園藝治療對於小腦萎縮症患者靈性福祉之探討

Abstract

脊髓小腦萎縮症為一種「罕見疾病」，也是罕見疾病中為數最多的一群。小腦萎縮症為一種晚發型遺傳性的神經退化疾病，目前此種疾病只能透過職能、物理來延緩病情，尚未有藥可以醫治。過去國內外並未有透過園藝治療來幫助這樣的個案，因此本次研究希望能透過一系列的園藝治療活動，來改善患者之生理、情緒、社交問題，並且能讓個案在靈性上有所轉變。由於領導者只有園藝背景，無法給予患者靈性上的引導，因此會邀請一位諮商師來做協助，以植物為媒材，透過適當的引導，讓個案能在靈性上有所啟發。 本研究透過準實驗設計的事前事後比較設計，研究小腦萎縮症患者參與園藝活動後的效益。為瞭解園藝治療對患者之效益，因此會進行兩梯次的研究，從第一梯研究中的結果及建議，來調整第二梯研究的課程內容。第一梯研究進行5週；第二梯研究共進行10周，活動每周1次，每次2小時。由於個案手部較不靈巧，因此每次的課程內容講授約40分鐘，活動操作則有1小時20分鐘。活動設計以植物的生命週期為主軸，以讓個案獲得靈性福祉效益為主要目標。研究對象由小腦萎縮症招募，評估工具使用手部功能、情緒、靈性及園藝活動參與態度問卷進行前後測，並於課程後一個月內進行電話訪談。 透過量化及質性分析，研究結果發現生理效益有些微的改善，可能由於活動時間較短，因此難有明顯效益。在情緒效益上，患者有相當顯著的提升，表示患者在此活動後更感到開心。而在園藝活動參與態度方面，病友在遠離、改善社交關係、促進正面情緒等夠面都有明顯的提升，表示個案在活動後對園藝的態度更為正面。在靈性效益方面，患者的正向靈性有所提升，然而負向靈性也較為增高，推測可能在引發靈性時，患者同時感受到開心與難過。在訪談結果上也能發現，個案的靈性確實在活動過程中有所引發及改變。 由結果可知，園藝治療對於小腦萎縮症患者確實在生理、情緒、社交及靈性效益上有所幫助，但由於這些個案的身體狀況皆大不相同，因此在活動課程中容易出現操作時間不一的情形，因此建議在後續研究上能於課堂前先進行個案狀況的瞭解，以設計出更加符合個案所需的課程，或者能對此狀況進行課程的調整。

The Spinocerebellar Ataxia as a 'rare disease', is a rare disease in a number of the largest group. Cerebellar atrophy as a late-onset hereditary neurological degenerative diseases, the disease only through the functions, physical delay the progression of the disease, drugs can heal. At home and abroad has not in the past through horticultural therapy to help such cases, so the hope that through a series of horticultural therapy activities to improve the patient's physiological, emotional, social problems, and make the case has been a change in the spiritual . As the leader gardening background, can not be given to patients spiritual guide, it will be invited to a counselor do to assist, plant media, through proper guidance, so that cases can inspire spiritual. This study quasi-experimental design comparing pre-and post design, research benefit patients with Spinocerebellar Ataxia after participating in gardening activities. To understand the benefits of horticultural therapy on patients, and therefore two-echelon research, from the first ladder study findings and recommendations to adjust the course content of the second ladder study. The first study was conducted five weeks ladder; second ladder study of 10 weeks, activity weekly, every two hours. Because the cases are less dexterous hands, so courses taught for about 40 minutes each time, active operation with 1 hour and 20 minutes. Activities designed to plant life cycle for the spindle, so that cases are spiritual welfare benefits as the main target. Study of Spinocerebellar Ataxia recruitment, assessment tools using hand function, emotional, spiritual, and horticultural activities measured before and after participating in the attitude questionnaire and telephone interviews conducted within one month after the course. Through quantitative and qualitative analysis, the results showed a slight improvement of the physiological benefits may be due to the short time of activities, it is difficult for obvious benefits. In the emotional benefits, the patients had significantly improved, which means that patients feel happy in this activity. Involved in gardening attitudes enough away from improving social relations, and promote positive emotions surface, the patients have improved significantly, said the cases after the event, a more positive attitude to gardening. Spiritual effectiveness, positive spirituality of patients has improved, however, also more negative spirituality increased, presumably to initiate spiritual, patients feel happy and sad. Can also be found on the interviews, the spirituality of the case did lead to change somewhat in the course of activities. From the results, horticultural therapy for patients with cerebellar atrophy does in the physical, emotional, social and spiritual benefits help, but due to the physical condition of these cases are quite different, and therefore prone to the active course different operating timecase, it is recommended that follow-up study in the classroom before the first case knowledge of the situation, in order to design more in line with the course of cases, or adjustment of status of course.