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題名:自閉症光譜障礙兒童之心血管健康和動作表現
作者:Luděk Kalfiřt
作者(外文):Luděk Kalfiřt
校院名稱:臺北市立大學
系所名稱:運動科學研究所
指導教授:楊艾倫
學位類別:博士
出版日期:2023
主題關鍵詞:自閉症光譜障礙兒童動作表現心率變異度動脈硬化程度肌力柔軟度運動介入Autism Spectrum DisordersChildrenMotor SkillsHeart Rate VariabilityArterial StiffnessStrengthFlexibilityExercise Intervention
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背景和目的:現代人的生活型態缺乏身體活動,進而造成肥胖的流行,也正是患有自閉症光譜障礙 (autism spectrum disorders, ASD) 兒童和正常發展 (typically developing, TD) 兒童共同面臨的問題。然而ASD兒童之相關併發症,如:自律神經系統失調、動作發展遲緩等。鑑於上述之影響,找到有效的解決辦法是必要的。因此,本研究目的為探討ASD兒童之動作表現、心率變異度及動脈硬化程度之潛在問題,並評估運動介入對於改善ASD兒童之動作表現、肌力及柔軟度等之有效性。方法:本研究第一部分為比較ASD兒童與TD兒童之間的動作表現、心率變異度及動脈硬化程度。本研究分別招募17位ASD兒童和15位TD兒童,其動作表現以布魯茵克斯-歐西瑞斯基動作能力第二版進行測驗,HRV使用POLAR錶(RS800CX)進行短時間的測量,並以HRV軟體進行分析;動脈硬化程度則使用非侵入式儀器(Cardio Vision MS-2000)進行檢測。之後以獨立T檢定及無母數檢定(Mann-Whitney U test)比較ASD與TD兒童在動作表現、HRV及動脈硬化程度之差異,並使用Hedge’s g計算效果量。本研究第二部分以統合分析的方式探討運動介入對ASD兒童的動作表現、肌力及柔軟度等之有效性。文獻數據來源包括PubMed, Web of Science, Scopus and Cochrane Library,依據篩選標準,最後納入12項研究。研究結果在動作表現的部分,包含BOT-2之總分,兒童動作評估測驗(Movement Assessment Battery for Children-Second Edition, MABC-2),粗動作發展測試第二版(Test of Gross Motor Development-Second Edition, TGMD-2);並以立定跳遠測試肌力、坐姿體前彎測試柔軟度。結果:本研究第一部分關於動作表現之結果顯示,ASD兒童的肌力和敏捷度、手部協調、整體動作表現皆顯著降低。此外,ASD兒童在HRV之結果顯示,其心跳區間(mean RR)、正常心跳間期差值平方和的均方根(RMSSD)、及低頻/高頻之比值(LF/HF)皆顯著降低;然而,在動脈硬化程度方面則無顯著差異。第二部分的結果則顯示運動介入顯著提升ASD兒童之動作表現和下肢肌力,但對於柔軟度則無顯著影響。結論:本研究第一部分證實ASD兒童與TD兒童相較,ASD兒童存在動作表現及自律神經失調的問題。第二部分則顯示運動介入可以有效改善ASD兒童的動作表現及下肢肌力。
Background and purpose: Children with autism spectrum disorders (ASD) struggle with the same issues as their typically developing (TD) counterparts, some of these issues are related to the modern lifestyle and include physical inactivity and the obesity epidemic. However, these problems are exacerbated in children with ASD due to the complications associated with this disorder such as autonomic dysregulation and delayed motor development. It is essential to be able to identify exact deficits and their severity and be able to apply effective means of addressing these deficits. Therefore, this study aimed to identify potential deficits in motor skills, heart rate variability (HRV), and arterial stiffness in children with ASD and to evaluate the effectiveness of physical exercise interventions in improving motor skills, strength, and flexibility of children with ASD. Methods: In the first part of this study, a comparison of motor skills, HRV, and arterial stiffness between autistic and TD children was conducted. 17 children with ASD and 15 TD children were recruited in this study. Motor skills of participants were assessed using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2), HRV was determined through a short-term HRV measurement using Polar heart rate monitor and analyzed by HRV software, measure of arterial stiffness was obtained non-invasively by computerized oscillometry using Cardio Vision MS-2000. Subsequently, the differences in motor skills, HRV, and arterial stiffness between ASD and TD groups were analyzed by independent t-test and the Mann-Whitney U test, moreover, the effect sizes were calculated using Hedge’s g. The second part of this study included a meta-analysis focused on examining the effectiveness of physical exercise interventions in improving motor skills, strength, and flexibility in children with ASD. The search was conducted in four primary electronic databases including PubMed, Web of Science, Scopus, and Cochrane Library. Based on the eligibility criteria, a total of 12 studies was selected. Outcomes of the studies were reported as total scores the BOT-2, Movement Assessment Battery for Children-Second Edition (MABC-2) or Test of Gross Motor Development-Second Edition (TGMD-2) for motor skills, standing broad jump for strength, and sit-and-reach test for flexibility. After the data extraction, the statistical analysis was conducted using Review Manager software. Results: The results of the first part of this study regarding motor skills showed significant deficits in children with ASD in strength and agility (p < 0.05), manual coordination (p < 0.05), and total motor composite (p < 0.05). In addition, children with ASD displayed significantly lower HRV represented by mean RR (p < 0.05), RMSSD (p < 0.05), and LF/HF (p < 0.001). However, the results did not reveal any significant differences between the groups in arterial stiffness. The results of the second part of this study demonstrated a significant positive effect of physical exercise interventions on level of motor skills (p < 0.001) and strength (p < 0.001) in children with ASD. On the other hand, the results did not show any significant effect of physical exercise interventions on flexibility of children with ASD. Conclusion: Firstly, the current study demonstrated deficits in motor skills and the presence of autonomic dysregulation in autistic children in comparison with TD children. Secondly, the present study confirmed the effectiveness of physical exercise interventions in improving motor skills and strength in children with ASD.
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