電腦認知遊戲訓練對健康長輩動作功能與認知之效益

Abstract

目的：本研究探討電腦認知遊戲結合兩種動作訓練對健康長輩認知功能及動作功能提升之效益。 背景：認知功能及動作功能的衰退是阻礙長輩成功老化的因素之二，在認知功能中的短期記憶力、分散注意力及抑制功能普遍衰退較快。由2009年所提出的「老化及鷹架理論」可知，認知功能是可以經由學習或訓練等過程獲得提升。近年來，部分研究進一步證實電腦認知遊戲訓練對認知功能具有正面效益，且容易做到個人化設計、激發長輩使用動機等優勢。此種認知介入方式還可結合動作功能之運用，但目前的文獻鮮少同時探討動作功能及認知功能的效益。 研究方法：使用兩組延遲介入隨機分派試驗(大動作組與小動作組)，並於社區招募符合收案條件之16位健康長輩參與研究。基準點至前測間共四週不介入，前測至後測間共四週進行電腦認知遊戲介入。大動作組與小動作組均接受8次電腦認知遊戲介入，每週兩次，一次30分鐘，並於基準點/前測/後測完成以下評估內容：(1)整體認知功能(MoCA)、(2)短期記憶力(DS-forward、電腦認知遊戲評估(GAME1))、(3)分散注意力(CTT-2、電腦認知遊戲評估(GAME2))、(4)抑制功能(SCWT、電腦認知遊戲評估(GAME3))、(5)上肢動作(NHPT(左手)、NHPT(右手))、(6)下肢動作及平衡(GUG、FTSST)，並以無母數統計檢定組間及組內是否有差異。 研究結果：(一)基準點/前測/後測整體比較：全體受試者除了上肢動作與下肢動作(GUG)，其餘評估項目整體上均有差異；大動作組除了短期記憶力(DS-forward)、上肢動作(NHPT(左手))與下肢動作(GUG)，其餘整體上均有差異；小動作組除了整體認知、短期記憶力(DS-forward)、上肢與下肢動作，其餘整體上均有差異。(二)前測/後測比較：全體受試者除了上肢動作(NHPT(左手))，其餘均有進步；大動作組除了上肢動作(NHPT(左手))與抑制功能(GAME3)，其餘均有進步；小動作組除了短期記憶力(DS-forward)、上肢與下肢動作，其餘均有進步。在前後測差值的比較上，大動作組唯在上肢動作(NHPT(右手))與下肢動作方面進步幅度比小動作組多。(三)基準點/前測比較：全體受試者除了下肢動作(FTSST)、短期記憶力(GAME1)及分散注意力(GAME2)，其餘均無差異；大動作組除了抑制功能(SCWT)，其餘均無差異；小動作組除了下肢動作(FTSST)，其餘均無差異。大動作組與小動作組於基準點、前測與基準點/前測差值組間比較均無差異。 結論：電腦認知遊戲介入後，全體受試者在短期記憶力、分散注意力及抑制功能有進步，又結合拍打之大動作組於電腦認知遊戲介入後，動作功能(包含上肢與下肢動作)除了左上肢動作以外，進步程度較手指按壓鍵盤之小動作組多，然而短期記憶力、分散注意力及抑制功能沒有比手指按壓鍵盤之小動作組進步地多。另由問卷調查與訪談可得知，本研究所研發之電腦認知遊戲能夠引起長輩的興趣，達到娛樂的效果。未來將蒐集更多實驗資料進一步驗證上述結果。

Aim: This research is trying to investigate the benefits to elders over 65s brought by our computer-based cognitive training game with high and low level of motor engagements on cognitive and motor functions. Background: The declination on cognitive and motor functions increases the difficulty to achieve successful aging. In addition, cognitive functions such as short-term memory, divided attention and inhibition show significant degeneration during aging. According to the scaffolding theory of aging, cognitive functions can be enhanced through training and learning. It is verified that the interventions utilizing computer-based cognitive games training have positive benefits on cognitive functions. The flexibility to customize and the entertaining effect to attract players are advantages using computer-based cognitive game to train the elders’ cognitive functions. In this research, we believe this kind of cognitive training has the possibility to incorporate the usage of motor functions. However, the benefit of simultaneously engaging in cognitive and physical activities for elderly is rarely studied and therefore, it will be the direction in this study. Method: The research separates all participants over 65s into two groups – high level motor engagement group and low level moto engagement group. We include 16 healthy elders in community to engage in this research. There are 4 weeks no intervention period between the baseline and the pre-test and 4 weeks intervention between the pre-test and post-test. 8 participants in each group go through 30 minutes computer game playing a day, two days a week and totally 8 times intervention of the playing. The outcomes include: (1)Overall Cognitive Function(MoCA)、(2)Short-term Memory(DS-forward、Evaluation from Computer–based Cognitive Game(Game1))、(3)Divided Attention(CTT-2、Evaluation from Computer–based Cognitive Game(Game2))、(4)Inhibition(SCWT、Evaluation from Computer–based Cognitive Game(Game3))、(5)Upper Limbs(NHPT(Left Hand)、NHPT(Right Hand))、(6)Lower Limbs and Balance(GUG、FTSST). We use nonparametric statistics test to find any difference both in inter-group and intra-group. Result: The statistical comparison of baseline/pretest/posttest: all participants exhibited difference except upper limbs and lower limbs(GUG). Participants in high level of motor engagement group showed difference except short-term memory(DS-forward), upper limbs(NHPT(Left Hand)) and lower limbs(GUG). Meanwhile, participants in low level of motor engagement group revealed difference except overall cognitive function, short-term memory(DS-forward), upper limbs and lower limbs. The comparison of pretest/posttest: All participants exhibited improvement except upper limbs(NHPT(Left Hand)). Participants in high level of motor engagement group displayed improvement except upper limbs(NHPT(Left Hand)) and inhibition(Game3). Participants in low level of motor engagement group exhibited improvement except short-term memory(DS-forward), upper limbs and lower limbs. As for the interval value between pretest and posttest, participants in high level of motor engagement group improved more than low level ones on upper limbs(NHPT(Right Hand)) and lower limbs. The comparison of baseline/pretest: All participants displayed no difference except short-term memory(Game1), divided attention(Game2) and lower limbs(FTSST). Participants in high level of motor engagement group exhibited no difference except inhibition(SCWT). Participants in low level of motor engagement group exhibited no difference except lower limbs (FTSST). Finally, no difference was found in the baseline comparison, pretest comparison and interval value between baseline and pretest between two groups. Conclusion: Generally, with the intervention of our computer-based cognitive game, all participants showed improvement in short-term memory, divided attention and inhibition. Although participants in high level of motor engagement group averagely had better performance on motor functions except upper limbs(NHPT(Left Hand)), the performance on cognitive functions had no better effects. Furthermore, the results from questionnaire showed that our computer-based cognitive game was capable of appealing elders’ interests and achieving the effect of entertainment. All of those results will be validated through more experimental data in the future.