智慧型手機應用在腦中風病人上肢功能訓練之可行性初探

The Feasibility of Smartphone-based Arm Training System for Persons with Stroke

陳育民(Yu-Min Chen)

指導教授 ： 張志仲

高雄醫學大學/健康科學院/職能治療學系碩士班/碩士(2020年)

摘要

前言
腦中風常伴隨上肢動作缺損。上肢動作訓練的方式必須要執行次數多、時間頻率高、以任務為導向，並提供適當的回饋，方能有助增加大腦可塑性。目前實證初步顯示以輔助科技作為治療媒介，對於腦中風上肢的復原程度有良好的效果。它透過各種感官、提供正確的動作指引，以提升功能性復健效益。手機app搭配無線網路，藉由遠距功能，能即時掌控患者的使用情形，節省人事成本。本研究目的是建構一個以智慧型手機為基底的上肢動作復健app系統，進一步探討其應用於腦中風個案的可行性和滿意度，同時分析app中偵測動作表現參數與上肢動作功能評估工具的同時效度。
方法
採方便取樣收集29位腦中風個案，包含急性後期與慢性期之患者。前者接受6週，後者接受8週，且每位皆執行每週5天、每天8回、每回5分鐘，共計每日40分鐘的復健app訓練。於訓練初期、期中及期末接受上肢功能評估，包含Fugl-Meyer Assessment－Upper extremity、Box and Block Test與Jamar® Hydraulic Hand Dynamometer，於期末另加System Usability Scale評量 (SUS)，及半結構化個別訪談，針對app使用心得和遭遇的問題為主。量性資料分析包括描述性統計、Pearson相關性檢定、Mann-Whitney U test 和Kruskal-Wallis test檢定。質性資料透過錄音及會談方式來收集，最後將彙整敘述作為可行性之評量。
結果
本研究共收集11位居住急性後期整合照護計畫 (PAC) 腦中風個案及18位居家慢性腦中風個案。在半結構化個別訪談中，歸類出三個影響滿意度的主要因素，而這三項因素中又細分幾項次要素，分別為（一）驅動程式/應用程式因素：系統練習活動任務難易度、系統整體功能、系統處理速度。（二）個案因素：遵循系統指示、手指動作控制、個案操作按鍵設定、復健動機、時間安排、身體狀況、運用於日常生活。（三）網路系統因素：網路連線。此外，SUS滿意度量表整體平均分數為83.97分，為可接受-優良滿意度層級。在不同性別、年齡層、教育程度和動作層級的組別中，對此系統滿意度皆呈現無顯著性差異。系統參數項目中，以接聽電話及摸鼻到臀部之表現與上肢動作功能評估工具可達中至高的同時效度 (r = .357 ~ .816；r = .489 ~ .770)。
結論
本研究支持以智慧型手機為基底的上肢動作復健app系統為一可接受、滿意度佳、易使用且易學習的復健訓練系統。質性訪談獲得正向回饋多過負向回饋，表示此系統可應用作為腦中風患者上肢動作練習之輔助科技。系統中的動作表現參數可成為上肢功能進步之回饋數據，可供照顧者及臨床專業人員作參考。

關鍵字

腦中風 ； 智慧型手機復健系統 ； 輔助科技 ； 上肢動作訓練 ； 可行性分析

並列摘要

Introduction
Stroke is often accompanied by upper limb movement defects. Stroke upper limb rehabilitation must be performed with high intensity, high repetiton, task-oriented training, and provide appropriate feedback that will contribute to increase brain plasticity. Preliminary evidences show that assistive technology has beneficial effects on the stroke upper limb recovery. It provides correct movement guidance through various senses to enhance the effectiveness of functional rehabilitation. The smartphone app, equipped with wireless network and remote supervison, can be used to monitor client’s training in real time and save personnel costs. The purposes of this study wereto explore the feasibility and satisfaction of a smartphone-based for stroke upper limb movement rehabilitation app system and to analyze the concurrent validity between the performance parameters in the app system and upper-limb functional assessment scores.
Methods
Convenient sampling was used to collect 29 stroke patients, including patients in post-acute care and chronic home care rehabilitation stages. The former receives 6 weeks, the latter receives 8 weeks treatment. Each subject was required to perform 5 days a week, 8 times a day, 5 minutes each time, and a total of 40 minutes of daily rehabilitation app program training. Upper limb functional assessments, including Fugl-Meyer Assessment-Upper extremity, Box and Block Test and Jamar® Hydraulic Hand Dynamometer were applied at the baseline, middle and end of the training periods. Additionally, System Usability Scale assessment (SUS) and individual semi-structured interviews about app experience and problems encountered are investigated after completed the training program. Data were analyzed by using descriptive statistics, Pearson correlation test, Mann-Whitney U test and Kruskal-Wallis test. Qualitative data was collected through recording and interviews, and finally the summary narrative is used as a feasibility assessment.
Results
This study recruited 11 post-acute care stroke patients and 18 chronic stroke subjects living at home. In the semi-structured individual interviews, three main factors, related to satisfaction, were classified, and these three factors were subdivided into several sub-elements, namely (1) Driver/Application factors: system practice activity task difficulty, system overall function, system processing speed. (2) Case factors: follow system instructions, finger motor control, case operation button settings, rehabilitation motivation, time management, physical condition, and use in daily life. (3) Net system factors: network connection issue. In addition, the overall average score of the SUS reached 83.97 points, which is an Acceptable-Excellent level. There were no significant differences in system satisfaction among groups of different genders, age, education levels, and upper limb motor status. The app system movement performance parametersfor answering the phone and for touching from the nose to the buttocks, showed medium to high concurrent validity (r = .357 ~ .816; r = .489 ~ .770) among the upper limb motor function assessment.
Conclusion
Findings in this study show that smartphone-basedstroke upper limb rehabilitation app is an acceptable, satisfactory, easy-to-use and easy-to-learn rehabilitation technology system. Qualitative interviews, receiving more positive feedback than negative feedback, indicates that this rehabilitation system can be applied as a useful assistive technology for stroke upper limb rehabilitation. The movement performance parameters in the app system can also provide feedback information in the improvement of upper limb function, which can be used as reference by caregivers and clinical professionals.

並列關鍵字

stroke ； smart phone rehabilitation system ； assistive technology ； upper limb movement training ； feasibility analysis

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