類別:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/142
2024-03-06T03:05:05Z高功能慢性中風患者因應障礙物之伸臂與取物動作運動學分析
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/27211
標題: 高功能慢性中風患者因應障礙物之伸臂與取物動作運動學分析; Kinematic Analysis of Obstacle Crossing During Reach- Grasp-Retract Movement in Highly Functioning Patients with Chronic Stroke
作者: Yi-Miau Chen; 陳怡妙
摘要: 中風患者伸臂取物的動作機轉及有效之復健治療模式常被廣泛研究,然當取物環境中有障礙物存在時,如何影響其動作表現,卻少有相關文獻探討,且大多僅針對伸手及物,而未探討取回的動作。本研究的目的為運用運動學分析來了解中風患者因應障礙物之伸臂與取回物品動作之控制與機轉。
研究方法:有7位高功能慢性中風患者同意參與此研究。受試者採坐姿,將目標物放在一個手臂長距離的桌上,共有兩種情境,一為障礙物置於手臂長65%處,障礙高度設定為上臂長30%及障礙高度為0%的控制情境。受試者執行伸手跨越障礙物,並將目標物拿回近身體桌面上的位置。利用動作分析系統(Vicon 512, Oxford Metrics Group, U. K.)紀錄伸臂取物動作過程。利用配對-t檢定及效應值來比較健側手與患側手伸臂取物及拿回動作,在障礙物高度為上臂長0%與30%情境下之各種運動學參數,包括動作距離、最大速度、達最大瞬間速度所花時間達整個運動時間的比例、手指最大張口角度、手指最大張口角度發生時間比例、動作時間、動作單位、伸臂跨過障礙物時的手腕距障礙物的高度與取回時物品距障礙物的高度等參數。
研究結果:比較健側手與患側手在障礙情境下的表現,發現兩者的運動學參數皆因障礙物存在而改變。患側手在伸臂過程中移動軌跡較短,手指最大張口角度發生的時間點較早與手腕距障礙物的高度較低。在取物回來的過程中,運動時間較長,速度較慢與物品距障礙物的高度較高,顯示兩者在執行因應障礙物取物動作時的動作控制可能不同。可能暗示患側手較缺乏因應障礙調整伸臂動作的彈性,但在將物品取回的過程中,會將手抬的較高,以因應其避免碰觸障礙物以達成取物的目標。另個別分析健側手及患側手在障礙物高度為上臂長0%與30%情境下,運動學參數的變化,結果顯示健側手的動作表現差異性較大,而患側手的動作表現差異較不顯著。
結論:高功能慢性中風患者的患側動作功能障礙,無法從臨床的動作評估中看出。但在障礙物干擾情境下,仍可發現其動作表現比健側手差,且在取回物品的動作差異更加明顯。這可能暗示障礙物與目標物品的存在,都會使動作控制變的較複雜,患側手的動作控制缺失會因而更明顯。在臨床上給予治療建議時,應提供目標導向的活動及提高活動的複雜性以訓練患側手的動作控制。; Objective: The reaching movement of stroke patient has been studied widely in order to understand the mechanism and effective treatment approach. To our knowledge, no prior study has disclosed how the obstacles near the target affect the motor performance of reaching. Besides, most studies explored only the reaching movement without the bring back component. The purposes of this study were to investigate the motor performance of U/E according to the obstacle while reaching for grasping and retracting for placing an object in stroke patients.
Research method: Our study enrolled 7 highly functioning participants with chronic stroke. All participants seated and were asked for reaching the target and then bring it back to put on the table. Obstacle with its height equal to 30% of upper arm length was placed at about 65% of the full arm length. Another condition was to put the obstacle with height of 0 as controlled. Kinematic data were measured using a 6-camera motion analysis system (Vicon 512, Oxford Metrics Group, U. K.). The following parameters were compared between the unaffected and affected upper limb of the stroke participants including reaction time, movement time, transport path, peak velocity (PV), percentage of movement where PV occurs, maximum grip aperture, percentage of reaching time where maximum grip aperture occurs, wrist–obstacle clearance, movement unit, object pick up time, object–obstacle clearance and object placing time in reach to grasp movement and retraction movement in control and obstacle crossing condition, Paired t-test (α=0.05) was used and the effect size was also calculated.
