2012-03-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646007摘要：隨著醫療技術的進步，早產兒的存活率於近 20 年來顯著地提昇，在這些存活的早 產兒當中，即使不具備明顯的腦神經功能異常，也有高比例呈現各種發展障礙，其中又 以動作發展遲緩最為顯著，尤其手功能發展障礙之比例更達早產兒族群的 70%。嬰幼兒 時期是手功能發展的重要階段，更是奠定未來日常生活功能技巧與學業表現的基石。然 而，目前在早產兒手功能發展的相關研究中，仍有以下重要問題尚待釐清與解決。第一、 由於醫療技術的進步使得更多更脆弱的早產兒能夠存活，多數探討早產兒手功能發展的 文獻已過時，無法完全用以代表目前早產兒族群；第二、過去的研究大多只探討單一時 間點或單一手功能發展的動作要素，無法完整呈現早產兒整體手功能發展情形；第三、 有學者認為早產兒與足月兒的手功能發展曲線呈平行發展，但也有學者認為兩者的發展 速度會隨著年齡增加而越來越接近，此議題目前仍沒有一致的定論；第四、多數早產兒 研究只著重於有顯著障礙之個案(如腦性麻痺)，許多不具備明顯神經功能異常卻在學齡 前期被診斷出遲緩的兒童，常被忽略且錯過黃金治療時期；此外、目前國內經驗發現， 早產兒的早期追蹤皆是以大動作技巧為篩檢指標，手功能發展受到國人長期忽視，延誤 了黃金治療時期。有鑒於手功能為兒童日常生活獨立及學習發展的重要指標，為解決上 述早產兒手功能研究廣度與深度的不足，本研究將同時採用橫斷性與縱貫性之研究設 計。橫斷性研究設計目的為廣泛且全面地探討 0 至 6 歲學齡前早產兒族群之手功能發展 與相關危險因子分析。縱貫性研究設計目的為縱向地了解早產兒手功能發展曲線與相關 危險因子、並了解早產兒手功能發展與足月兒的差異是否隨著年齡的增加而有所改變、 最後探討危險因子對於手功能發展之影響是否隨著時間不同而有所改變。本研究預計四年完成。研究對象將取自於 3-5 所早產兒基金會簽約醫院，並在相同地區募集正常發展的對照組個案。橫斷性研究預計募集 0-6 歲的早產與對照組個案各 210名 (6, 12, 24, 36, 48, 60, 72 個月各 30 名)；縱貫性研究預計募集 6 個月與 48 個月的早產 兒與對照組各 60 名，且每年接受一次追蹤評估(共追蹤 3 年)。手功能發展評估以國際功 能分類-兒童及青少年版 (ICF-CY)架構為依據，評估工具包含握力器、量尺、皮巴迪動 作評估量表、嬰幼兒姿勢與精細動作評量、文蘭適應性量表、與夏威夷早期學習量表。 資料分析將使用獨立 t 檢定探討早產兒與足月兒在動作發展上的差異；階層式多元廻歸 分析檢測相關預測因子；並利用多元線性模型 (multivariate linear model) 分析早產兒之 發展曲線。本研究將可以協助從事早產兒相關的工作人員與研究人員，了解早產兒手功能發 展，並了解其與足月兒的差異，有助於臨床人員提供家長或照顧者適當的教育與諮詢。 另外，本研究將可掌握 0 至 6 歲學齡前早產兒的手功能發展以及相關危險因子（早期的 發展、出生體重、懷孕週數、醫療史、父母社經或壓力等），有利於臨床人員藉由早期 的動作發展或相關記錄，預期兒童往後的表現，並給予適切的治療計畫，以提升手功能 早期療育之成效。本研究也可協助建立台灣地區早產兒手功能發展曲線。預期能提供更 具實證基礎的資訊，並期能充實與提升國內早產兒手功能發展之研究與臨床工作內涵。<br> Abstract: The development of hand functional skills is critical for children to interact with their environments and to accomplish activities of daily living. However, a number of questions in the development of hand functional skills in preterm population remain un-answered. Most importantly, the population characteristics of preterm children have been changed largely during the last two decades. Studies that conduced decades ago are not appropriate to explain the current population. Second, studies only focused on single time point or single component of hand functional skills can not represent the general development of children’s hand functional skills. Third, studies that recruited preterm children with at least one medical complication are not able to represent the majority healthy preemie population whom is free of medical concerns. Finally, there is no conclusion regarding the progression of motor development in preterm children comparing to full-term children. Some researchers claimed that the progression of motor development in preterm and full-term children are parallel while others suggested that preterm children’s motor development will catch up to their counterparts with the increasing of age. As a result, a study investigates children’s hand functional skills broadly and deeply in current preterm population is proposed.The population-based subjects of preterm children will be collected between 2012 and 2015 for both cross-sectional and longitudinal follow-up designs in this project. Children with premature history will be recruited via the database of Premature Baby Foundation (PBF) in Taiwan. We will contact 3-5 out of 21 contracted hospitals with PBF for recruiting the target subjects (n=270). The matched typically developing full-term children will be recruited from local convenient samples in the same area as the preterm children located (n=270). The ICF-CY will be used to guide the evaluation of hand functional skills for this project. The body function and structure level tests (hand strength and size) will be used to represent the child’s basic hand function. The activity level tests (Peabody Developmental Motor Scales II and Postural and Fine Motor Assessment of Infants) will be used to examine a child’s hand functional skills and efficacy by professional examiner’s direct measurement. The participation level tests (Hawaii Early Learning Profile and Vineland Adaptive Behavior Scale – Chinese version) will be used to represent a child’s participation in daily life. Data will be analyzed using SPSS-PC for Windows Release 19.0. Independent sample t-test is used to test the motor development differences between pre and full-term infants; hierarchical multiple regression is used to test the factors that can predict hand functional skills, and multivariate linear model is used to analyze the developmental curve of preterm children’s hand functional skills.The study will establish a comprehensive picture about the development of hand functional skills as well as its risk factors in the preterm population. The results will provide update knowledge for the clinicians who work with preemie children and therefore benefit for the parents and primary care providers’ consultation. It can also increase clinician’s understanding in preterm children’s hand functional performance and offer insight into the types of intervention strategies that might prove to be helpful in preterm population.早產兒手功能兒童發展危險因子PrematureHand Functional SkillChild DevelopmentRisk Factors