本體覺刺激對於健康老人焦慮情緒之探討

Abstract

焦慮影響生活層面包含情緒、認知、睡眠等。其機轉與大腦結構及神經傳遞物質皆有關。而本體覺刺激經肌肉、關節，由脊柱內側蹄系路徑傳遞至中樞投射區，影響網狀結構及大腦皮質，可能影響自律神經系統，具安定、鎮靜效果，可以重量背心、關節擠壓及按摩等施予。老人焦慮情緒處理雖有多感官介入研究，但較少探討本體覺刺激及生理影響，多以主觀或行為評估。故研究目的為探討本體覺刺激於老人焦慮情緒於自律神經系統影響，並比較三種刺激方式之自律神經反應及其適用族群。 採交叉設計試驗，收錄20名健康老人，以5分鐘平板電腦認知遊戲提升緊張、焦慮情緒，再以5分鐘重量背心、按摩或關節擠壓舒緩。使用Procomp 2 Dual Channel System擷取心律變異度及皮膚電阻數值。以中文版焦慮特質量表－特質部分評估焦慮特質。統計分析以成對T檢定比較本體覺刺激期與遊戲期間自律神經興奮變化；以單一變異數分析比較本體覺刺激間改變自律神經興奮差異；並以Spearman rho分析焦慮程度與本體覺刺激前後之焦慮變化程度的相關性。 按摩與重量背心於皮膚電阻數值顯著立即降低交感神經興奮(p<0.001)，且本體覺刺激與休息間具顯著差異(p<0.001)，其中按摩較休息與關節擠壓佳。但於提升副交感神經興奮則無顯著差異，其與休息間無顯著差異。本體覺刺激於焦慮特質間之相關性，重量背心與關節擠壓於焦慮特質程度越高者副交感神經興奮提升較少；而本體覺刺激於焦慮特質程度較高者交感神經興奮降低較少。 本研究發現本體覺刺激於立即減緩老人焦慮情緒之自律神經表現具潛力，尤其按摩效果較佳，且於焦慮特質程度較低的老人具較多影響。但刺激需視主觀感受調整，避免因不適而影響效果。建議未來研究比較焦慮症與一般健康老人於本體覺刺激反應，並可搭配主觀與客觀評估工具探討長時間效益。

Anxiety affects everyday life, including emotion, cognition and sleep, etc. Its mechanisms have been known to be related to the brain structures and the neurotransmitters. Proprioceptive stimulus goes through muscles and joints, and transfers through dorsal column medial lemniscus, which projects on the central nervous system. It influences the reticular activating system and cerebral cortex, which may then affects the autonomic nervous system (ANS) that has a result of calm and sedation. Proprioceptive stimulus could be received through wearing a weighted vest, doing joint compression, or receiving a massage. Although there were researches focusing on the effect of multisensory on anxiety of elderlies, only few of them focusing whether on proprioceptive stimulus or the physical aspects of anxiety. Most researches on anxiety of elderlies used subjective assessments or behavioral observation as assessment methods. Thus, the aim of this study is to investigate the effects of proprioceptive stimulus on reducing the elderlies’ anxiety level on the objective physiological indicators-the reactions of the ANS. Furthermore, we compared the relaxing effects of three different modes of proprioceptive stimulus-wearing a weighted vest, receiving a massage, and doing joint compression exercise. This study enrolled 20 healthy elderlies. It was a crossover design, which elevated the level of anxiety through iPad cognitive game and soothed the emotion and physical reactions through one of each proprioceptive stimulus. All the cognitive games or relaxation sessions were five minutes. The subjective anxiety trait level of elderlies was assessed by the Chinese version of state trait anxiety inventory-state anxiety (STAI-T). The Procomp 2 Dual Channel System was used for recording changes of the ANS, which obtained the heart rate variation indexes (HRV) and skin conductance level (SC). The statistical methods are 1) paired t-test for comparing the differences of HRV and SC between game sessions and proprioceptive stimulus sessions, 2) one-way ANOVA for comparing between the three simulative methods, and 3) Spearman rho for the relationship between anxiety trait level and the changes of the ANS after receiving proprioceptive stimulus. The results showed that, 1) the SC reduced both during receiving a massage or wearing a weighted vest (p<0.001). 2) Receiving a massage lowered the SC significantly more that taking a rest or doing joint compression (p<0.001). There were no differences between the changes of the parasympathetic nervous system index (PNS) between the effects of any of the proprioceptive stimulus and taking a rest. 3) The relationship between the level of anxiety trait and the changes of the ANS pre/post of the proprioceptive stimulus indicated that wearing a weighted vest and doing joint compression raise the PNS, and all three stimuli could reduce the sympathetic index more on elderlies with lower anxiety trait level. Proprioceptive stimulus has its potential on changing the ANS to sooth the physiological aspect of anxiety in healthy elderlies, and has more effects on elderlies who have lower anxiety trait level. The intensity of the stimulus should be adjusted subjectively, in order to avoid the cause of uncomfortable feelings, which may affect the results of soothing. Further researches could focus on the effects of proprioceptive stimulus between healthy elderlies and elderlies with anxiety diagnosis. Also, comparing the results between subjective and objective assessments in long term experiments.