虛擬實境對腦性麻痺兒童伸取行為之訓練療效：個案報告

Training Effects of Virtual Reality on Reaching Behaviors in Children with Cerebral Palsy: Case Report

康琳茹(Lin-Ju Kang) ； 陳祐蘋(Yu-Ping Chen) ； 宋文旭(Wen-Hsu Sung) ； 莊天佑(Tien-Yow Chuang) ； 李淑貞(Shwn-Jan Lee) ； 蔡美文(Mei-Wun Tsai) ； 鄭素芳(Suh-Fang Jeng) ； 董基良(Ji-Liang Doong)

《物理治療》 30卷6期 (2005/12) Pp. 339-347

摘要

虛擬實境為利用電腦科技創造出的虛擬物體及情境，虛擬實境訓練被認為可以增進腦性麻痺兒童的上肢功能，因為其具有降低身體上的限制、精確的調整任務難度及回饋、提昇動機、並量化感知訊息等優點。本研究目的為探討虛擬實境訓練系統對一位腦性麻痺兒童上肢伸取行為之療效，個案為一名六歲男孩，診斷為四肢痙攣型腦性麻痺，上肢功能方面僅能以右手執行簡單日常活動，左手伸取範圍小且幾乎不能抓握，認知功能正常，可以聽懂簡單指令並配合治療活動。本研究採單一受試者A-B-A實驗設計，個案接受3次基準期測量、4次訓練期測量及2次追蹤期測量，訓練期為期四週，每週三次，每週治療時問累積120分鐘。利用「虛擬實境手部復健系統」及「EyeToy(上標 TM)Play遊戲」進行虛擬實境訓練計畫，配合治療師的徒手引導，並依個案進步情形逐漸降低引導及增加訓練遊戲難度。成效測量包括(1)伸取動作之運動學分析：執行洞洞板活動及投遞信封活動時4項運動學參數（動作時間、路徑長、動作單位及最大動作速度）的表現；(2)伸取觸碰擺動的球；(3)皮巴迪動作發展量表第二版之精細動作。本研究使用視覺觀察法及兩標準差帶分析法比較相隔兩時期表現測量數值的差異。個案在訓練期於兩種測量活動之3個方向皆有運動學參數獲得進步，追蹤期部分參數的進步繼續維持；於伸取觸碰擺動的球在訓練期分數進步但無法維持到追蹤期；皮巴迪動作發展量表的精細動作能力於訓練期進步11分，追蹤期分數增加1分。本個案報告顯示，虛擬實境上肢訓練計畫可以增進腦性麻痺兒童上肢伸手取物的動作表現、上肢預期性動作控制能力，及精細動作能力，而訓練效果似乎可以維持到治療結束後一個月。其結果可以作為臨床上治療腦性麻痺兒童上肢功能的參考及提供一項治療的新選擇。

關鍵字

虛擬實境 ； 腦性麻痺兒童 ； 伸取行為

並列摘要

Virtual reality (VR) is a computer technology that artificially generates sensory information in a form that people perceive as real-world objects and events. It has been proposed that VR can improve upper-extremity function in children with cerebral palsy (CP) by decreasing physical disabilities, precisely adjusting the difficulty of task and feedback, enhancing motivation and manipulating perceptual information. The purpose of this study was to investigate the training effects of VR on reaching behavior in a child with CP. This case was a 6-year-old boy with spastic quadriplegic CP who had good cooperation and normal cognition. A single-subject A-B-A design was used. The case received 3 baseline, 4 intervention, and 2 follow-up measures. He received a 4-week (3 times a week) individualized VR training using VR-hand function training system and Eyetoy-play system with therapist's manual guidance. The outcome measures included (1) four reaching kinematic parameters (movement time (MT), path, peak velocity (PV), and number of movement units (MU)) in 2 activities (pegboard and mail-delivery) at 3 directions (abduction, adduction, and forward); (2) touching a swing ball; and (3) the fine motor domain of Peabody Development Motor Scale-2nd edition (PDMS2). Visual inspection and 2-standard deviation band method were used to compare the outcome measures between the two adjacent phases. Improvements were found in the kinematic parameters in all directions from baseline to intervention, and the effects were maintained in some directions from intervention to follow-up. Improvement was also shown in the ability to touch a swing ball, but the effect was not maintained from intervention to follow-up. Furthermore, there was an increase (11 points) in the PDMS2 scores from baseline to intervention and an increase (1 point) from intervention to follow-up. This case study demonstrated the potential effect of VR training program to improve the upper-extremity function in children with CP. The training effects might retain for 1 month post intervention.

並列關鍵字

Virtual reality ； Cerebral palsy ； Reaching behavior