Results: In the obstacle crossing condition, the performances of the kinematic parameters of unaffected and affected upper limbs were both changed by the obstacle. Shorter transport path, smaller percentage of reaching time where maximum grip aperture angle occurs and lower wrist clearance in reach to grasp, whereas longer movement time, slower average speed and higher object clearance in retraction movement were found in affected than in unaffected side. The result might imply that the motor control of affected and unaffected upper limb was different in the obstacle crossing condition. When kinematic parameters of both unaffected and affected upper limb were analyzed in conditions with obstacle height of 0% & 30%, significant differences were found in the unaffected upper limb but not the affected side. The result maybe imply that the affected upper limb lacking the flexibility to adjust the arm movement according to the obstacle height, but when carried an object, it moved higher to prevent hitting the obstacle.
Conclusions: The subjects in this study were with highly motor function and invisible motor deficit observed through clinical evaluation, but when asked them to carry an object crossing an obstacle without hitting it, the motor differences between the unaffected and affected upper limb emerged. The existed of an obstacle as well as an object increased the complexity and demand of the task, the moving body needed to adapt the motor control of reaching hand in order to achieve the task goal, by the way, the motor deficit of the stroke patients would be amplify by the obstacle. When providing the treatment programs to the highly functioning patients with chronic stroke, more complicated and goal directed tasks should be used to treat the motor control of affected upper limb in clinical settings.2008-01-01T00:00:00Z音樂對於健康老人與主觀認知退化個案之自律神經系統與焦慮情緒之影響
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/7218
標題: 音樂對於健康老人與主觀認知退化個案之自律神經系統與焦慮情緒之影響; The Effects of Music on Autonomic Nervous System and Anxiety in Healthy Elderly and Persons with Subjective Cognitive Decline
作者: Min-Chun Chang; 張敏君
摘要: 失智症是全球關注的重要議題,近年來相關研究也逐漸往前延伸至被視為是失智症危險因子的主觀認知退化(subjective cognition decline, SCD)。此族群雖尚無症狀出現,但除認知相關抱怨外,也常伴隨焦慮之情緒,而此焦慮情緒可能會進一步導致認知功能的退化,然而目前關於主觀認知退化族群多聚焦於其認知功能的介入,少有焦慮相關介入。在焦慮介入方面,音樂被視為是具效果,且安全、容易執行的介入方法。因此本研究將探討音樂應用於主觀認知退化族群之降低焦慮之效益,並進一步比較主觀認知退化族群與健康老人的焦慮情緒反應差異。
本研究使用單組前、後測之研究設計,參與本研究之受試者為神經內科門診轉介主觀認知退化個案10人及社區據點招募之健康對照老人15人。以主觀自評量表(中文版特質焦慮量表、焦慮視覺類比量表)與客觀評估工具(心律變異性、膚電活動)作為結果評量。研究流程如下:受試者先穿戴生物回饋之偵測系統,接著進行認知任務以提升其緊張與焦慮程度,再以隨機順序提供其喜愛的音樂或白噪音,比較音樂與白噪音對於降低焦慮情緒之立即效益,並進一步比較兩族群的效果差異。
結果顯示心率變異性之高頻功率與副交感神經的變化無一致之反應,但代表交感神經活性之膚電活動在音樂介入(p = .002,Z = -3.027)及白噪音介入(p = .001,Z = -3.323)後有顯著下降,而單純休息則無顯著下降;主觀焦慮視覺類比量表之分數也有相同的正面效果,但差異並未達顯著。此外,也發現主觀認知退化個案與焦慮特質較高者有較大的自律神經變化幅度。
音樂與白噪音介入皆可有效降低客觀之焦慮情緒反應,而音樂有較高的主觀接受度,顯示音樂應用於健康老人與主觀認知退化個案族群,為一有立即效果且可行性高的焦慮介入方式。建議未來可增加樣本數,延長介入及收集資料的時間並選擇合適之焦慮刺激,以驗證音樂對於主觀及客觀焦慮情緒反應之效應。; Subjective cognitive decline (SCD) is considered as a risk factor of dementia and associates not only with cognition deterioration but with higher anxiety level. Anxiety may further lead to decreasing cognitive function and negative impacts on the well-being and quality of life. To ease anxious emotions, music has been viewed as an effective, safe and easy alternative to medication. However, little research has focused on older adults and persons with SCD. Thus, the purpose of this study is to investigate the effects of music on reducing anxiety of the healthy elderly and persons with SCD and to compare the anxiety level between SCD and healthy controls.
