本論文旨在探究上肢復健者的使用需求，以發展出一套符合治療需求之上肢復健產品。研究內容包含三部分：現有臨床上肢復健產品的使用現況與需求調查、市售數位遊戲產品應用於上肢復健的治療成效及使用性評估，及數位的上肢復健產品設計。第一部分，以問卷調查全國職能治療師，關於臨床上肢復健產品的使用問題及需求，並歸納改善設計需求方針。第二部分，以前後測隨機控制臨床試驗，調查市售數位遊戲產品應用在上肢復健治療的療效、使用問題及需求，提出數位遊戲產品的改善設計需求方針。第三部分，依前二部分研究結果，設計一套符合治療需求的數位上肢復健產品，並以問卷調查中風個案使用此數位上肢復健產品的可行性。

本研究歸納出下列八項成果。第一部分結果：(1) 大部分的臨床上肢復健產品的主要使用問題點為產品基座不穩及使用時感到乏味，(2) 職能治療師指出，三個主要的改善設計需求為產品各功能可調整、操作元件可更換及記錄動作數據，(3) 新發展的上肢復健產品類型包含有靈巧度訓練產品、日常生活活動訓練產品、感覺再教育產品、上肢外旋與內旋訓練產品及手腕伸展訓練產品。第二部分結果：(4) Wii 組比較傳統組的效果量，結果發現在FMA量表具有高度的效果量。(5) 在主觀滿意度評估方面，發現參與Wii組及XaviX組的患者比傳統組的患者有較佳的娛樂性，但在治療動機則未達顯著差異。(6) 綜合專業職能治療師及中風患者的意見，改善設計建議如下：軟體方面，增加遊戲難易度的分級、增加遊戲反應時間的範圍、擴大感應器可感應的區域、記錄動作表現和分數。硬體方面，加強控制器與手的固定方式、控制器為可調式適合不同手部尺寸的患者使用、遊戲內容與控制器符合實際生活上的任務、設計身體控制訓練的控制器、簡易化控制器的操作方式、可調整控制器的重量。第三部分結果：(7) 本研究所提案的數位上肢復健產品設計，Reh-Hand Touching，以觸控螢幕呈現治療任務的各關卡，配合日常生活用的物品為操作物件。硬體設計特點：提供不同形狀及大小的操作物件，讓不同上肢恢復程度的患者易於握持、操作物件可調整重量。軟體設計特點：包含一般模式及計時模式、每個關卡會呈現使用者的成功與否的音效，操作次數及總時間等資訊給使用者、可調整單一動作反應時間及感應區域大小。(8) 多數中風患者對本套產品表示有高度的滿意度。

The purpose of this dissertation was to survey the usage needs for upper extremity rehabilitation products (UERP), and to design a UERP to meet the treatment needs. It includes three parts: I) to investigate the usage status, usage problems and needs of existing clinical UERP; II) to evaluate the therapeutic effectiveness and usability of the commercial videogames applied in rehabilitation; and III) to design a digital upper extremity rehabilitation product. In Part I, a questionnaire was used to survey the usage problems and needs of UERP, and a guideline for improvement design of such products was summarized. In Part II, a randomized controlled trial was used to survey the therapeutic effectiveness, usage problems and needs of the commercial digital videogames applied in rehabilitation, then a guideline for improvement design of such products was summarized. In Part III, according to the results of the two previous parts, a design proposal for a digital UERP with treatment needs was proposed, and its feasibility was evaluated with a questionnaire.

Eight main results can be concluded from this study: (1) Most of the UERP had two major problems: the base of existing clinical UERP was unstable, and the products were boring to use. (2) The therapists reported three major needs for design improvement - adjustability of functions, exchangeability of components, and recording of movement data. (3) Some therapists suggested for designing new types of UERP, such as products for manual dexterity training, ADL training, sensory re-education, arm supination and pronation training, and wrist extension training. (4) The effect size of the Wii group versus the conventional group on the Fugl-Meyer Assessment of motor function was larger than that of the XaviX group versus the conventional group. (5) The enjoyment of patients was significantly greater in the video game groups than in the conventional group, but the motivation was not significantly different across groups. (6) Suggestions of therapists and patients for improvement design in game devices were summarized, where software interface of such products needs to: a) increase difficulty and the response time levels of the games, b) record movement data and game scores each time; and the hardware design needs to: d) improve the means to fix the controller on the user’s hand, e) make the controller adjustable to fit different hand dimensions of the patients, f) design the game and controller movements corresponding with the real-life activities, g) simplify the controller''s operation. (7) Finally, a design proposal for a digital UERP with treatment needs in mind was proposed, named as Reh-Hand Touching. The Reh-Hand Touching has a touch screen to display the game contents and it incorporates objects from daily live in its operation. The hardware design features includes: a) the shapes and sizes of the operation objects can be chosen by the users to fit their own hand dimensions, b) weight of the object can also be adjusted accordingly. The software design features are: c) it displays visual and verbal cues, game scores, and operation times to the patients in each stage, notifying whether or not their action succeeded, d) it allows adjustments of the reaction time to movements and the scope of sensing area of the objects. (8) Most patients, after a trial with this product, reported high satisfaction with it for rehabilitation.

