- 學位論文
中風後患者與老人之模擬駕駛評估與臨床篩檢
Clinical screen and simulated driving evaluation for elderly and patients following stroke
摘要
高齡駕駛者與中風後患者恢復駕駛前之臨床篩檢以及駕駛表現評估是需重視的問題。過去研究多以臨床評估與實際道路測試的相關性為主，然而，臨床評估與影響交通安全之緊急煞車反應測試的相關性，以及針對高齡駕駛者與腦中風患者駕車時之腦波訊號相關研究仍需進一步研究探討。本研究收取青年15位、中年11位、老年10位以及10位右側偏癱中風病患，每位受測者需參與駕駛相關生理功能評估、駕駛自主動作/緊急反應腦波測試以及不同時速下之煞車反應時間測試。結果顯示，高齡駕駛者在中、高車速下感知-反應時間(PRT)的花費時間較青年駕駛者長，其認知評估(TMT-B和CDT)與動作功能評估(RPW、髖屈曲和膝伸直肌力)亦比青年人差。對老年人來說，中、高車速下的TMT-B、CDT對PRT具有良好的預測性。另外，中風病患無論在慢、中、高車速下的總煞車時間(TBT)、煞車-動作時間(BMT)、PRT以及FPT皆比健康成年人長，且認知與動作評估表現亦較差。對中風病患而言，在慢、高車速下CDT對PRT以及在慢速下RPW對BMT具有良好的預測性。在自主動作腦波測試，BP潛伏期及動作誘發電位振幅皆隨著年紀增加而減少；中風病患BP潛伏期則較健康成年人長。駕駛緊急狀況反應測試下，老年人PRT與青年人有差異是因為前期認知決策時間較長導致，而中風病患與健康成年人有差異是因為後期動作啟動時間較長導致。本研究結果支持隨著年紀增加，認知功能下降影響駕駛表現；然而中風病患雖然身體功能恢復良好，但動作功能的限制主要還是影響駕駛表現的重要因素。
並列摘要
For the elders and people who suffered stroke, their drivingability needs to be re-examined whether they had the ability to drive safely.The past researcheshad emphasized on the connection between clinical assessment and on-roadtest, however, the relationship between clinical assessment and the emergency brake reaction time which affected the traffic safety and the changes of EEG for the elders and stroke patients when they driving were not verified clearly. The present study involved 15 teenagers, 11 middle-aged, 10 elders, and 10 people who suffered stroke with right side hemiparesis. Each participant had to complete the physical functional assessments, the EEG tests at two conditions (self voluntary movements and emergency braking), and braking reaction time test at different speed. The result shows that the elder drivers showed longer perception reaction time (PRT) than young drivers at mid and high driving speed. Besides, the cognitive (TMT-B/CDT) and motor function assessment (RPW/hip flexion and knee extensionforce) were also worse than young drivers. For aging effect, the TMT-B and CDT were the excellent predictors for PRT. On the other hand, the stroke patients showed longer TBT (Total Braking Time), BMT (Brake Movement Time), PRT, and FPT than healthy adults. For stroke effect, the CDT was a good predictor for PRT at slow and high driving speed and the RPW was a good predictor for BMT. For the self voluntary movements test, EEG data showed that BP latentcy and amplitude for activating movement were reducing with the age. In addition, the stroke patients’ BP latentcy was longer than healthy adults. However, NS latentcy did not show asignificantly difference for strokes and healthy adults. In emergency braking reaction time test, the longer cognitive process would cause the difference of PRT between teenagers and elders. On the other hand, the longer movement activated time would result in the variable result of PRT between stroke patients and healthy adults. To sum up, this study suggested that cognitive function related with driving performance would be affected with aging. However, although the stroke patients have recovered the ability of physical function well, the limitation of movement function would still was an important factor for driving safely.