摘要
背景:视觉-运动整合发育测验设计于20世纪70年代,90年代引入国内,因不受语言、文化背景限制而广泛常规性用于评估、识别正常儿童的智能发育和学习行为等问题。目的:分析视觉-运动整合能力发育测验在听力残疾儿童中的应用价值,探讨大规模用于聋童智能筛查的可行性。其信度效度值与陕西省和美国正常儿童常模比较。设计:随机整群抽样方法,相关对照分析和多元逐步回归。单位:西安交通大学医学院第一附属医院神经内科。对象:选择1998-01/2000-12西安市、咸阳市、长安县、户县、临潼县6所聋哑学校中18岁以下身体健康、发育正常、除听力残疾外无任何其他疾病的学生638人。另随机选取聋童43人进行脑电地形图检测。男23人,女20人。年龄(11.62±1.98)岁,视觉-运动整合发育测验发育商为86.60±15.68,以平均值86.6为界线分为<86.6组20人及≥86.6组23人。方法:①视觉-运动整合发育测验按照Beery K.E 最新修订第4版要求进行不限时测验,1图记1分,连续3图不通过时停止记分,原始分最高27分,最低0分。②信度检验包括分半(把测验项目按奇偶数分半)重测(2个月后再测)及两测验者间信度(同一测试,两人单独评分)。③效度检验以希内学习能力测验、韦氏儿童智能操作量表、瑞文联合型测验为结构效标;以学习成绩、教师、家长评价为准则关联效标。均由专业人员严格按指导语进行。对有阅读能力者直接测试,年龄小无阅读能力的,由班主任用手语翻译测验内容,至完全理解后正式施测记分。④使用7314/F /W 型DYD-300A 脑电地形图机,国际标准10/20系统放置电极。常规描记两组盲童脑电图30m in 作视觉分析。取单极导联下安静闭眼时,无任何干扰或伪差的代表性脑电图波120s存入计算机,分析时由经验丰富的脑电图医师通过人机对话方式选取20s最具代表意义的脑电波计算脑电绝对功率值。主要观察指标:视觉-运动整合发育测验信度、效度结果,以及视觉-运动整合能力与脑电生理改变的关系。结果:共调查6所聋哑学校18岁以下聋童638人,排除因资料不全、有先天性疾病或曾患中枢神经系统疾病的72人后,最终566人进入统计分析。男346人,女220人,平均年龄(12±3)岁。①视觉-运动整合发育测验信度检验结果:不同年龄组为0.63～0.99,总人群中平均为0.92。566例聋童的视觉-运动整合发育测验结果建成年龄等值常模表后与陕西省和美国正常儿童相比,每一原始分对应的年龄等值平均相差(1.79±0.9),普遍落后于正常儿童。②视觉-运动整合能力发育测验效度结果:视觉-运动整合能力发育测验发育商与希内学习能力,韦氏操作量表、瑞文渐进测验的相关系数分别为0.6610,0.3576,0.5174。③视觉-运动整合能力发育与脑电生理改变的关系:视觉运动整合能力发育好的聋童在左侧半球中央、顶、枕区多个区域的多个频段δ,θ,α1及总功率上的脑电绝对功率值高于视觉运动整合能力差的聋童。结论:视觉运动整合能力发育测验作为一种筛查工具,能方便有效地反映出学龄期聋童的认知发育和智能水平,并可反映大脑视觉运动整合中枢的脑电活动水平。
BACKGROUND： Visual-motor integration （VM1） test was introduced into China in the 1970s and 1990s and widely used for evaluation and identification of problems in intellectual development and learning ability in children due to its good applicability without limitations by language and cultural background. OBJECTIVE： To assess the value of developmental test of VMI in children with hearing handicap, and evaluate its practical feasibility in largescale screening of intelligence problems in these children by comparing its reliability and validity with the norms of children in Shaanxi Province and the USA. DESIGN： A controlled correlation and multiple stepwise regression analysis with randomized eluster sampling. SETTING： Neurological Department of the First Hospital Affiliated to Medical College of Xi＇an Jiaotong University. PARTICIPANTS： From January 1998 to December 2000, 638 children under 18 years of age with hearing handicaps were chosen from 6 schools of dell-mutes in Xi＇an City, Xianyang City, Chang＇an County, Huxian County, and Lintong County in Shaanxi Province. Another 43 children with hearing handicap including 23 male and 20 female children aged （11.62±1.98） years were. selected randomly for EEG and brain electrical activity mapping （BEAM） examination, who had a mean development quotient of VMI of 86.60±15.68. The children were divided by the development quotient into two groups, namely those with development quotient 〈 86.6 （n=20） and those with development quotient ≥ 86.6 （n=23）. METHODS： ①The VMI test was performed in accordance with the Fourth edition of VM1 Manual by Beery K.E. The test was terminated when the testee failed to correctly copy three consecutive geometrical figures without time limit. The scale score varied from 0 to 27. ②The reliability test included split-half reliability test in which the items were split into two parts according to odd-even number, re-test reliability that