【学位级别】医学博士

【论文完成日期】2004-05-20

【论文中文题名】注意缺陷多动障碍儿童姿势控制功能特点研究

【论文外文题名】A study on the Postural Control Function of Attention Deficit Hyperactivity Disorder Boys

【论文著者】姓名：任园春 ren yuan chun

【论文著者】学号：B10199764

【论文著者】系别：精神卫生研究所

【论文著者】专业：精神病与精神卫生学

【论文著者】研究方向：儿童精神病学

【指导教师】姓名：王玉凤 wang yu feng

【指导教师】学校：北京大学医学部

【指导教师】系别：精神卫生研究所

【指导教师】专业：精神病与精神卫生学

【中文文摘】目 的 注意缺陷多动障碍是儿童期最常见的行为障碍，患病率为3-6%。ADHD共患多种障碍，但有关运动障碍问题的研究较少。已知姿势控制功能是人类运动技能的基础，其损害与行为、情绪、注意和认知均有一定的关系。本研究的目的是：（1）探讨ADHD儿童及其不同亚型动、静态姿势控制功能特点；（2）探讨其与ADHD的临床症状、行为学特点和认知功能的关系；（3）寻找ADHD发病及非药物治疗的神经生理学依据。 方 法 以DSM-IV为诊断标准，以7-15岁的ADHD男孩及与之按年龄、智商匹配的正常男孩共73对为研究对象。使用人体动、静态姿势控制测试仪（SMART EquiTest 8.0版 Neuro-Com Int.，Clackamas，OR），以SOT、US中的重心晃动速度评价静态姿势控制功能，以MCT、LOS、SQT和RWS中的反应潜伏期、重心转移的速度、方向和节律的控制评价动态姿势控制功能。采用父母填写的ADHD症状量表、Conners、Rutter和Achenbach儿童行为问卷评价ADHD儿童的临床症状和行为特点，采用中国韦氏儿童智力量表、韦氏记忆量表、Stroop测验和瑞文标准推理测验评定认知功能。对两组儿童的姿势控制功能数据进行显著性检验，对ADHD儿童动、静态姿势控制功能与临床症状、行为和认知功能进行相关性分析。 结 果 1．ADHD儿童在基础感觉状态、视觉和/或本体信息传入减少和/或不正确时，平衡分低于正常对照，视觉和前庭系统的感觉分也低于对照组（P均<0.05）；在本体信息传入不正确和/或视觉信息存在、去除或传入不正确时的策略分低于对照组（P均<0.05）； 2．ADHD儿童在突然的大幅度姿势干扰下，反应潜伏期长于对照组（P<0.05）；向不同方向转移重心时，重心移动速度慢于对照组，前后的方向控制性得分低于对照组（P<0.05）；快速转身的时间长、转身后的重心摇摆速度快于对照组（P均<0.05）；在以慢和中等节奏进行节律性运动时，前后方向的方向控制性得分低于对照组，差异有显著性（P均<0.05）。 3．ADHD-I组在本体信息传入减少或不正确、视觉信息存在或去除，或本体和视觉信息传入均不正确的情况下的平衡分和策略分、视觉和前庭系统的感觉分均低于对照组（P均<0.05）；ADHD-C组视觉系统的感觉分低于对照组（P <0.05）；两亚型之间其他测试指标的差异均无显著性（P均>0.05）。 4．两亚型在突然的大幅度姿势干扰下，反应潜伏期都长于对照组（P<0.05）；ADHD-I组在向不同方向转移重心时，向前的方向控制性得分低于对照组；快速转身时间长于对照组；在以慢节奏进行节律性运动时，前后方向的控制性得分低于对照组，差异均有显著性（P均<0.05）。ADHD-C组与ADHD-I组和对照组之间均未发现显著性差异（P均>0.05）。 5．ADHD儿童快节奏运动中的方向控制性与临床症状总分相关；慢节奏运动中的方向控制性与多动冲动症状分相关；运动平均反应潜伏期与注意缺陷症状分相关，上述差异均达到统计学意义（P均<0.05）。 6．ADHD儿童在视觉和/或本体信息传入减少和/或不正确时的平衡分、视觉感觉分、主动快速重心转移和节律性重心转移时的方向控制性、原地快速转身后的重心晃动速度均与Achenbach儿童行为量表中的交往不良和体述因子分相关，前庭感觉分与体述因子分相关，差异均达到统计学意义（P均<0.05）。 7．ADHD儿童在视觉和/或本体信息传入不正确时的平衡分、视觉感觉分与C因子分相关；在本体传入不正确和/或视觉传入不正确时的平衡分和视觉感觉分与瞬时记忆呈正相关、与Stroop测试中的字义干扰时呈负相关；视觉和本体信息传入都不精确时的平衡分与瑞文标准推理测试的标准分呈负相关，上述差异均有显著性（P 均<0.05）。 结 论 1、ADHD男孩静态姿势控制功能的特点为：视觉和前庭系统的信息加工受损，尤其是前庭系统抑制视觉和本体信息干扰的整合功能受损明显；动态姿势控制功能的特点为：运动信息和时间加工技能受损，运动控制能力下降。 2、ADHD男孩动、静态姿势控制功能受损主要体现在注意缺陷亚型，混合型患儿仅有视觉和运动信息加工受损。 3、ADHD男孩动态姿势控制功能与临床症状的严重程度有关；姿势控制功能的损害程度与交往不良和体诉症状有关；静态姿势控制功能与注意、记忆、选择性抑制和计划能力等认知功能损害的程度联系更密切。

