園藝活動提昇慢性精神病患認知功能

Abstract

精神病患長期住在療養機構，缺乏感官刺激及受到病程影響，其認知功能有退化情形；精神分裂病的認知缺損，尤其在注意力、記憶力和執行的功能缺陷相當明顯。神經化學分析顯示神經傳導中血清素、多巴胺和穀氨酸鹽量的減少，與該疾病有明顯關聯，需要用藥物治療，可改善其疾病，但是仍有殘餘症狀需要適切的治療。精神病患長期住在療養機構，缺乏感官刺激以及受到病程的影響，其認知功能有退化情形；因此提供較多刺激有助於引起畏縮病患對他們周遭環境的興趣。本研究係職能治療師在署立療養院教導慢性精神病患運用適合其能力的園藝生產技術，讓病患用到思考與體力，藉助在蔬菜與花卉栽種、照顧過程，將澆水、播種、移植、繁殖、土壤消毒、換盆、施肥、修剪、除草、除蟲、採收、用具清潔等操作項目，融入日常活動中。並結合收穫、烹飪與院區庭院景觀認識及觀察，以改善病患認知功能。 本研究分兩次進行，即在春、夏季及秋、冬季，每週安排課程二次，每次1.5小時的園藝。第一次 (春、夏季) 為期16週32次園藝活動；第二次 (秋、冬季) 為期18週36次活動。對象是行政院衛生署八里療養院慢性精神病患者，分為對照組及實驗組。評估工具愛倫認知階層測驗 ( Allen cognitive level test; ACL測驗 ) 、「迷你精神狀態評量」 ( Mini-Mental State Examination，簡稱MMSE ) 、「畫時鐘測驗」( Clock Drawing Test，簡稱CDT )為三項量化評估研究，職能治療綜合評量表、園藝活動問卷調查表為本研究參考。本實驗所用工具皆為評量認知功能，受測時間10分鐘之內且可例行性施測。愛倫認知階層評量是不使用紙與筆測驗，而是採用手部功能完成結構性的操作。迷你精神狀態量表是使用紙與筆測驗且與評估者針對題問內容採用問與答方式。畫時鐘測驗是使用紙與筆測驗，其內容是畫圖標示數字即可。愛倫認知能力統計檢定結果實驗組園藝活動前後改變分數 0.50±0.86，p<0.05；MMSE統計檢定結果實驗組園藝活動前後改變分數4.11±5.35，p<0.05，認知功能五子項中定向感與語言兩項有顯著差異 ；CDT統計檢定結果實驗組園藝活動前後改變分數0.42±0.69，p<0.05。職能治療綜合評估量表結果顯示病患在四個月活動期間，“專注度”、“學習能力”、“決斷能力”、“遵行指示”及“解決問題能力”均有進步，且以第三個月治療與復健的效果達到高峰，並且認知能力可從level 2 (average)，提昇level 3 ( good ) 。經過第一次研究園藝活動實施，結束後問卷調查與結果；病人能夠“放鬆心情”及對園藝活動課程安排感到滿意。第二次研究問卷調查，病患對親近自然感到心情放鬆。 精神病患的行為能力與一般正常人比較，隨著年齡增長有較嚴重的能力退化之虞。除了藥物治療控制病情之外，其復健在維持能力的展現，避免能力退化的速度超出一般正常人狀態。園藝治療著眼在維持與提昇病患現有的能力，以減少藥品的消耗與金錢的支出。

Clients who are mentally illed with prolonged hospitalization are usually degenerated in cognitive function due to their symptoms or lack of sensory stimulation. Cognitive impairment in schizophrenia clients are obvious especially in attention, memory and executive function. Neurochemical analysis shows that decreased neurotransmitters serotonin, dopamine and glutamate is related to the incidence of schizophrenic disorder. Medication is an essential treatment, yet residual symptoms need further collaborate therapy. If provided with multiple sensory stimulation, the withdrawal patients may get interested in their living environment. In this study conducted at a public psychiatric center, chronic schizophrenia patients were guided to do horticultural activities for a period of 4 months by the OT. The horticulture program provides just right challenge to clients' thinking process and endurance. Through patients' planting and caring for vegetables and flowers various skills and responsibility are scheduled into patients' daily life, such as watering, seed sowing, transplanting, propagation, compost preparation, soil disinfecting, repotting, plant feeding, plant pruning, weeding, ground fertilization, insecticide spraying, harvesting, and general cleaning of horticulture equipment / tools ). In addition, harvest cooking and landscape introduction were programmed to enhance patients' cognitive function and get improved rehabilitation. The study was conducted twice, namely in spring-summer and autumn-winter of 2005. Each had an 1.5 hr class twice a week for the whole period with the first program lasting 16 weeks and 32 classes and the second program lasting 18 weeks and 36 classes. The subjects, chronic schizophrenic patients resided at Bali Mental Hospital, Taipei are devided to activity group and control group. For evaluation, three quantitative instruments are used, includingACL ( Allen cognitive level test ) , MMSE ( Mini-Mental State Examination ) and CDT (Clock Drawing Test ). In addition COTE and horticultural activity questionnaire are used as quality assessment tools. These tools are used to test cognitive function, and each can be operated within10 minutes regularly. ACL is a manual operating test which contains several structured patterns. MMSE is a 5 portion questionnaire. CDT is a drawing test that marks numbers. In ACL test, the t-test analysis shows that singnificant improvement is obtained with the activity group. ( 0.50±0.86，p<0.05 ) , In MMSE, t-test analysis shows singnificant score change ( 4.11±5.35，p<0.05 ) and CDT shows singnificant change as well ( 0.42±0.69 ，p<0.05 ). In COTE, patients showed progress in various Cognitive function related items, i.e.‘concentration’,‘learning ability’,‘decision making’,‘follow direction’and‘problem solving’.The rehabilitation peaked at the third months of the horticultural program. The cognitive capability increased from level 2 ( average ) to level 3 ( good ). At the end of each study the patients claimed to fell relaxed and satisfied. As compared with ordinary people, clients with psychiatric problems would show more functional decline. Beside medicttion, rehabilitation program that prevent patients from deterioration is a more important treatment for psychiatric patients. Horticulture therapy aims to maintain and enhance the patients' present ability and thus reduce the medicine expenditureand related costs.