使用虛擬實境遊戲訓練之視覺功能和克式持續度表現於台灣注意力不足過動症孩童

The Training Effect of Virtual Reality Games on Visual Function and Conners’ Continuous Performance Test in Attention Deficit Hyperactivity Disorder Children in Taiwan

詹子瑄(Zih-Syuan Chan)

指導教授 ： 孫涵瑛

共同指導教授 ： 蔡政道(Jeng-Dau Tsai)

中山醫學大學/醫學科技學院/視光學系/碩士(2022年)

https://doi.org/10.6834/csmu202200092

摘要

目的：探討注意力不足過動症孩童在視覺功能與持續性注意力表現，並藉由虛擬實境遊戲來訓練注意力不足過動症孩童觀察其成效。
方法：招募30位患有注意力不足過動症的孩童和30位年齡配對的對照組，年齡介於6至13歲。每位受試者皆進行視覺功能檢測、視覺相關問卷和持續性注意力表現。視覺功能檢測包括辨色力測驗、立體視檢查、近點聚合檢查、遠/近距離眼位量測、雙眼融像聚合檢查、調節幅度檢查以及調節靈敏度測驗，視覺相關問卷使用聚合不足狀問卷評估主觀性視覺抱怨程度，客觀的持續性注意力表現以克氏持續度表現測驗來進行。其中17位注意力不足過動症的孩童額外進行三個月的虛擬實境遊戲訓練，評估訓練前後視覺相關檢測和克氏持續度表現的差異。
結果：注意力不足過動症組近點聚合檢查中破裂點表現較對照組好(p = 0.04)；但在最佳矯正視力和調節靈敏度則有統計上顯著較差的情況（分別為p = 0.021和p = 0.015）。聚合不足症狀問卷中顯著地得分較高(p < 0.001)且視覺抱怨特別集中在行為表現相關症狀。克氏持續度表現上，注意力不足過動症組遺漏錯誤(p = 0.008)和反應時間的標準差(p = 0.046)統計上顯著較高。而聚合不足症狀問卷中的視覺抱怨分別與視覺功能和克氏持續度表現存在相關性，其中最佳矯正視力和問卷總分(r = -0.407, p = 0.025)以及調節幅度分別與問卷中的「失去注意力」(r = -0.379, p = 0.039)、「對於記住重點感到困擾」(r = -0.503, p = 0.005)和「閱讀速度慢」(r = -0.373, p = 0.042)皆呈現負相關。正負融像性聚合中，CISS中的「失去注意力」與正融像性破裂點(r = -0.433, p = 0.019)以及負融像性破裂和回復點皆達統計上顯著負相關(r = -0.383, p = 0.037和r = -0.418, p = 0.021)。克式持續度表現上，問卷中的「閱讀速度慢」與反應時間(r = -0.459, p = 0.028)、反應時間的標準差(r = -0.492, p = 0.017)、變異性(r = -0.423, p = 0.05)和反應時間間隔變化(r = -0.451, p = 0.031)此四項皆達統計上的負相關，而反應時間的標準差也與問卷中的「眼睛感到不舒服」呈現顯著負相關(r = -0.467, p = 0.025)。另外，注意力不足過動症組於虛擬實境遊戲訓練前後在雙眼近點聚合的表現有統計顯著的進步(p = 0.039)；且遠距離垂直眼位中，正眼位組的比例有統計上明顯的增加(p = 0.034)，但在問卷中的「失去焦點」和「重複閱讀同一行」此兩題的抱怨有所增加，且達統計上顯著的差異（分別為p = 0.028和p = 0.046），克式持續度表現中的反應時間間隔變化也有退步的現象(p = 0.047)。
結論：注意力不足過動症在聚合不足症狀問卷和克氏持續度表現都有顯著的表徵和抱怨。此外虛擬實境遊戲訓練對於視覺功能有部分的改善，未來在臨床上可藉由虛擬實境技術來改善注意力不足過動症的視覺品質。

關鍵字

克氏持續度表現測驗 ； 注意力不足過動症 ； 視覺功能 ； 虛擬實境 ； 聚合不足症狀問卷

並列摘要

Purpose: To investigate visual function and sustained attentional performance in attention deficit hyperactivity disorder (ADHD) children and observe the training effect when utilizing virtual reality (VR) games in ADHD children.
Methods: A total of 60 children (30 children with ADHD and 30 age-matched controls) between 6-13 years of age were recruited. Visual function, visual-related questionnaire, and sustained attentional performance were recorded in all participants. Visual functional test included color vision, stereoacuity, near point of convergence (NPC), phoria in both distance and near, fusional vergence, amplitude of accommodation (AA) and accommodative facility (AF). Convergence insufficiency symptoms survey (CISS) were used to evaluate subjective visual complaints and objective sustained attentional performance was measured with Conners’ continuous performance test (CPT). Furthermore, 17 of ADHD children participated VR games training and evaluated the difference of visual-related examination and CPT within pre and post training.
Results: NPC showed significantly better in ADHD group than control group (p = 0.04); however, best-corrected visual acuity (BCVA) and AF seemed worse than controls (p = 0.021 and p = 0.015, respectively). The results indicated higher CISS scores in ADHD group (p < 0.001) and visual complaints focusing on performance-related symptoms. In CPT parameters, ADHD group had more omissions errors (p = 0.008) and worse performance (p = 0.046) on hit reaction time standard deviation (HRTSD). Additionally, visual complaints in CISS had negative correlations with visual function and CPT, respectively. There was a significant negative correlation between BCVA and CISS scores (r = -0.407, p = 0.025). AA was associated with the severity of CISS symptoms namely lose concentration (r = -0.379, p = 0.039), trouble remembering (r = -0.503, p = 0.005) and read slowly (r = -0.373, p = 0.042). The correlation between “lose concentration” in CISS and either positive fusional vergence at break point (r = -0.433, p = 0.019) or the break and recovery point in negative fusional vergence is statistically significant (r = -0.383, p = 0.037 and r = -0.418, p = 0.021, respectively). Our findings suggested that symptoms of read slowly in CISS is negatively associated with hit reaction time (r = -0.459, p = 0.028), HRTSD (r = -0.492, p = 0.017), variability (r = -0.423, p = 0.05), and hit reaction time inter-stimulus intervals change (ISICH) (r = -0.451, p = 0.031). A trend toward correlated between the severity of eyes uncomfortable in CISS and lower HRTSD score (r = -0.467, p = 0.025). After 3 months of VR games training, significant improvement of ADHD group in NPC (p = 0.039) and a higher proportion of orthophoria was observed in vertical phoria at distance (p = 0.034). Whereas, score of “lose place” and “have to re-read” in CISS were increasing (p = 0.028 and p = 0.046, respectively) and getting worse on ISICH in CPT (p = 0.047).
Conclusions: Children with ADHD had significant complaints in both CISS and CPT. In addition, the results had significant improvements of visual function after VR games training in ADHD group. It might be a clinical choice to improve visual function for ADHD children in the future.

並列關鍵字

Conners’ continuous performance test ； Attention deficit hyperactivity disorder ； Visual function ； Virtual reality ； Convergence insufficiency symptoms survey

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