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研究生:王菁憶
研究生(外文):Ching-yi Wang
論文名稱:虛擬實境訓練對於帕金森病患者伸手動作影響
論文名稱(外文):The effect of virtual reality training on reaching movement in patients with Parkinson’s disease
指導教授:馬慧英馬慧英引用關係
指導教授(外文):Hui-Ing Ma
學位類別:碩士
校院名稱:國立成功大學
系所名稱:職能治療學系碩博士班
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:111
中文關鍵詞:時間線索動作分析帕金森病虛擬實境訓練
外文關鍵詞:Parkinson’s diseasevirtual trainingexternal timing cueingmotor analysis
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過去研究顯示時間線索對於帕金森病患者之伸手動作有所助益,而虛擬實境為具高度操控性及穩定性等優點之新興介入工具,因此本研究結合時間線索與虛擬實境工具,希望能深入探討帕金森病患者在虛擬情境下的動作表現與介入後的類化效果。本研究目的有二:(1) 利用客觀運動學數據分析虛擬實境與實際物理環境之伸手動作差異;(2) 探討給予虛擬實境訓練後,實際物理環境下之伸手動作是否能有顯著改善。
共33位帕金森病個案參與本研究,17位個案分配至虛擬實境組,16位個案制控制組。兩組個案皆先進行一次實際軌道與虛擬情境抓球,取得物理情境之前測數據與虛擬情境數據,之後虛擬實境組進行一次虛擬實境接球訓練,控制組利用左手進行翻轉明尼蘇達手部靈巧度測驗之安慰劑訓練,最後兩組進行與第一次完全相同之軌道抓球實驗,並取得後測資料。
本研究發現在一般情形下抓取靜止目標物時,兩情境之伸手動作表現並無顯著差異,但增加活動難度後,虛擬情境相較於物理環境,其成功率較低、手腕運動時間較長且手腕尖峰速度較低。快速的時間線索可誘發帕金森病患者較短之手腕動作時間與較快之手腕尖峰速度,卻會導致過低的接球成功率,而最適合時間線索會因情境有所差異。研究結果顯示虛擬介入可適用於帕金森病患者身上,並能類化至物理環境,可縮短手腕動作時間,增加手腕尖峰速度。
It has been reported that external cueing could improve reaching performance in patients with Parkinson’s disease (PD), but only few studies have focused on external timing cueing. Virtual reality (VR) is a new application with high stability and good operation, and it has been used in many fields in recent years. Therefore, we attempt to provide external timing cueing in virtual context and to explore the effect of VR training on reaching movement in PD. The purposes of this study are (1) to compare reaching performance between the VR and real context, and (2) to examine the effect of VR training in reaching for a real object.
This study included 33 patients with PD (17 subjects in VR group and 16 subjects in control group). All participants reached for the stationary and moving ball in the real context and VR context, and the reaching performance in the real context as the pretest. Then, the VR group received a VR training program and the control group used left hand to perform the Minnesota Manual Dexterity Test (MMDT) as placebo therapy. Finally, all participants reached for the ball in the real context again as the posttest.
Compared between VR context and real context, the motor performance is similar in reaching stationary ball. But after increasing activity difficulty, there were lower success rate, longer wrist movement time, and lower wrist peak velocity in VR context. The faster timing cueing could facilitate shorter wrist movement time and higher wrist peak velocity, but decrease success rate. Therefore there were the most appreciate timing cue for PD subject in VR and real context. The reaching performance in PD would benefit from virtual intervention, and the effect would generate to real context.
第一章、緒論 1
第一節、研究動機及目的 1
第二節、研究重要性 5
第二章、文獻回顧 7
第一節、 帕金森病及其動作動作缺失 7
第二節、 帕金森病動作之介入 11
壹、外在線索對帕金森病抓握動作之影響 11
貳、視覺時間線索對帕金森病抓握動作之影響 13
第三節、 虛擬實境系統 15
壹、虛擬實境定義及其形式 15
貳、虛擬實境於醫療復健與研究之應用 17
叁、虛擬實境優點與其限制 20
第四節、總結與實驗問題 22
第三章、研究方法學 23
第一節、研究設計 23
第二節、研究受測者 25
第三節、研究工具 26
壹、臨床篩檢工具 26
貳、軌道設計 29
叁、虛擬實境系統 31
肆、明尼蘇達手部靈巧度測驗(Minnesota Manual Dexterity Test, MMDT) 35
伍、動作分析儀器 36
第四節、研究流程 37
第五節、重要參數定義及資料處理 42
第六節、資料分析與統計方法 44
第四章 前導實驗 45
第一節、電磁場三度空間動作儀器校正 45
第二節、時間限制條件修正 47
第五章、研究結果 49
第一節、基本人口學資料 49
第二節、帕金森病人於不同情境下之動作表現差異性結果 51
壹、靜止球狀態下的動作表現 51
貳、滾動球狀態下的動作表現 53
参、靜止球與滾動球狀態下的表現差異 71
第三節、虛擬介入與安慰劑介入後帕金森病人伸手動作效益差異性結果 79
第六章、討論 87
第一節、帕金森病人於不同情境下之伸手動作表現差異性探討 87
壹、靜止球狀態下的動作表現 87
貳、給予視覺時間線索之不同時間線索比較 90
叁、靜止球與滾動球狀態下的表現差異 93
第二節、虛擬介入與安慰劑介入後帕金森病人伸手動作效益差異性探討 96
第七章、結論 98
第一節、總結 98
第二節、臨床應用及學術發展 100
第三節、本研究限制及未來研究建議 101
誌謝 102
參考文獻 103
英文參考文獻 103
中文參考文獻 111
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