Single subject pretest-posttest design was used. 10 SCD subjects referred from the memory clinics and 15 healthy controls recruited form the community participated this study. The anxiety level was assessed both by self-reports (State-Trait Anxiety Inventory and Visual Analogue Scale of Anxiety) and by objective measurements related to autonomic nervous system activities (heart rate variability and electrodermal activity). Preferred music and white noise were provided to ease participants’ anxious emotion which was raised by cognitive iPad games. Although there was no positive effect after three interventions in the aspect of heart rate variability, results of electrodermal activity showed that only music and white noise could decrease skin conductance and the activation of sympathetic nervous system. The results were consistent with self-reported VAS scores. Furthermore, persons with SCD and higher anxious trait tended to have larger physiological responses.
Music and white noise both showed positive effects on reducing anxious level in both subjective and objective aspects and music seems to be more acceptable and feasible. Further studies with larger sample size are needed to reach more significant and generalizable outcomes. The recording time of baseline status and interventions can be increased to ensure that participants get calm and ready.2020-01-01T00:00:00Z電腦化視-動-整合測驗
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/52460
標題: 電腦化視-動-整合測驗; Development of Visual-Perceptual-Motor-Integration Computerized Assessment (VPMICA)
作者: Candy Chieh Lee; 李劼
摘要: 前言: 「視知覺動作能力(VPMS)」涵括了視知覺、手眼協調、視動整合的能力。 VPMS失能,往往對學齡兒童的職能表現與功能性技巧造成負面的影響,因此兒童職能治療師時常需要針對學齡兒童的VMPS困難進行測驗、評估。 因此治療師與老師需要有效測驗,以供治療對象篩選、設立治療計劃,乃至於監控進步成效。 近年來隨著數位科技日新月異的進步,過去紙本化VPMS測驗在施測與記分上的諸多劣勢亦逐漸被彰顯。隨著科技進步,電腦化的復健模式於近十年內蓬勃進展,藉由電腦化的測驗工具,兒童VPMS評估有了更俱效率的方法。因此本研究發展一基於電腦的兒童VPMS評估工具。本研究的目的如下: 1) 設計與發展VPMICA, 2)對VPMICA進行效度驗證。(藉由比對Beery VMI, TVPS-3 and DTVP-2 eye-hand coordination subtest結果,同時效度), 3) 對VPMICA進行信度驗證4) 檢視VPMICA對兒童書寫困難的區別效度。
方法:為評估同時效度, 43名參與並完成下列四項評估:VPMICA, Beery VMI, TVPS-3 and DTVP-2 eye-hand coordination subtest。為評估再測信度, 43名參與者中有15名需在兩週後再進行一次VPMICA。為評估區別效度,對 26 名有書寫困難的兒童完成VPMICA. 信度使用ICC係數 (intraclass correlation coefficients) 做前後測的分析。The用皮爾森相關分析 (Pearson’s correlation) 來檢與測Beery VMI, TVPS-3 and DTVP-2之收斂效度。
結果: 本研究的樣本共有69名受試者。結果顯示VPMICA在三個分測驗皆有高度的再測信度(VD = .933; VM = .803; FC = .982; FG = .990; VC = .985; Circle = .997; Pentagon = .993; Star = .999; VMI =.997). 在收斂效度的部分VPMICA的三個分測驗分別與TPVS-3,DTVP-2 ,VMI有顯著的中度相關 (VD r = .611, n = 43, p < .01; VM r = .446, n = 43, p < .01; SR r = .312, n = 43, p < .05; FC r = .526, n = 43, p < .05; FG r = .406, n = 43, p < .01; VC r = .646, n = 43, p < .01; circle r = -.600, n = 43, p < .01; pentagon r = -.744, n = 43, p < .01; star r = -.708, n = 43, p < .01 VMI raw score r = .641, n = 43, p < .01; VMI standard score r = .760, n = 43, p < .01; VMI scaled scores r = .778, n = 43, p < .01)。 最後本研究也發現正常發展孩童和書寫困難孩童的VPMICA 的分數有顯著的差異。
