治療性觸控螢幕電腦化系統在中風上肢復健之療效分析-單一個案研究

Effects of therapeutic screen-task computer program for stroke upper limb motor rehabilitation-single subject design

林郁芬(Yu-Fen Lin)

指導教授 ： 張志仲

高雄醫學大學/健康科學院/職能治療學系碩士在職專班/碩士(2016年)

摘要

背景：中風病人常因為肌肉無力、痙攣、缺乏自主動作控制等上肢機能缺損，導致日常生活功能的缺失，此一生活功能喪失而形成的依賴性，往往進而促使個人與家屬的生活品質降低。因此，如何改善中風病患上肢功能與執行動作之缺損，進而促進上肢肌力並提升上肢功能回復，是相當值得探討之議題。本研究旨探討利用治療性觸控螢幕電腦化系統與傳統復健此兩種模式，應用在中風後病患偏癱側上肢功能的訓練成效進行分析比較。
　　方法：本研究採用Single-Subject Designs(AB)實驗設計，共計 4位單側腦中風個案參與實驗介入。研究共為期十週，前四週為基線期，讓研究對象患側上肢從事每週三次、每次40分鐘的傳統復健；而後六週為治療期，利用治療性觸控螢幕電腦化系統進行同樣每週三次、每次40分鐘的復健。每週會進行評估紀錄，主要有三項評估工具分別為福格梅爾動作評估量表、箱子和木塊測驗、JAMAR 握力器之握力測驗，瞭解並比較基線期及治療期患側上肢的動作與功能恢復以及肌力的改變。
　　結果：治療性觸控螢幕電腦化系統是能夠提升中風病患上肢功能恢復。在四位個案中僅有一人在三項結果評估皆未呈現顯著進步。在FMA的結果評估無論是經兩個標準差寬帶檢定或是C統計的估算，三位個案皆有進步且達顯著差異；在箱子與木塊測驗中，三位個案於兩個標準差寬帶檢定皆達顯著差異，C統計估算則有兩位個案達顯著差異；在JAMAR握力測驗中，僅有一位個案於兩個標準差寬帶檢定呈現顯著差異，另有兩位個案於C統計估算結果達顯著差異。
結論：本研究支持以治療性觸控螢幕電腦化系統應用於中風上肢復健方面，可以提升部份上肢患側功能訓練進展，並促使療效增加。未來建議可以進行治療性觸控螢幕電腦化系統應用在改善中風個案上肢功能的隨機臨床療效驗證以提供更完善的療效證具。

關鍵字

上肢功能恢復訓練 ； 中風 ； 復健科技

並列摘要

Background: Patients with stroke will lost the performance of functional abilities in activities of daily living due to upper limb motor impairment. The interventions help to promote arm and hand recovery after persons with stroke are desert further research. Therefor this study expects to investigate the effects of therapeutic touch screen-task computer system on upper limb functional recovery in patients with stroke
　　Methods: In this study, Single-Subject Designs (AB) was applied with recruiting 4 patients with stroke that accept the training of traditional rehabilitation for 4 weeks (40 minutes per session/ 3 sessions per week) and following by training with therapeutic touch screen-task computer system for 6 weeks (40 minuites per session/3 sessionsper week). The evaluation interval was set at one week during the baseline phase and intervention phase. The assessmen tools included Fugl-Meyer motor assessment (FMA), Box and Block Test (BBT) and Jamar hand-held dynomether. Visual analysis, two-standard bands analysis and C statistics were used for data analysis.
　　Resoults: The evaluation indicated that therapeutic touch screen-task computerized system might imrpove the recovery of upper limb function for patients with stroke. Among the four patients, only one subject did not have significant improvement in the three evaluations. In the Fugl-Meyer assessment, there were three subjects demostrated significant gains analized by two-standard deviation band analysis and C Statistics analysis. In Box and Block Test, there were two subjects showed significant improvements analized by two-standard deviation band analysis and three subjects showed significant improvements analized by the C statistics analysis. In the Grasp Strength Test assessment, only one subject showed significantly increase analized by two-standard deviation band and there were two subjects showed significantly increase analized by C statistics analysis.
Conclusion: Finding in this study supports the clinical aplication of therapeutic touch screen-task computer system in upper limb stroke rehabilitation. This system may enhance the training effect for functional recovery of the affected arms and promote the efficacy in intervention. Key issue for future study includes conducting randomized clinical trail to provide more solid evidence for the application of the system.

並列關鍵字

Assistive technology ； functional recovery of upper extremity ； stroke

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