全人照護及太極拳運動對於重度憂鬱小腦萎縮患者之影響－前驅研究

Impact of Holistic Care with Tai Chi Exercise on Depressed Patients with Spinocerebellar Degeneration Disease-Pilot Study

劉青山(Chin-San Liu) ； 蕭真真(Chen-Chen Hsiao) ； 郭倩嵐(Chine-Lane Kuo) ； 邱重閔(Chong-Min Chiu) ； 鄭文玲(Wen-Ling Cheng) ； 郭建成(Chien-Cheng Kuo) ； 黃林來招(Lai-Chao Huang Lin) ； 林廉証(Lien-Cheng Lin) ； 張惠茹(Hui-Ju Chang) ； 李涵薇(Han-Wei Li) ； 鄧麗君(Li-Chun Deng) ； 張瑞芝(Jui-Chih Chang) ； 羅綸謙(Lun-Chien Lo) ； 劉鵬達(Peng-Ta Liu) ； 魏大森(Ta-Sen Wei)

《The Changhua Journal of Medicine》 14卷4期 (2016/12) Pp. 179-186

https://doi.org/10.6501/CJM.1404.004

摘要

背景：小腦脊髓萎縮症（spinocerebellar ataxia, SCA）是一種神經退化性疾病，在SCA小腦腦幹之病理切片都會發現神經元大量萎縮及退化，神經精神神經元也會受到損傷，因此SCA合併憂鬱症患者是普遍之現象。目的：近年皆在推行全人醫療團隊模式（Holistic Medical Team, HMT），而SCA患者具有身心靈及社會人群負面之影響，因此本研究以全人醫療團隊模式介入加上首創太極拳運動輔助病患平衡功能之治療期望可以有效降低患者焦慮及憂鬱。方法：本研究分為HMT組（12人）及HMT加上太極拳運動組（10人），試驗為期兩年。並測定患者治療前後憂鬱度之評估。結果：統計分析顯示，參與HMT加上太極拳運動組，其臺灣人憂鬱症量表（Taiwanese Depression Scale, TDS）憂鬱數值進步指數確實分數高於單純HMT組，即表示HMT加上太極拳運動組，比單純HMT組TDS憂鬱進步指數有明顯增加之趨勢（6 ± 9 vs. -5 ± 8, p = 0.488）。分組分析發現，TDS數值大於19分之憂鬱者共三人，其加入HMT及太極拳介入前後，TDS憂鬱指數顯著降低（23 ± 5 vs. 6 ± 3, p = 0.057）。結論：高度憂鬱度之SCA患者，介入兩年之HMT加上太極拳運動，其憂鬱程度有接近顯著之下降。

關鍵字

臺灣人憂鬱症量表 ； 全人醫療團隊 ； 小腦萎縮症 ； 太極拳Ro, qua interte pro

並列摘要

Background: Spinocerebellar ataxia (SCA) is a neurodegenerative disease. In pathological sections of the brain stem of SCA patients' cerebellum, a large number of neurons are atrophied and degenerated. Neuropsychiatric neurons may also be damaged, and hence cerebellar atrophy accompanied by depression is a common phenomenon. Objective: In recent years, holistic medical treatment (HMT) has been practiced worldwide. It has been observed that SCA has a negative impact on body and mind and a detrimental effect on society. This study was based on the whole medical team model, and the effects of Tai Chi exercise intervention on balance, anxiety and depression in SCA patients were assessed. Methods: The study participants were divided into the HMT group (N = 12) and the HMT group with Tai Chi exercise (N = 10). Over a period of two years, depression scores of the patients as assessed by the Taiwanese Depression Scale (TDS) via a questionnaire were measured before and after intervention. Results: Improvement of depression was observed in the SCA patients who received HMT and participated in Tai Chi exercise as compared with HMT intervention only according to TDS score improvement (6 ± 9 vs. -5 ± 8, p = 0.488); however, this improvement did not reach statistical significance. In the group of patients with severe depression (TDS ＞ 19), an almost significant reduction in depression score was observed after HMT/Tai Chi intervention in comparison with HMT alone (23 ± 5 vs. 6 ± 3, p = 0.057). Conclusion: HMT with Tai Chi exercise is a potential therapy resulting in reduction of depression in SCA patients with severe depression.

並列關鍵字

depression ； holistic medical ； treatment ； spinocerebellar ataxia ； Tai Chi