肢體障礙者電腦輔具評量以訓練成效之研究

Assessments and interventions of computer access for persons with physcial disabilities

吳亭芳(Tingfang Wu)

指導教授 ： 吳武典

國立臺灣師範大學/教育學院/特殊教育學系/博士(2001年)

摘要

本研究探討肢體障礙者電腦輔具的評量與訓練成效，主要分為三個研究進行，分別為研究一「肢體障礙者電腦輔具評量表」之發展，研究二腦性麻痺患者電腦輔具訓練成效之探討，以及研究三脊髓損傷患者電腦輔具訓練成效之探討。
在研究一中，研究者利用文獻資料以及個人臨床工作經驗編纂「肢體障礙者電腦輔具評量表」。內容包括四部分：操作電腦評量、電腦鍵盤操作評量、身體操控部位評量和滑鼠操作評量。本量表經八位專家檢核有其內容效度，信度則以施測者間對項目勾選之一致性來建立。其施測者間一致性介於 .76至1.00，顯示此量表有良好的信度。
研究二之目的在於探討電腦輔具介入是否可以增進腦性麻痺患者電腦輸入的效能。研究者利用單一受試跨受試多探試處理，以三位腦性麻痺患者為研究對象，依據「肢體障礙者電腦輔具評量表」評量結果提供腦性麻痺個案電腦輔具訓練。結果顯示，三位腦性麻痺受試者在輔具提供並經過一段時間的練習後，電腦輸入的速度以及輸入的正確率都明顯優於基線階段並且可以保留到維持階段。研究二之結果可以顯示「肢體障礙者電腦輔具評量表」之評量結果可以有效作於臨床介入之參考依據。
研究三之目的在於探討電腦輔具介入是否可以增進脊髓損傷患者電腦輸入的效能。研究者利用單一受試跨受試多探試處理，以三位脊髓損傷患者為研究對象，依據「肢體障礙者電腦輔具評量表」評量結果提供脊髓損傷個案電腦輔具訓練。結果顯示，三位脊髓損傷受試者在輔具提供後，電腦輸入的速度以及輸入的正確率都明顯優於基線階段，並且可以保留到維持階段。子研究三之結果可以顯示「肢體障礙者電腦輔具評量表」之評量結果可以有效作於臨床介入之參考依據。
依據三個研究的結果，可獲得以下結論：(1)「肢體障礙者電腦輔具評量表」是一個信、效度良好的評量工具，可以有效提供肢體障礙者合適的電腦輔具；(2)透過合適的輔具以及訓練，腦性麻痺以及脊髓損傷患者可以有效執行電腦輸入。

關鍵字

肢體障礙者 ； 腦性麻痺 ； 脊髓損傷 ； 電腦輔具 ； 輔具評量 ； 輔具訓練成效

並列摘要

Computer technology has developed rapidly and become essential for people’s daily lives. However, persons with physical disabilities usually experience obstacles in computer access through conventional input apparatus because of their abnormal postures and movements. Computer adaptation technology, a specific access technology that meet clients’ needs to access computers, have been emerged recently. How to choose a proper computer access apparatus to fit special needs for individuals with physical disabilities is a critical issue in computer adaptation technology.
In this dissertation, a systematic evaluation procedure, called computer access assessment (CAA) for therapists, are developed to perform holistic assessment and interventions. With the aid of such evaluation procedure, appropriate devices and intervention strategies will be recommended for individuals with physical disabilities to access computers. Effectiveness of such assistive devices on accuracy and speed of computer inputs for persons with physical disabilities were also been investigated.
This dissertation contributes to three fundamental topics. First, an innovative decision procedure of CAA will be proposed. CAA was developed through extensive literature review and clinical experiences of researchers. Content validity was established through a panel of expertise in this area. Eight faculties from occupational therapy, special education, and computer education, are involved in reviewing assessment items. According to clients’ special needs, we reconstruct a new procedure with the following four major steps: (1) seating and positioning needs, (2) keyboard adaptation needs, (3) potential anatomical control site allocations, and (4) mouse adaptation needs. Advices about special equipment needs will be provided at the end of the evaluation. The interrater reliability of CAA was investigated through case studies of two senior occupational therapists by evaluating 23 clients simultaneously and administrating the CAA independently. Interrater agreements of two rates were between .76 and 1.00.
In the second part, we use a single-subject multiple probe design to examine the effectiveness of using computer input devices on children with cerebral palsy. Three children with cerebral palsy participated in this study. Two were spastic quadriplegia and one is athetosis. In the baseline phase, test subjects used the regular mouse to move the cursor and click the target. In the intervention phase, the researcher provided subjects the computer input devices based on the results of administrating the CAA. Experimental results suggested that each subject’s accuracy and speed of input improved during intervention phase. Children with cerebral palsy are beneficial significantly after this study.
Finally, we duplicate the research design to examine the effectiveness of using computer input devices on persons with spinal cord injury. Three persons with spinal cord injury participated this study. The subject’s levels of the lesion were cervical 3-4, cervical 4-5 and cervical 5-6. Test results indicated that persons with spinal cord injury indeed improved the accuracy and the speed of computer inputs after the assitive equipment provided.
In summary, computer access assessment for persons with physical disabilities is a valid and reliable evaluation tool for clinical prationioners. Through appropriate input devices, clients with cerebral palsy and clients with spinal cord injury are able to operate computer effectively

並列關鍵字

persons with physical disabilities ； cerebral palsy ； spinal cord injury ； computer access ； computer access assessments ； treatment efficacy

參考文獻

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