中風病人電腦化螢幕活動上肢動作表現與常用臨床評估工具之相關性分析

背景：研究指出大約55%~75%的中風個案遺留動作缺失合併生活品質降低的情形，因此有必要發展一套可適用在臨床並具療效的電腦化螢幕活動上肢訓練系統做為治療媒介，以協助提升中風上肢動作復健的治療效益。本研究主要目的為：(一)調查電腦化螢幕活動上肢訓練系統使用在臨床治療時，病人偏癱上肢執行電腦化螢幕活動之表現的一致性。(二)比較分析傳統職能治療臨床上常用的中風後上肢功能評估工具與電腦化螢幕活動上肢訓練系統回饋動作表現結果之間的相關性。方法：本研究採方便取樣方式，共徵召30位符合條件之中風受試者，研究流程為先接受四種臨床常用標準化評估工具施測(上肢功能研究量表、傅格-梅爾上肢動作功能評量表、上肢抓握功能移位測試、手握力測試)；再執行十種電腦化螢幕活動並記錄活動結果(抬手平撥活動、區塊填滿活動、固定伸手指物、隨機伸手指物、雙手交替平撥、交替繪圖辨識、握力張指活動、食指輕拍活動、圖形描繪-水平、圖形描繪-圓形)。個案接受四種標準化評估工具及電腦化上肢功能訓練系統的螢幕治療性活動順序皆採隨機方式進行。每位個案皆在兩次治療時間內(共60分鐘)完成所有資料的收集。結果：(一)電腦化螢幕活動上肢訓練系統內活動包含五大訓練向度，每一訓練向度選取具代表性的兩個活動做為上肢動作功能表現細項依據，每一個活動各執行三次；將三次活動表現的平均值結果為該項活動的表現，計算三次活動的組內相關係數(ICC)，十種活動的組內相關係數皆高，相關係數範圍分布在0.76~0.96之間，顯示個案在電腦化活動的執行表現紀錄具有良好的一致性表現。（二）將電腦化螢幕活動上肢訓練系統內五種向度十種活動；再從十種活動中選取一種活動當成該向度的代表；此五種具代表性的活動分別是上肢移位活動(水平)、固定伸手指物、雙手交替平撥、握力張指活動、標準描繪活動-圓形；將其分數加總起來作為個案電腦化螢幕活動上肢訓練系統表現的總分，將電腦化螢幕活動上肢訓練系統表現的總分與四種臨床常用標準化評估工具的評估結果以皮爾森相關性進行分析，發現相關係數介於0.56~0.82，顯示達中度以上的相關程度。結論：本研究初步發現中風個案在電腦化螢幕活動上肢訓練系統的訓練活動中，活動表現具良好一致性，而從螢幕活動表現分數的高低亦能適度反應出臨床手功能評估分數的高低，本研究支持利用電腦化螢幕活動上肢訓練系統是一套具良好信、效度並適合做為中風個案上肢動作功能復健的輔助訓練器具。

關鍵字

電腦化螢幕活動；中風；上肢復健

並列摘要

Background: Previous studies suggested that 55%-75% survivors had motor impairment and lower quality of life after stroke. A clinically efficient computerized upper-limb training system is needed for advancing upper-limb rehabilitation. The aims of this study were: (1) to investigate the consistency of the upper limb motor performance in the computerized screen tasks upper-limb training system.(2) to analyze the correlation among the common clinical upper-limb function assessments and the motor performance measure in this system. Methods: Convenient sampling was used and thirty eligible participants were recruited. Participants received four standardized assessments (Action Research Arm Test, Fugl-Meyer Assessment of Motor Recovery, Box and Blocks Test, Jamar Dynamometer), then perform ten computerized screen training tasks (H-V movement, Fill Block-big, Fixed R, Two-point R, Bi-Pan, Bi-Gesture, Finger Open, Index Tap, Track Figure-Horizontal, Track Figure-Round). All the functional assessments and screen tasks performance measures were completed within two treatment sessions (60 minutes). The order of all assessments or the computerized screen tasks training programs was randomized. Results: (A) There are five dimensions in the computerized screen tasks training system and this study chose two screen tasks in each dimension to represent the upper-limb motor function training domain. Each task was performed three times and the intraclass correlation coefficient (ICC) values were calculated for internal consistency. Internal consistency was high (r =0.76-0.96). (B) In each dimension, one key task was chosen. The five key tasks were H-V movement, Fixed R, Bi-Pan, Finger Open and Track Figure-Round. The sums of the five tasks scores were calculated as the total scores of the computerized upper-limb training system. Correlation between the total scores of the computerized upper-limb training system and the scores of the four standardized assessments tools and the results revealed moderate to high correlation (r = 0.56-0.82). Conclusions: The performance of the patients with stroke in the computerized upper-limb training system was correlated with standardized hand-function assessments. The computerized upper-limb training system has good psychometric properties and is suitable for upper-limb rehabilitation in patients with stroke.

並列關鍵字

Computerized screen training tasks ； Stroke ； Upper-limb rehabilitation

參考文獻

邱弘毅. (2008). 腦中風之現況與流行病學特徵. 腦中風會訊, 15(3), 2-4.

Al Mahmud, A., Mubin, O., Shahid, S., & Martens, J. B. (2008). Designing and evaluating the tabletop game experience for senior citizens. Paper presented at the InProceedings of the 5th Nordic conference on Human-computer interaction: building bridges.

Google Scholar

Anderson, F., Annett, M., & Bischof, W. F. (2010). Lean on Wii: physical rehabilitation with virtual reality Wii peripherals. Stud Health Technol Inform, 154, 229-234.

Google Scholar

Annema, J. H., Verstraete, M., Abeele, V. V., Desmet, S., & Geerts, D. (2013). Video games in therapy: a therapist's perspective. International Journal of Arts and Technology, 6(1), 106-122.

Google Scholar

Annett, M., Anderson, F., Goertzen, D., Halton, J., Ranson, Q., Bischof, W. F., & Boulanger, P. (2009). Using a multi-touch tabletop for upper extremity motor rehabilitation. Paper presented at the Proceedings of the 21st Annual Conference of the Australian Computer-Human Interaction Special Interest Group: Design: Open 24/7.