結論 :本研究的結果證明VPMICA是一個具備信效度的評估工具,可以精準的測量到孩童VPMS 的能力。本研究結果支持未來在研究或臨床上面學校老師與職能治療師等可以選用此工具來評估及監測書寫困難孩童的VPMS 能力。; Background & Literature Review: The visual-perceptual-motor skills (VPMS) serve as an umbrella term encompassing visual-perceptual, eye hand coordination, and visual motor integration skills. Since dysfunction or difficulties in VPMS in school-aged children can negatively impact a child’s occupational performance and functional skills, pediatric occupational therapists often need to assess and treat school-aged children with difficulties in VPMS. It is important, therefore, for therapists and educators to use tests that possess sound measurement properties in order to monitor progress, plan treatments and to determine eligibility for therapeutic services. However rapid digital technology developed in the recent years, it is striking that most of the assessment tools assessing VPMS in children is still mostly paper-based which may be prone to several disadvantages due to manual administering and scoring. Fortunately, due to the advance of technology, the application of computerized methods in rehabilitation has expanded in recent decades and could be a solution to better and quicker assessment of children’s VPMS.
Objective: We aim to develop a computer based VPMS assessment tool for children. The objectives of this study are the following: 1) To design and develop the VPMICA, 2) To validate the VPMICA by assessing the concurrent validity with Beery VMI, TVPS-3 and DTVP-2 eye-hand coordination subtest, 3) To examine the test-retest reliability of the VPMICA and 4) To examine the discriminate validity of the VPMICA on children with handwriting difficulties.
Methods: To assess the concurrent validity, 43 participants were recruited and completed 4 assessments: VPMICA, Beery VMI, TVPS-3 and DTVP-2 eye-hand coordination subtest. To assess the test-retest reliability, 15 out of the 43 participants recruited earlier were asked to complete the VPMICA two weeks after. To assess the discriminant validity, 26 children with handwriting difficulties were recruited to complete the VPMICA.
Data Analysis: The IBM SPSS 22.0 was used to perform the statistical analysis. First descriptive statistics were calculated to characterize the performance of the participants. Then, the test-retest reliability of the VPMICA was assessed using test-retest correlation between scores in trial 1 and trial 2 using the intraclass correlation coefficients (ICC). The convergent validity of the Computer-Based Assessment of Visual Motor Integration for Children with Beery VMI, TVPS-3 and DTVP-2 subtest were estimated with Pearson correlations. The discriminant validity was computed using the scores of children with handwriting difficulties.
Results: The VPMICA exhibited high reliability (VD = .933; VM = .803; FC = .982; FG = .990; VC = .985) in VP subtests, high reliability (Circle = .997; Pentagon = .993; Star = .999) in EHC subtests and high reliability in VMI (.997). Significant moderate correlations were found between VPMICA VP subtest scores and TVPS-3 scaled scores in the entire sample except the spatial relationship subtest (VD r = .611, n = 43, p < .01; VM r = .446, n = 43, p < .01; SR r = .312, n = 43, p < .05; FC r = .526, n = 43, p < .05; FG r = .406, n = 43, p < .01; VC r = .646, n = 43, p < .01). Significant moderate correlations were found between VPMICA EHC subtest scores and DTVP-2 eye-hand coordination subtest standard scores in the entire sample (circle r = -.600, n = 43, p < .01; pentagon r = -.744, n = 43, p < .01; star r = -.708, n = 43, p < .01). Significant moderate correlation was found between VPMICA VMI subtest scores and VMI scale scores in the entire sample (VMI raw score r = .641, n = 43, p < .01; VMI standard score r = .760, n = 43, p < .01; VMI scaled scores r = .778, n = 43, p < .01). And significant differences were found on the scores VPMICA VP, VMI and EHC subtests between typically developed children and children with handwriting difficulties.
