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標題: | 探討以動手樂活動為基礎之認知促進方案於社區長者之成效轉移效果 The Transfer Effect of Tinkering Activity-Based Cognitive Intervention for Community Dwelling Older Adults |
作者: | 陳愉滋 Yu-Tzu Chen |
指導教授: | 毛慧芬 Hui-Fen Mao |
關鍵字: | 老人,認知訓練,轉移效果,認知彈性,主動推理, Older Adults,Cognitive Intervention,Transfer Effect,Cognitive Flexibility,Active Inference, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 背景:健康長者認知訓練型態雖多元,但大多研究的訓練成效具專一性,探討何種認知訓練型態或內容有較佳的訓練成效及促進成效轉移的文獻卻仍有限。認知彈性是較高階的認知功能,與長者日常生活功能表現最相關。本研究假設在執行高階的認知彈性活動時,因需整合低階的認知過程以完成任務,可能使認知訓練成效轉移到其他未特別訓練的認知面向。本研究應用之動手樂活動便以認知彈性為訓練目標能力,讓長者自發性主動思考問題解決方式,或許可成為轉移效果較佳的新興認知促進方案。
目的:探討動手樂活動與桌遊活動訓練方案,對於促進社區認知正常長者認知彈性、其他認知功能(注意力、記憶力等)與日常生活功能之立即效益,並進而探討強調主動推理導向的動手樂活動,在認知彈性上的訓練成效,是否較典型桌遊活動具較佳的轉移效果。 方法:本研究為隨機對照試驗。招募臺灣北部社區健康長者,並隨機分派至動手樂活動組(實驗組)或桌遊活動組(對照組)。兩組皆進行2小時/週,共12週之動手樂活動或桌遊活動方案,並於課程結束後參與後測。本研究以威氏康辛卡牌分類測驗、交替任務測驗及認知彈性量表評估認知彈性,其他認知功能評估工具包含:魏氏智力/記憶量表(知覺組織、語文理解、訊息處理、短期記憶、工作記憶)、遠距創造測驗(聚合性思考)、用途替代測驗(發散性思考)、彩色路徑測驗(執行功能),並以簡短版技能表現評量評估工具性日常生活功能。 結果:共24位長者完成後測,動手樂活動組11位,桌遊活動組13位。介入後,動手樂活動組於認知彈性具正向效益(p =.075, d =.77),且成效可轉移的認知面向包含:知覺組織(p =.048, d =.59)、短期記憶(p =.009-.047, d =.82-1.25)、聚合性思考(p =.074, d =.89)、發散性思考(p =.059-.099, d =.35-.53)、執行功能(p =.041, d =.30)。桌遊活動組認知彈性指標未顯著進步,成效可轉移的認知面向包含工作記憶(p=.091, d=.66)與執行功能(p=.033, d =.47)。整體而言,動手樂活動訓練成效可轉移的面向較桌遊多,其中發散性思考(p =.003-.047, d =.86-1.31)與短期記憶(p =.093, d =.78)的轉移效果更優於桌遊。然而,動手樂活動與桌遊活動於工具性日常活動之成效可能因工具敏感性不足而未顯著變化。 結論:強調主動推理導向的動手樂活動,除在認知彈性具正向效果,成效亦可轉移至較多種認知面向(知覺組織、短期記憶、執行功能、聚合性思考及發散性思考),可能是較推薦應用於健康長者的認知促進模式。然由於樣本數較小,仍須後續探究。 Background: Various types of cognitive intervention for healthy older adults are developed, yet most of them show specificity of training effect, and the literature on the effectiveness or transfer effects comparison between methods is still limited. Based on previous studies, cognitive flexibility is a higher-level cognitive function closely related to the daily function of older adults. This study hypothesized that the integration of lower-level cognitive processes was required to complete tasks when engaging in cognitive flexibility activities. Thus, the training effects may transfer to other untargeted cognitive domains. "Tinkering Activities," focusing on cognitive flexibility and encouraging active problem-solving, may serve as a cognitive intervention approach with better transfer effects. Objective: This study aimed to (1) explore the effectiveness of Tinkering Activities and Board game on cognitive flexibility, other cognitive functions (e.g., attention, memory, etc.), and daily function in older adults; (2) investigate whether an active inference-oriented Tinkering Activities has better transfer effects than a typical Board game. Method: This study is a randomized controlled trial. Participants were recruited from communities in northern Taiwan and randomly assigned to the Tinkering group (experimental group) or the Board game group (control group). A two-hour session was provided weekly for 12 weeks for each group. Participants finished post-tests after the intervention. We used the Wisconsin Card Sorting Test, the Task Switching, and the Cognitive Flexibility Scale to assess cognitive flexibility. Other cognitive measures included the Wechsler Intelligence/Memory Scale (perceptual organization, verbal comprehension, information processing, short-term memory, working memory), the Remote Association Test (convergent thinking), the Alternative Uses Test (divergent thinking), and the Color Trails Test (executive function). The Brief UCSD Performance-Based Skills Assessment was used to measure instrumental activities of daily living. Results: 24 participants completed the post-test, with 11 participants in the Tinkering group and 13 in the Board game group. After the intervention, the Tinkering group showed positive within-group effects on cognitive flexibility (Task Switching) (p = .075, d = .77). The transfer effects were observed in the perceptual organization (p = .048, d = .59), short-term memory (p = .009-.047, d = .82-1.25), convergent thinking (p = .074, d = .89), and executive function (p = .041, d = .30). The Board game group did not show improvement in cognitive flexibility, but transfer effects were observed in working memory (p = .091, d = .66) and executive function (p = .033, d = .47). The transfer effects of the Tinkering group in divergent thinking (p = .003-.047, d = .86-1.31) and short-term memory (p = .093, d = .78) were even better than those of the Board game group. Tinkering Activities generally showed superior transfer effects compared to the typical Board game approach. However, potentially due to the insufficient tool sensitivity, the improvement in instrumental activities of daily living were insignificant for both groups. Conclusions: Active inference-oriented Tinkering Activities showed positive effects on cognitive flexibility and demonstrated transfer effects to multiple untargeted cognitive functions. These findings suggested that the Tinkering Activities program may be better recommended for enhancing cognitive functions in healthy older adults. However, further studies are still needed due to the small sample size. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/90268 |
DOI: | 10.6342/NTU202301172 |
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顯示於系所單位: | 職能治療學系 |
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