初步探討視覺處理訓練對於中風患者平衡能力之表現

Retraining Visual Processing Skills To Improve Balance After Stroke - A Pilot Study

陳柏文(Bo-Wen Chen)

指導教授 ： 林志峰

中山醫學大學/醫學科技學院/物理治療學系碩士班/碩士(2015年)

摘要

研究目的：為驗證儀器Agility®其信度；同時測試儀器Agility®與臨床上常見之手眼協調測試之相關性；爾後針對中風病人臨床上頭眼協調運動之介入，主看其平衡能力之表現；開發頭眼協調量化及訓練之硬體系統。
研究方法及資料：儀器信度，收入健康受試者，共3次量測，每次間隔一個禮拜；頭眼協調之訓練計劃介入臨床上之中風患者，12次訓練後探討其平衡能力之表現；開發頭眼協調量化及訓練之硬體系統，分析方法以SPSS for windows 14.0版套裝軟體進行「信度分析」、「皮爾森相關係數」及「變異數分析」。
研究結果：
第一部份受試者為27位健康人，Agility®、手碰鼻、直尺抓握等信度值呈(ICC = 0.707~0.875)為中度至高度相關，相關性方面Agility®之模式間呈負相關(r = -.655 , p < 0.01)有統計上之差異，Agility®之擊滅模式與手碰鼻測試為正相關(r = .616 , p < 0.01)有統計上之差異。第二部份受試者為6位臨床上之中風病人，在進入第二次評估後，與初始資料相比兩組皆無統計上之差異，單純數值相比不考慮組別，則手指碰鼻(p = 0.037)及直尺抓握(p = 0.025)有統計上之差異。第三次評估與初始資料兩組相比發現前伸側有統計上之差異(p = 0.026)，單純數值相比不考慮組別，則手指碰鼻(p = 0.014)及直尺抓握(p = 0.028)有統計上之差異。第三部份頭眼協調量化兼訓練之硬體系統已完成第一代，其計時器亦修改至光源驅動。
結論與建議：
Agility®本身信度之建立是中度置高度可信的，且臨床上之手指碰鼻測試亦為儀器之校標效度；Agility®合併頭眼協調訓練計畫可提升中風病人往前伸取之穩定度，不管是Agility®合併頭眼協調訓練計畫，還是傳統復健治療，皆能有效提升手眼協調能力；頭眼協調量化兼訓練之硬體系統已完成，未來可檢視其信效度。

關鍵字

手眼協調 ； 頭眼協調 ； 平衡能力 ； 視覺處理

並列摘要

Purpose:
The Reliability of Agility® apparatus, correlation between hand-eye coordination test and Agility® apparatus. The effective of head-eye coordination training in stroke patients balance stability. Development of the head-eye coordination quantification apparatus.
Methods and Analysis:
The apparatus reliability including health subjects into 3 sessions. Head-eye coordination program including stroke patients into 12 sessions training, and development programs quantification equipment. Used SPSS for windows 14.0 to reliability and Pearson correlation coefficient and multiple variable repeated measurements.
Results:
Including 27 health subjects, and Agility® reliability is to good (p = 0.707~0.875), between of both mode(r = -.655) is significant(p<0.01), between of finger to nose test and modes (r = .616 )is significant( p < 0.01).Including 6 stroke subjects into training program, the time effect show significant with finger to nose(p = 0.037), yardstick(p = 0.025) at second assessment compare baseline, finger to nose (p = 0.014), yardstick(p = 0.028) at third assessment, and time*group effect show significant with forward stability(p = 0.026) at third assessment compare baseline. The head-eye coordination apparatus has prototype, and change the timer's action by light.
Conclusion and Discussion:
The reliability of the Agility® is moderate to good, and has good criterion validity in convergence. Head-eye coordination training program, can improve forward reach stability, both of head-eye and traditional training can improve finger to nose and yardstick ability in stroke, head-eye coordination quantification apparatus was development, future can study it reliability and validity.

並列關鍵字

Eye-Hand Coordination ； Eye-Head Coordination ； Balance Ability ； Visual processing

參考文獻

1. Eng and Tang, (2007). Gait training strategies to optimize walking ability in people with stroke: A synthesis of the evidence. Expert Rev Neurother. 2007 October ; 7(10): 1417–1436.

2. Weerdesteyn, V., Niet, M. d., Hanneke, Alexander, & Geurts, M., PhD1–2. (2008). Falls in individuals with stroke. JRRD, 45, 1195-1214.

3. Pavol, M. J., Runtz, E. F., Edwards, B. J., & Pai, Y.-C. (2002). Age Influences the Outcome of a Slipping Perturbation During Initial But Not Repeated Exposures. MEDICAL SCIENCES, 57A(469-477).

4. W.-L. Hsu., Li-Shan Chou., Marjorie Woollacott. (2012). Age-related changes in joint coordination during balance recovery. AGE (2013) 35:1299–1309

5. Freitasa, S. M. S. F., Scholzb, J. P., & Latashc, M. L. (2010). Analyses of joint variance related to voluntary whole-body movements performed in standing. Journal of Neuroscience Methods, 188, 89-97.