Conclusion: The preliminary results indicate that the VPMICA is a valid tool that accurately assesses VPMS in children with handwriting difficulties and Teachers and occupational therapist can also use this assessment tool to evaluate and monitor children’s VPMS. In addition to its demonstrated reliability and validity, the VPMICA is cost effective and relatively easy to administer. These factors support the use of VPMICA in assessing VPMS in children.2015-01-01T00:00:00Z電腦化數字警醒測驗於中風患者之效度與反應性驗證
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/68014
標題: 電腦化數字警醒測驗於中風患者之效度與反應性驗證; Validity and Responsiveness of the Computerized Digit Vigilance Test in patients with stroke
作者: Tzu-Ting Chen; 陳姿廷
摘要: 背景:電腦化數字警醒測驗(computerized Digit Vigilance Test, C-DVT)可方便、有效地評估中風患者之持續性注意力,於慢性中風患者具良好的再測信度、同時效度及生態效度。然而測量結果之有效性易受樣本不同而改變,C-DVT於亞急性中風患者是否具有良好的生態效度、預測效度及反應性仍未知,因此限制此測驗於亞急性中風患者之適用性與臨床及研究之使用價值。
目的:本研究欲驗證C-DVT於亞急性中風患者的效度(含生態效度、預測效度)及反應性(含團體層級、個別層級),以期確認此測驗之心理計量特性及實用價值。
方法:招募60位亞急性中風患者,於住院二週內完成前測,再間隔一至三週完成後測,二次施測內容相同,包含C-DVT測驗、巴氏量表(Barthel Index, BI)及巴氏量表-補充量表(BI-based Supplementary Scales, BI-SS)的執行能力量表(Ability Scale)。生態效度分析C-DVT與BI、執行能力量表分數前後測結果之相關性;預測效度則分析C-DVT前測與BI、執行能力量表後測分數之相關性。團體層級反應性以配對t檢定(paired t-test)檢驗C-DVT前、後測之平均分數是否達統計顯著差異,再以標準化平均反應值(standardized response mean, SRM)呈現二次測驗平均分數的差異程度;個別層級反應性依據改變分數進退步及是否超過最小可偵測差異值(minimal detectable change, MDC)將患者分成四組,呈現各組人數比例,以驗證C-DVT是否具備個別層級之反應性。後續分析不同施測間隔下(<14天、≥14天)的反應性,團體層級反應性以配對t檢定二組前、後測之平均分數是否達統計顯著差異,並以SRM呈現差異程度,使用拔靴法(bootstraps)分析二組SRM是否具有顯著差異。個別層級反應性則先計算各組的人數比例後,以邊際同質性檢定(marginal homogeneity test)檢驗不同施測間隔下各組的人數比例是否具有顯著差異,再依據各組人數比例計算其合併標準差(pooled standard deviation),以z檢定及各組比例95% CI (confidence interval)檢驗相同組別之患者人數比例差異是否顯著。
結果:共49位患者參與此研究(33位男性),平均年齡56歲。生態效度結果顯示,C-DVT與BI、執行能力量表之前後測分數達中度相關(ρ = 0.43 ~ 0.59)。預測效度方面,C-DVT前測與BI、執行能力量表後測分數達低到中度相關(ρ = 0.39 ~ 0.51)。團體層級反應性分析顯示C-DVT於前、後測之平均分數達顯著差異,SRM為0.31。個別層級反應性之分析結果,32.7%的患者C-DVT呈現進步達顯著程度。分二組之團體層級反應性結果顯示,配對t檢定<14天組C-DVT前後測之平均分數沒有顯著差異,不具有反應性(SRM = -0.05);≥14天組C-DVT前後測之平均分數呈現顯著差異,且具有中度之效應值(SRM = 0.74),拔靴法結果顯示<14天與≥14天二組SRM的95% CI不重疊,具有顯著差異。分二組之個別層級反應性結果,<14天、≥14天組分別有21.7%、42.3%患者分數進步達統計顯著,邊際同質性檢定發現<14天、≥14天的二組人數比例分配無顯著差異,比較相同組別人數比例差異也未達統計顯著。
結論:C-DVT於亞急性中風患者具備良好的生態效度及預測效度,可接受的團體層級與個別層級反應性,可幫助臨床及研究人員推論亞急性中風患者ADL之表現與能力、預測出院時ADL功能,以及了解團體及個別患者持續性注意力功能之改變。; Background: Computerized Digit Vigilance Test (C-DVT) can be used to assess sustained attention of patients with stroke conveniently and efficiently. The test–retest reliability, concurrent validity and ecological validity of the C-DVT are sufficient in patients with chronic stroke. However, such positive findings can not be assumed for patients with subacute stroke because psychometric properties are population dependent. Thus, the psychometric properties of the C-DVT in patients with subacute stroke remain unknown.