【外文文摘】Objectives To explore features of dynamic and static postural control function of different subtypes ADHD boy; to explore the relationship between postural control function and clinic symptoms, behavior and cognitive function. Methods The present study involved two groups of subjects: seventy-three ADHD boys (age range 7.6 to 15.3 years) diagnosed with DSM-IV diagnostic criteria and seventy-three normal controls(age range 7.6 to 15.6 years) matched by sex and age. All subjects were placed on the SMART EquiTest platform. The tests of SOT, US, MCT, LOS, RWS and SQT were adopted to evaluate the dynamic and static postural control function. DSM-IV Symptom questionnaire, Conner's Parent Rating Scale, Rutter Scale and Achenbach's Child Behavior Checklist were used to evaluate the features of clinic symptoms and behavior. A set of neuropsychological investigations such as C-WISC, WMS, Raven's Standard Progressive Matrices and Stroop Test were adopted to evaluate the cognitive function. Results 1、Significantly lower Equilibrium Score in SOT1, SOT3, SOT4, SOT5 and SOT6 and faster sway velocity of COG during unilateral stance with/without eyes closed were observed on ADHD group(P<0.05). The Sensory analysis of ADHD group showed visual and vestibular sensory organization ratios were lower than controls. 2、Significantly higher latencies in averages of large platform translations observed on ADHD. Limit of Stability test on ADHD children showed significant slower velocity moving the COG voluntarily and poorer directional control. We also found significantly longer turn time and faster turn sway in SQT and poorer forward/backward directional control during performing weight shift by low and medium rhythm on ADHD(P<0.05). 3、Significantly lower Equilibrium Score in SOT4, SOT5, SOT6 and faster sway velocity of COG during right foot stance with and without eyes closed were observed on ADHD-I group(P<0.05). Both ADHD-I and ADHD-C's visual sensory organization ratios were lower and latencies were higher significantly in large platform translations than controls. Vestibular sensory organization ratios were lower only in ADHD-I .We also found poorer forward directional control in LOS test, longer turn time in SQT and poorer forward/backward directional control during performing weight shift by low rhythm on ADHD-I. No difference between ADHD-I and ADHD-C on all above tests was disclosed. 4、Significant correlation between directional control during rhythm weight shift , latencies in large platform translations and the clinical symptom score; Equilibrium Score in SOT1, SOT3, SOT4, SOT5 and SOT6, visual sensory organization ratios, directional control on LOS and RWS , the turn sway on SQT and the factor of poor social communication and physical complain of the Achenbach's Child Behavior Checklist; Equilibrium Score in SOT3, SOT4, SOT6, visual sensory organization ratios and sway velocity of COG during unilateral stance and C factor of C-WISC, instant memory of WMS, the interference of word meaning of Stroop Test and the standard score of Raven's Standard Progressive Matrices were observed. Conclusion 1、Visual and vestibular information processing skill of ADHD boys were impaired while their vestibular integration to the confusion of visual and somatosensory was impaired especially. The deficits of motor and time processing as well as motor control were also showed in ADHD group indicating the existing of dynamic and static postural control deficit. 2、The postural control dysfunction of ADHD male was embodied mainly in ADHD-I while the ADHD-C only have poorer visual and motor information processing skill than normal boys. 3、In ADHD male, the dynamic postural control was correlate with the deficit degree of clinical symptom; the dysfunction degree of postural control correlated with mal-social communication; the static postural control have a close relationship with the degree of cognitive dysfunction, such as attention, memory, selective inhibition and plan.