能力與動作表現相互之間的關連性。研究方法：以兒童動作評估測驗（Movement ABC）篩檢出15位DCD孩童及15位年齡、性別相仿之典型發展孩童，個別施以TVPS-R及VMI測驗。以獨立樣本t檢定比較二組孩童在各項測驗表現是否有顯著差異，並以描述性統計與卡方考驗分析各項測驗中，DCD孩童達臨床認定需接受治療標準之人數及顯著性，最後以Pearson’s correlation分別了解二組孩童在視知覺、視覺動作統合和動作能力之間的相關性。研究結果：除了TVPS-R的視覺圖形辨識力、視覺封閉力子測驗及VMI的動作協調補充測驗外，DCD孩童在其餘測驗之子項目與整體分數上均顯著低於典型發展孩童，而二組孩童在TVPS-R與VMI之間均呈現顯著正相關。研究結論：整體而言，本研究中DCD兒童的視知覺與視覺動作統合能力確實較典型發展兒童差；然而，DCD兒童的視覺動作統合能力表現大多仍屬於臨床標準範圍。此外，本研究亦發現視知覺與視覺動作統合之間確實存在部分關連性，未來研究可從不同次族群間及DCD孩童障礙表現的異質性做進一步確認。

Purpose: Many studies have revealed that children with developmental coordination disorder (DCD) display more deficits in comparison with typically developing children on visual perception or visual-motor integration tasks. However, the relationship between these functions has not been fully explained. The purpose of this study was to explore the performance on visual perception and visual-motor integration tasks in children with DCD in Taiwan. In addition, the association between these tasks was also investigated in this study. Methods: Fifteen children with DCD, aged 9 and 10 years, along with 15 age- and sex-matched typically developing children, were recruited using the Movement Assessment Battery for Children (Movement ABC). Two measures were given to all these children-- the Test of Visual-Perceptual Skills (non-motor)-Revised (TVPS-R), and the Beery-Buktenica Developmental Test of Visual-Motor Integration (VMI), with Supplemental Developmental Tests of Visual Perception (VP) and Motor Coordination (MC). Independent t-tests were used to compare the children with DCD with the typically developing children on all tests. The proportion of children with DCD that scored within the clinical range, namely scores below the 15th percentile, was also calculated for each subtest, and the total score on both TVPS-R and VMI tests. In addition, Pearson’s correlation analyses were performed between the different measures. Results: The results showed that children with DCD performed significantly worse for all tasks than typically developing children, except for Visual-Figure Ground and Visual Closure subtests of the TVPS-R and Motor Coordination supplemental test of the VMI. Nine (60%) children with DCD had a total score on the TVPS-R below the 15th percentile, but, on the VMI, none of DCD children was within the clinical range. Furthermore, for both groups, Pearson’s correlation analysis revealed a significant positive correlation between visual perception task and visual-motor integration task. Conclusions: On the basis of our findings and in line with pervious studies, children with DCD demonstrated poorer performance on visual perception tasks than typically developing children did. These clumsy children in the present study had more deficits on Visual-Form Constancy and Visual Closure subtests of the TVPS-R. Children with DCD also performed worse on visual-motor integration task, but, in general, their performance did not seriously fall within the clinical range. Moreover, moderate but significant correlation between these measures indicated that visual perception and visual-motor integration could not be considered as independent or separate systems for children with DCD. However, further investigation of this issue seems to be warranted for the subtypes of children with DCD, owing to the heterogeneity of the group of DCD.