腦性麻痺孩童雙側上肢體感動作訓練系統之發展:可行性評估

Development of a Kinect-based Bilateral Intensive Training Program for Children with Cerebral Palsy: A Feasibility Study

蕭稑錡(LU-CHI HSIAO)

指導教授 ： 陳顥齡

國立臺灣大學/醫學院/職能治療研究所/碩士(2019年)

https://doi.org/10.6342/NTU201900112

摘要

背景
腦性麻痺為造成孩童失能的主要原因，並影響孩童日常生活活動。腦性麻痺孩童常伴隨著上肢動作功能缺損而影響其日常活動。現今，雙側上肢療法被視為一個實證治療介入用以改善腦性麻痺孩童上肢動作功能，然而高密集的雙側上肢療法可能導致降低孩童復健治療動機。近幾年，許多研究應用虛擬實境於復健治療中，但是虛擬實境用於復健治療的療效仍具有爭議。既然高密集性的雙側上肢療法可能降低腦性麻痺孩童治療動機且虛擬實境應用於復健治療的療效仍具有爭議，也許應用雙側上肢療法開發於虛擬實境是個可行的解決方法。因此本研究主要目的為發展一個促進孩童動機同時具有復健療效的Kinect雙側上肢治療方案，並測試其可行性。研究假設為1.此Kinect雙側上肢治療方案對於腦性麻痺孩童是可行的復健方案2.此方案提供腦性麻痺孩童最適化挑戰、樂趣與安全3.此方案有達成復健目的。
方法
此Kinect雙側上肢治療方案為基於雙側上肢治療的原則進行遊戲設計，強調雙手的使用及密集且重複的訓練，並參照動作學習理論的概念。研究者使用遊戲體驗問卷來測試孩童動機，並運用運動分析系統來測試是否實現復健目標。在可行性研究中，一共招募10位腦性麻痺孩童。十位孩童平均年齡為119.2個月(標準差:29.16個月)，男女比為1:1，患側邊為左側共五位。所有孩童皆體驗20分鐘的Kinect雙側上肢治療方案，在遊戲過程中會使用動作分析系統紀錄孩童上肢各肢段的關節運動學，並於遊戲體驗結束後，藉由遊戲體驗問卷方式探討腦性麻痺孩童接受此雙側上肢治療方案的使用者經驗。
結果
結果顯示遊戲提供腦性麻痺孩童適當的挑戰。此外，孩童皆認為在遊戲過程中為安全無虞。大部分家長也願意讓孩童於家中接受此Kinect雙側上肢治療方案。另外，根據動作分析結果，上肢關節角度顯示此雙側上肢治療方案有達到訓練功能性角度的目的；互相關(cross-correlation)的結果顯示烘焙大師為雙手對稱遊戲，而冰果大師為雙手不對稱遊戲。
討論
上述研究結果支持此Kinect雙側上肢治療方案對於腦性麻痺孩童是一可行性治療方案。此治療方案提供孩童最適化挑戰、樂趣與安全，同時也達到復健目的。遊戲體驗問卷的結果亦支持此Kinect雙側上肢治療方案提供孩童友善的環境。
大部分家長亦可以接受於家中由職能治療師進行此雙側上肢治療方案。因此，這Kinect雙側上肢治療方案是可行並可以應用作為雙側上肢治療的替代性方案。

關鍵字

虛擬實境 ； 雙側上肢治療 ； 腦性麻痺 ； 可行性試驗 ； 體感裝置

並列摘要

Cerebral palsy (CP) is the primary cause of disability in children, and it influences their activities of daily living. Children with CP demonstrate a deficiency in upper limb motor ability, and various upper limb motor impairments will affect their activities of daily living. Nowadays, bilateral intensive training (BIT) is viewed as an effective approach to improve the upper limb motor function of children with CP. Nevertheless, large doses of intensive practice may reduce children’s motivation in rehabilitation programs. In recent years, numerous studies have applied diverse types of Virtual reality (VR) systems in the area of rehabilitation. However, the effects of VR are still controversial. Since the high intensity of BIT may reduce children’s motivation and the effect of VR is still controversial, integrating VR with the principle BIT may be a possible way to resolve. The purpose of this study was primarily to develop a motivation and rehabilitation-specific Kinect-based BIT program for children with CP. The hypotheses of this study are (1) The Kinect-based BIT program is feasible for children with CP. (2) It provides the just-right challenge, fun, appeal, and safety for children with CP. (3) It achieves the rehabilitation intentions and elicits the expected training.
The Kinect-based BIT program was developed by the principles of BIT, emphasizing on bilateral hand use and intensive, repetitive training. In addition, the features of motor learning theory were considered to bring in the program. a game experience questionnaire was used to test motivation and the motion analysis system was used to test whether or not rehabilitation-specific goals were achieved. In this feasibility study, ten children with CP were enrolled. The mean age of these children was 116.2 months (standard deviation (SD) = 29.16 months). The male-to-female ratio in this study was 1:1. In half of the children, the affected side was the right side, while the affected side of the others was the left. Participants played Kinect-based BIT games for 20 minutes. Upper limb joint kinematics was recorded via the motion analysis system when the children played the games. After finishing gameplay, the children were asked to complete the questionnaire on the subjective gameplay experience.
The results of the game experience questionnaire indicated that the children expressed a positive attitude toward this Kinect-based BIT program. The mean score of the difficulty in the game was 6.45 (SD = 1.48). The result showed that the game provided appropriate challenges for the children with CP. The results on safety during the gameplay demonstrated that all the children felt safe while playing the game. Most of the parents expressed that they could accept such VR games. In addition, the results of the kinematic data showed that the game trained the functional range of motion of the children with CP. The results of the cross-correlation showed that the movements in the Master Baker tended to be symmetrical and the movements in the Master I-Vendor tended to be asymmetrical.
According to the results of the questionnaire and kinematic measurements, Kinect-based BIT programs may provide a feasible treatment modality for children with CP. Kinect-based BIT program provides the just-right challenge, fun, appeal, and safety for children with CP. Also, it achieves the rehabilitation intentions and elicits the expected training. The results of the game experience questionnaire support the conclusion that the games provided a child-friendly environment. Most of the parents could accept that their children played these games at home for rehabilitation purposes. Hence, both Kinect-based games are feasible and can be applied as alternative approaches for BIT.

並列關鍵字

virtual reality ； bilateral intensive training ； cerebral palsy ； feasibility study ； Kinect

參考文獻

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