臺灣博碩士論文加值系統

背景與目的：國外文獻研究顯示重度肢體障礙兒童，早期使用電動輪椅參與各項活動，可以擁有有效和安全的行動能力，並在認知、社會、心理等方面的發展有明顯之進展。然電動輪椅駕駛能力的建立，是重度肢體障礙兒童能夠使用電動輪椅參與各項活動的重要條件。過去國外有關電動輪椅介入成效研究，大多是探討肢體障礙兒童居家使用電動輪椅對兒童認知、社會、心理方面的成效，而對於個案身體功能的影響以及在校園使用電動輪椅對學生在學校活動表現和情境參與影響之研究文獻卻是匱乏。本研究主要目的有兩部分，一為探討重度肢體障礙學生經電動輪椅的駕駛訓練後其電力移動能力的改變，另一為探討12週校園使用電動輪椅課程對重度肢體障礙學生之粗動作功能、心肺耐力、學校功能、以及電力移動能力的影響。本研究同時探討重度肢體障礙學生家長及學校教師對電動輪椅介入的意見。方法：本研究採對照研究設計。本研究共有15位來自同一特教學校之重度肢體障礙學生參與，其中實驗組有8位，對照組有7位；兩組受試學生的年齡、性別、所屬學部、醫學診斷、和粗動作功能等均無顯著差異。本研究實驗組受試學生由研究者依照受試學生駕駛電動輪椅能力建立快慢，進行不同時數結構式的電動輪椅駕駛訓練計畫。本研究在電動輪椅駕駛訓練計畫進行前、結束後以及12週校園使用電動輪椅課程介入後，以修正自Furumasu操控能力測試的「電力移動能力評估」，來進行實驗組受試學生電動輪椅駕駛能力測量，並以魏克森符號等級測驗法檢定訓練成效。本研究實驗組與對照組受試學生，在實驗組受試學生接受12週校園使用電動輪椅課程前後，均接受以粗動作功能評量表測試粗動作功能、以六分鐘爬行測試測試心肺耐力、和以學校功能評估量表測試學校活動與情境參與表現等評估，並以曼惠氏檢定比較兩組受試學生各參數表現之差異。本研究在電動輪椅介入結束後，分別針對實驗組受試學生家長及學校教師進行意見調查。結果：本研究8名實驗組受試學生在進行電動輪椅駕駛訓練計畫3-20小時的訓練後，其訓練後比訓練前的「電力移動能力」呈顯著進步（分別為119.61±40.5分和69.4±56.4分，p＜0.05），且達成功能性或邊緣性操作電動輪椅；其中邊緣性操作電動輪椅的受試學生，在爾後的12週校園使用電動輪椅課程訓練，其電力移動能力持續呈現進步狀態。實驗組與對照組的重度肢體障礙學生之粗動作功能與心肺耐力，於12週校園使用電動輪椅課程介入前後的改變量，並無統計上顯著的差異，而兩組學生的學校功能在全體總分、特殊教育教室的教學安置、校園內轉換情境、和身體活動表現等的介入前後改變量則有統計上顯著的差異(p<0.05)，其中實驗組優於對照組。本研究結果顯示實驗組受試學生之家長及學校教師對電動輪椅介入計畫持正向的意見。結論：重度肢體障礙學生可經由物理治療師訓練，多數達到功能性或邊緣性操作電動輪椅。本研究發現12週校園使用電動輪椅介入課程可以促進重度肢體障礙學生在學校活動的表現及情境參與度，且電動輪椅使用並未對他們的動作功能與心肺耐力造成顯著退化的影響。

Background & Purposes. Previous studies in the foreign countries have found that powered wheelchairs could offer an effective and safe method of locomotion at home environment and could improve the cognitive and psychosocial development for young children with severe physical impairments. The effectiveness of the powered wheelchair intervention programs on the physical and school functioning in students with severe physical impairments have not been documented. The purpose of this study were to assess the change of driving competence after the powered wheelchair driving training, and to assess the effectiveness of 12-week usage of powered wheelchairs in school on gross motor function, cardiopulmonary endurance, and school performance and participation in students with severe physical impairments. This study also collected the opinions on the powered wheelchair intervention program from the parents and school teachers of the students who participated in this study. Methods. A control study design was used in this study. Fifteen students with severe physical impairments were recruited in this study, including 8 students in the intervention group and 7 students in the control group. Only subjects in the intervention group received 3-20 hours of powered wheelchair driving training, depending on the driving competence of the subject achieved during the training. Then, each subject in the intervention group drove the powered wheelchair as the mobility aids to participate some of school activities for 12 weeks. The Furumasu’s Driving Test was used to measure changes in driving competence of subjects in the intervention group before and after the powered wheelchair driving training, and after the 12-week usage of powered wheelchair in school. All subjects from the intervention and control groups were evaluated on the gross motor function with the Gross Motor Function Measure, the cardiopulmonary endurance with the 6-minute crawling test, and the school performance and participation with the school function assessment at the beginning and at the end of the 12-week usage of the powered wheelchair in school for students in the intervention group. The Wilcoxon signed rank test and the Mann-Whitney U test were utilized to compare difference of each outcome measure within and between groups, respectively. Results. It demonstrated a significant difference of the driving competence of subjects in the intervention group between before and after driving training and between before and after 12-week usage of powered wheelchair in school (p＜0.05). These students with severe physical impairments were able to achieve a functional or marginal powered- wheelchair driving skills. The changes of the gross motor function and cardiopulmonary endurance did not differ significantly, but those of the school functioning differed significantly, in subjects between intervention and control groups after the subjects in the intervention group participating the 12-week usage of powered wheelchair in school. Subjects in the intervention group appeared to have more positive changes in school functioning as compared to that of the control group. The parents and school teachers of the students who participated in the intervention group showed supporting attitudes on the powered wheelchair intervention program. Conclusions. Most of the students with severe physical impairments could achieve functional or marginal powered-wheelchair driving skills through the driving training. The school functioning was significantly improved in students with severe physical impairments with the participation of the 12-week usage of powered wheelchair in school. The gross motor function and cardiopulmonary endurance in students with severe physical impairments were not affected with this powered wheelchair intervention program.

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