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標題: | 感覺統合介入於重度年輕型失智症患者的效益初探 Effects of a Sensory Integration Intervention for Younger Persons with Severe Dementia: A pilot study |
作者: | 廖子瑄 TZU-SHIUAN LIAO |
指導教授: | 毛慧芬 Hui-Fen Mao |
共同指導教授: | 吳建德 Chien-Te Wu |
關鍵字: | 年輕型失智症,重度失智症,感覺統合,動作功能,精神行為症狀, young-onset dementia,severe dementia,sensory integration intervention,motor function,behavioral and psychological symptoms of dementia, |
出版年 : | 2018 |
學位: | 碩士 |
摘要: | 背景:相較於老年型失智症患者,年輕失智症患者病因多元,較容易出現動作上的困難,且退化的速度較快。然目前年輕型失智症患者的研究較少,尤其針對重度年輕型失智症患者介入之量性研究闕如。年輕型失智症患者因認知功能衰退、活動量降低、接收或主動搜尋各種感官刺激缺乏,造成感覺剝奪並影響適應性反應,而加重精神行為症狀與肢體動作之問題。臨床上,職能治療常使用感覺統合療法於不同領域的患者,以不同感覺輸入增加患者的適應性行為,並促進情緒及動作功能正常,然此療法是否適用於重度年輕型失智症患者之動作限制與情緒行為,其效益仍有待驗證。
目的:本研究以感覺統合療法作為介入媒介,探討其對年輕型失智症患者的動作功能、精神行為症狀及認知功能的立即效益。 研究方法:為單組前後測設計,由失智症協會轉介10位有動作障礙的重度年輕型失智症患者參與本研究,接受12次(每週1次,每次2小時)感覺統合治療,並於12次介入前後完成下列各項成效評估,包含:精神行為症狀—(1)簡短版神經精神量表(2)中文版柯恩—曼斯菲爾激動情緒行為量表、動作功能—(3)Tinetti平衡及步態評估表(4)中風病患姿勢控制評估量表、認知功能—(5)簡短版嚴重損害量表,並在每次介入前後重複量測動作功能、情緒—(6)觀察情緒量表修正版及活動表現(7)個案活動表現評估作為立即成效;照顧者的成效指標包含(1) 流行病學研究中心憂鬱量表(2) 照顧者能力評估表。資料分析以無母數統計探討前後測成效是否達顯著差異(p<.05),且以二因子重複量測變異數分析,探討立即成效是否達顯著差異(p<.05)。 研究結果:在立即效益方面,患者的正向情緒(高興[p=0.032]、警醒度[p=0.017])及動作功能(姿勢控制[p=0.012]及步態[p=0.018])有顯著改善,且整體活動表現亦較介入前佳(平均總分進步14.50±2.25)。介入12週後,年輕型失智症患者在動作功能(姿勢控制[p=0.126]及步態[p=0.414])有進步的趨勢,而精神行為症狀嚴重度(p=0.400)、躁動行為(p=0.610)及認知功能(p=0.397)與介入前相比稍微退步,然皆未達顯著差異;此外,照顧者的憂鬱情緒及照顧能力比介入前稍微退步,而照顧 結論:感覺統合療法對於重度年輕型失智症患者的情緒、動作功能及活動表現有正面的立即效益,可能介入頻率不足,雖對於動作負荷稍微進步,然差異不大,未達統計上顯著。功能的退化有延緩的趨勢,然患者的精神行為症狀及認知在介入間仍持續退化,顯示其效益較難長期維持,未來研究設計可增加樣本數及對照組進一步驗證感覺統合療法是否有延緩退化的作用。 Backgrounds: The causes of young-onset dementia (YOD) are variable, and it may lead to more difficulties and faster degeneration. However, there are few studies on YOD, especially for quantitative studies to investigate the intervention effect involving younger persons with severe dementia. YOD persons suffer from cognitive decline, decreased activity, and lack of sensory stimuli, causing sensory deprivation and impaired adaptive responses. This phenomenon might lead to worse behavioral and psychological symptoms of dementia (BPSDs) and motor function. Occupational therapists often use sensory integration intervention (SI) to increase adaptive behavior, normalizing emotional and motor function in persons with other diagnosis. Nevertheless, benefits of SI for younger persons with severe dementia need to be verified. Aims: The purpose of this study was to investigate the efficacy of a sensory integration intervention on the enhancement of motor function, BPSDs and cognition in younger persons with severe dementia. Methods: This was a one-group pretest-posttest designed study. The subjects included 10 younger persons with severe dementia. They participated in a 2-hour session of a SI program per week for 12 weeks. Main outcomes included BPSD (Neuropsychiatric Inventory-Questionnaire and Cohen- Mansfield Agitation Inventory), motor function (Postural Assessment Scale for Stoke and Performance-oriented mobility assessment) and general cognition (Severe Impairment Battery Short Version). Immediate outcomes included motor function, emotion state (Modified Observed Emotional Rating Scale) and activity performance (Activity Performance Rating Scale). Secondary outcomes included care skills (Care Skill Inventory), caregiver burden (Zarit Caregiver Burden Interview Short Form) and emotional state (Center for Epidemiological Studies Depression Scale) in caregivers. Statistical analysis included the Wilcoxon Signed Ranked Test for pre- and post- of 12-week intervention comparison and the two-way Repeated Measures ANOVA to examine the immediate effects of pre-and post-performance per session. Results: The results showed significant improvement in motor function (postural control[p=0.012] and gait pattern [p=0.018]), emotion state (pleasure[p=0.032]、alertness[p=0.017]) and activity performance (mean=14.50±2.25) immediately after intervention. However, after 12-sessions intervention, there was only a trend of improvement in motor function, and no significant change in BPSD and cognitive function. Besides, there was no significant change in care skills, caregiver burden and depressive emotion in caregivers. Conclusions: The present study showed that sensory integration intervention had significant positive immediate effect on emotional, motor function and activity performance in younger persons with severe dementia, however, it could not sustain for a long period of time. It was suggested to apply more frequent SI intervention (ie. 2 times per week) to obtain better efficacy. Future studies need larger sample sizes and adding control group to verify whether sensory integration intervention coould benefits in delaying degeneration. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/79051 |
DOI: | 10.6342/NTU201802954 |
全文授權: | 未授權 |
電子全文公開日期: | 2023-10-05 |
顯示於系所單位: | 職能治療學系 |
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