tested the same group of children again in two months and inter-examiner reliability in which two examiners were asked to grade the same test paper. ③The validity test included structural and correlation validity test. Three well-revised and already established norms of scales in China, including Hiskey- Nebraska test of learning aptitude （H-NTLA）, performance scale of Wechsler intelligent scale for children （PS-WISC） and Combined Raven＇s test （CRT）, have been chosen as the structure validity eriteria. The performance IQ of PS-WISC, learning quotient of H-NTLA, percentile rank of CRT and standard score of VMI were taken respectively for each test in this study. Academic achievements and teachers＇ and parent＇s rating were used as the validity correlation criteria. During the administration procedure, a card describing the requirements in detail were presented to the deaf children with reading capacity, while for those too young to read, the teacher was asked to help translate the requirements using standard sign language, but no any hints or clues in relation with the test contents were given. ④The test did not start until the subjects fully understood the requirement （7314/F/W DYD-3OOA）. EEG recording was performed with the leads deposited according to the international standard 10/20 lead system. Routine EEG had been recorded at least 30 minutes for Visual assessment, and stable and representative waves for 120 seconds free of biases or inferences were recorded using unipolar lead from the subjects at rest with the eyes closed and stored in computer. Experienced EEG experts were asked to ±lect the most representative waves of 20 seconds in a double-blind manner to compute the absolute power spectrum of the brain wave. MAIN OUTCOME MEASURES： Reliability and validity of VMI test, relationship between VMI ability and cerebral electrophysiological changes. RESULTS： Totally 638 children under 18 years old with hearing handicap were involved, of whom 72 wen eliminated because of lack of data, congenital disease or central nervous system diseases. Finally 566 cases were available for analysis, including 346 male and 220 female children with an average age of （12±3） years. ① The reliability of VMI reached an average of 0.92, varying from 0.63 to 0.99 in each group. The equivalent age corresponding to the scores of the VMI test norm established for the 566 healthy deaf children was lower by an average of （1.79±0.9） years than the equivalent age in the norms of the normal children in Shaanxi Province delayed and USA. ②The standard score of VMI test showed the highest correlation coefficient of 0.661 0 with the learning quotient of H-NTLA, while the correlation with PS-WISC and CRT were 0.357 6 and 0.517 g, respectively. ③Children with higher VMI score showed more powerful absolute spectrum among frequency ranges 8, 0, α1 and total power spectrum in the central, parietal and occipital regions of the left hemisphere, respectively. CONCLUSION： VMI test can efficiently reflect the development status of visual-motor integration or intelligence of the school-age deaf children and represent the level of central EEG activity.
出处
《中国临床康复》
CSCD
北大核心
2005年第24期234-237,共4页
Chinese Journal of Clinical Rehabilitation
