Wii Fit訓練對於一名腦性麻痺兒童前置性姿勢調整的影響

Effect of Wii Fit-based Training on Anticipatory Postural Adjustments in a Child with Cerebral Palsy

劉文瑜(Wen-Yu Liu) ； 蔡意茹(Yi-Ju Tsai) ； 黃美涓(Alice MK Wong) ； 林燕慧(Yau-Hua Lin) ； 許智欽(Chih-Chin Hsu) ； 達恆裕(Hen-Yu Lien)

《物理治療》 34卷3期 (2009/06) Pp. 201-208

摘要

背景與目的：在先前的研究中指出，腦性麻痺兒童在功能性活動中常出現較不安全、且沒有效率的前置性姿勢調整(anticipatory postural adjustments, APA)的方式。為改善前置性姿勢調整需要仰賴大量的重覆練習，而Wii電子遊戲可以藉曲多樣化的情境提昇遊戲者大量的重覆練習意願。Wii Fit電子動戲更加入一個平衡板來偵測遊戲者童心(center of gravity, COG)的移動，讓遊戲者藉由一個外在的電子影像做為額外的視覺回饋來瞭解自身的COG控制。目前無研究對Wii Fit或外在COG移動回饋練習對於前置性姿勢調整之影響探討。因此，本個案報告的目的是描述利用Wii Fit電子遊戲對一位腦性麻痺兒童訓練及其對於伸手向前取物前置性姿勢調整的改變。方法：一位瘦擎型雙邊麻痺(spastic diplegia)腦生麻痺兒童參與本報告，接受為期4週，每過3天的個別化Wii Fit訓練。採訓練前後重複量測的方法，評估個案在站立下以最舒服的速度傲的次伸手向前取球時，足底壓力中心(center of pressure, COP)移動及前腔肌(tibialis anterior)的潛伏活化時間參數來討論前置性姿勢調整的變化。結果：雖然經過練習前後個案手臂向前時瞬間未見壓力中心向後移動的一致出現，但個案在訓練間無不良反應，且個案前經肌活化與手臂向前敢動的絕對相隔時間差縮短。結論配合物理治療師個別化設計，Wii Fit電子遊戲可能可以做為提升腦性麻痺兒童的部份前置性姿勢調整之訓練輔助工具，未來值得更進一步的探討。

關鍵字

前置性姿勢調整 ； 腦性麻痺 ； 壓力中心

並列摘要

Background and purpose: Previous studies have indicated that children with cerebral palsy (CP) develop less efficient, more unsafe, and more laborious anticipatory postural adjustments (APAs). Children require massed practice in order to improve their APAs. Wii can serve as an additional avenue for enhancing children's participation in the massed practice. The new Wii Fit balance system provides an external visual feedback that assists users in understanding the excursion of their own center of gravity (COG). To date, there has been no study on the effect of Wii Fit balance training or practice with external COG-excursion feedback on APAs. In this report, we aimed to describe APAs in a child with CP who performed Wii Fit balance exercise. Methods: A pre-post tests design was used, and APAs were assessed at the baseline and after Wii Fit training. The Wii Fit balance exercise was performed 3 days a week for 4 weeks. The changes in APAs were defined on the onset of center of pressure (COP) excursion and the reach-movement-related activation of tibialis anterior (TA). Outcome: After training, the time differences between the initiation of reach and the onset of COP excursion were shorten. However, the posterior shifts of COP excursion were not observed at the baseline and after Wii Fit training. No adverse effect had been noted during the practice. Conclusions: This case report demonstrates that the individualized Wii Fit training is a safe approach, and it may serve as the training equipment for physical therapists to accelerate the development of APAs in some children with CF. Further research is warranted in order to determine the optimal training parameters.

並列關鍵字

Anticipatory postural adjustments ； Cerebral palsy ； Center of pressure