建構虛擬實境訓練於長照機構老人的認知、動作控制和生活品質之成效探討

本研究採準實驗性研究設計，取樣於南部某五家長照機構，研究目的探討運用虛擬實境認知和動作控制訓練 (Virtual Reality Training on Cognition and Motor Control, VRTCM) 於社會局主管機關之長期照顧機構類：長期照顧型、養護型老人的成效。對象為65歲以上，以同一個信封袋編號隨機抽樣分派，樣本數收案共70人，實驗組30人，對照組30人，因季節性流感及老人體況發燒不適流失10人，排除視障、無法言語溝通、失智症、認知功能障礙（Mini Mental Status Examination, MMSE < 13分）、植物人、手部障礙者。實驗組共介入八週VRTCM系統，每週一次、每次45~60分鐘介入措施，對照組則無介入。研究工具以實驗組及對照組前後測，包含日常生活工具量表 (Activity of Daily Living, ADL)、認知功能量表 (Cognitive Assessment Screening Instrument, CASI)、簡短智能測驗 (MMSE)、畫鐘測驗 (Clock Drawing Test-Drawing Part, CDT-D)、台灣簡明版生活品質問卷（World Health Organization Quality of Life Brief, WHQOL-BREF）以二因子變異數分析 (Two way ANOVA) 比較兩組介入前後之顯著性，顯著水準訂為α=.05。再由實驗組產生VRTCM的系統參數：每週點擊正確率 (Correct Rate) 與每週點擊時間差母體變異數 (Population Variance of Time Difference)，以單一樣本重複測量變異數分析 (Repeated measured ANOVA) 來分別探討認知功能及動作控制訓練進步的情況。研究結果顯示，實驗組相較於對照組，在認知功能CASI、MMSE得分達顯著差異 (p < .05)，在CASI向度中得分，短期記憶 (p = .00)、注意力 (p = .00)、集中心算力 (p = .01)、語言能力 (p = .00)、思緒流暢度 (p = .02) 均達顯著差異 (p < .05)。在WHQOL-BREF量表得分達顯著 (p < .05)。在ADL及CDT-D量表未達顯著 (p > .05)。而實驗組以廣義估計方程式 (Generalized estimating equation, GEE) 探討在實驗組問卷前後測在VRTCM介入後的進步程度，在CASI問卷得分短期記憶、注意力、集中心算力、定向感、語言能力、思緒流暢度及MMSE得分上與生活品質均達顯著差異 (p =.00, <.05)。實驗組平均正確率數值有顯著提升0.18，與平均反應時間差母體變異數值有顯著降低20.62。結論為VRTCM可幫助長照機構老人之認知功能、生活品質成效較好，故本研究VRTCM為高齡化社會健康促進訓練之參考。

關鍵字

虛擬實境；認知功能；動作控制；長期照護機構；機構住民

並列摘要

This study used experimental research design. Participants were sampled in five long-term care center in the south of Taiwan. The purpose of this study was to examine the effectiveness of Virtual Reality Training on Cognition and Motor Control (VRTCM) on elderly in long-term care of the competent authorities of the Social Welfare Bureau. The subjects were over 65 years old and were randomly sampled by the same envelope bag number. 60 olders were randomly assigned to 30 experimental groups and 30 control group, 10 olders were excluded by the seasonal influenza. Exclude visual impairment, inability to communicate, dementia, cognitive dysfunction (Mini-Mental Status Examination, MMSE < 13 points), vegetative, handicapped.The experimental group was involved in the eight-week VRTCM system, 45 to 60 minutes once a week of interventions were received, and no intervention in the control group. The Activity of Daily Living (ADL), the Cognitive Assessment Screening Instrument (CASI), the Short Smart Test (MMSE), and the clock test (Clock Drawing Test-Drawing Part, CDT-D), Taiwan's World Health Organization Quality of Life Brief (WHQOL-BREF) were tested in the two groups. For analysis, the present study used the Two -way ANOVA. The significant level was set to α=.05. The system parameters of VRTCM were generated by the experimental group: The Correction Rate and the Weekly (Population Variance of Time Difference) were measured by Repeated measured ANOVA. Explore the progress of cognitive function and motion control training. The results showed that the experimental group had significant differences in cognitive function CASI and MMSE compared with the control group (p < .05), scored in CASI dimension, short-term memory (p =.00), attention (p = .00), set center calculation (p = .01), language ability (p = .00), and thought fluency (p = .02) all showed significant differences (p < .05). The score on the WHQOL-BREF scale was significant (p < .05). The ADL and CDT-D scales were not significant (p > .05). The experimental group used the generalized estimating equation (GEE) to explore the progress of VRTCM intervention before and after the experimental group questionnaire, and the short-term memory, attention, central computing power, orientation, language ability, and thoughts in the CASI questionnaire. There was a significant difference in fluency and MMSE scores from the quality of life (p = .00, <.05). The results showed that the average correct rate of the eighth week was significantly increased by 0.18. The experimental group compared with the control group and the variation of difference in response time of the eighth week also was significantly reduced by 20.62 in VRTCM index. In terms of cognitive function and life ability, short-term memory, attention, language ability, thought fluency, and quality of life were significantly improved after the intervention. By training of VRTCM could improve the motor control ability, many domains of cognitive function, and improve the quality of life in the elderly with mild cognitive dysfunction. Thus, present study could be the reference for promoted training of aging social health in the future.