Purposes: To examine validity (including ecological validity and predictive validity) and responsiveness (including group-level responsiveness and individual-level responsiveness) of the C-DVT in patients with subacute stroke.
Methods: We recruited 60 patients with subacute stroke who were admitted to rehabilitation ward. This study contained two assessment sessions with 1to 3-week interval. The first assessment session was completed within two weeks after admission, and the second assessment session was completed whin two weeks before discharge. Subjects were evaluated by the C-DVT, Barthel Index (BI) and BI-based Supplementary Scales (BI-SS)-Ability Scale in both sessions. Researcher examined the ecological validity of C-DVT using Spearman's ρ to analyze the association between the scores of the C-DVT and both the BI and Ability Scale at the same session. The predictive validity using Spearman's ρ to examine the association between the scores of the C-DVT at admission and BI and Ability Scale at discharge. Researcher examined the group-level responsiveness using paired t-test and standardized response mean (SRM). The individual-level responsiveness was examined by the percentages of patients in the 4 categories (significant improvement, nonsignificant improvement, nonsignificant worsening and significant worsening), which was divided into on the basis of the value of minimal detectable change (MDC). In addition, researcher divided patients into 2 groups according to the assessment intervals (<14-days and ≥14-days) for analyzing the responsiveness of the C-DVT. The group-level responsiveness of the 2 groups was examined using paired t-test and SRM, and then researcher compared SRM of the 2 groups using the bootstrap approach. The individual-level responsiveness of the 2 groups was examined by the proportions of patients in the 4 categories. Then, researcher used marginal homogeneity test to examine the distributions of 4 categories of the 2 groups, calculated pooled standard deviation of proportions and used Z-test and proportions 95% CI of each proportions to exmined difference of proportion in the same category of the 2 groups.
Results: 49 patients participated in this study. The C-DVT scores were moderately correlated with the scores of the BI and Ability Scale (ρ = 0.43 ~ 0.59), supporting the ecological validity. Low to moderate association (ρ = 0.39 ~ 0.51) between the scores of the C-DVT at admission and the scores of the BI and Ability Scale at discharge was found, supporting the predictive validity. The group-level responsiveness of C-DVT presented small SRM (0.31) and a significant difference (p = 0.034) between admission and discharge. The individual-level responsiveness of C-DVT showed 32.7% patients in the category of significant improvement. The group-level responsiveness of the <14-days group presented a little SRM (-0.05) and no significant difference, but the ≥14-days group presented moderate SRM (0.74) and a significant difference. The bootstrap analysis showed that SRM of the 2 group was significant difference. The results of individual-level responsiveness of the 2 groups was found 21.7% patients of <14-days group and 42.3% patients of ≥14-days group were in the category of significant improvement. In the 2 groups, the distributions of 4 categories were not significant different. The difference of proportions in the same category of the 2 groups was not
statistically significant.
Conclusion: The C-DVT has good ecological validity and predictive validity, and acceptable group-level responsiveness and individual-level responsiveness in patients with subacute stroke. These findings support the result of C-DVT can be inferred the patient’s ADL performance and ability, and predicted patient’s ADL function at discharge. The C-DVT also can be an ideal outcome measure to understand the changes of patient’s sustained attention for clinical professionals and researchers.2018-01-01T00:00:00Z