中文摘要 ------------------------------------------------------------------- i

Abstract ----------------------------------------------------------------- ii

誌謝 ---------------------------------------------------------------------- iii

目錄 ---------------------------------------------------------------------- iv

表目錄 -------------------------------------------------------------------- viii

圖目錄 -------------------------------------------------------------------- x



第一章 緒論 ---------------------------------------------------------------- 1

1.1 研究背景與動機 ---------------------------------------------------------- 1

1.1.1上肢復健產品的使用現況初期研究 -------------------------------------------- 2

1.2 研究目的 --------------------------------------------------------------- 8

1.3 研究範圍與限制 ---------------------------------------------------------- 9

1.3.1 研究領域 ------------------------------------------------------------- 9

1.3.2 研究範圍 ------------------------------------------------------------- 9

1.3.3 研究限制 ------------------------------------------------------------- 9

1.4 研究架構與流程 ---------------------------------------------------------- 11

1.4.1 研究架構 ------------------------------------------------------------- 11

1.4.2 研究流程 ------------------------------------------------------------- 12

1.4.3 論文架構 ------------------------------------------------------------- 14



第二章 文獻探討 ------------------------------------------------------------- 15

2.1中風患者的病症特徵 -------------------------------------------------------- 15

2.1.1 中風患者的病症 -------------------------------------------------------- 15

2.1.2 中風個案的上肢復健恢復期 ------------------------------------------------ 16

2.2 臨床上肢復健產品的治療成效之相關研究 ---------------------------------------- 17

2.2.1 上肢復健的治療成效評估工具 ---------------------------------------------- 17

2.2.2 臨床治療原理應用之相關研究 ---------------------------------------------- 18

2.2.3 臨床復健產品與治療成效之相關研究 ----------------------------------------- 18



2.3 市售的數位遊戲產品應用在上肢復健治療之相關研究 -------------------------------- 20

2.3.1 應用Wii於復健治療的相關研究 --------------------------------------------- 20

2.3.2 應用Sony Play Station於復健治療的相關研究 ------------------------------- 20

2.3.3 應用Kinect於復健治療的相關研究 ------------------------------------------ 21

2.3.4 自行開發之虛擬遊戲應用復健治療的相關研究 ----------------------------------- 21

2.3.5 市售的數位遊戲產品類型 -------------------------------------------------- 22

2.3.6 Wii、Kinect、XaviX 遊戲設計的差異 -------------------------------------- 26

2.4 復健產品設計與使用性評估 -------------------------------------------------- 26

2.4.1 科技接受模型 ---------------------------------------------------------- 26

2.4.2 科技接受模式評估數位遊戲系統之相關研究 ------------------------------------- 27

2.4.3 以使用者為中心之輔具設計相關研究 ------------------------------------------ 27

2.5 小結 ------------------------------------------------------------------- 28



第三章 臨床上肢復健產品的使用需求調查 -------------------------------------------- 29

3.1 研究目的 ---------------------------------------------------------------- 29

3.2 研究方法 ---------------------------------------------------------------- 29

3.2.1 問卷調查對象 ----------------------------------------------------------- 29

3.2.2 調查問卷內容 ----------------------------------------------------------- 29

3.2.3 調查過程 -------------------------------------------------------------- 30

3.2.4 數據分析 -------------------------------------------------------------- 31

3.3 研究結果與討論 ----------------------------------------------------------- 32

3.4 臨床上肢復健產品的改善設計要點 ---------------------------------------------- 35

3.5 小結 ------------------------------------------------------------------- 36



第四章 市售數位遊戲應用於上肢復健的使用需求調查 ------------------------------------ 37

4.1 研究目的 ---------------------------------------------------------------- 37

4.2 第一階段：市售數位遊戲產品應用在上肢復健的現況調查 ------------------------------ 38

4.2.1 研究方法 -------------------------------------------------------------- 38

4.2.2 研究地點 -------------------------------------------------------------- 38

4.2.3 研究對象 -------------------------------------------------------------- 38

4.2.4 調查內容 -------------------------------------------------------------- 39

4.2.5 資料分析 -------------------------------------------------------------- 39

4.2.6 現況調查結果 ----------------------------------------------------------- 39

4.3 市售數位遊戲產品在上肢復健的治療成效及使用性評估 -------------------------------- 41

4.3.1 研究目的 -------------------------------------------------------------- 41

4.3.2 研究方法 -------------------------------------------------------------- 41

4.3.3 研究地點 -------------------------------------------------------------- 41

4.3.4 研究對象 -------------------------------------------------------------- 41

4.3.5 實驗過程 -------------------------------------------------------------- 42

4.3.6 介入的治療活動 --------------------------------------------------------- 42

4.3.7 上肢動作功能評估量表 ---------------------------------------------------- 44

4.3.8 使用性及主觀滿意度調查 -------------------------------------------------- 44

4.3.9 資料分析 -------------------------------------------------------------- 45

4.4 研究結果與討論 ----------------------------------------------------------- 46

4.4.1 治療成效評估結果 ------------------------------------------------------- 46

4.4.2 使用性及主觀滿意度調查結果 ----------------------------------------------- 49

4.4.3 實地觀察發現的使用問題 -------------------------------------------------- 50

4.5 符合治療需求的數位遊戲改善設計要點 ------------------------------------------ 51

4.6 小結 ------------------------------------------------------------------- 51



第五章 數位上肢復健遊戲產品設計 ------------------------------------------------- 52

5.1 研究目的 ---------------------------------------------------------------- 52

5.2 研究方法 ---------------------------------------------------------------- 52

5.3 第一階段：數位上肢復健產品設計 ---------------------------------------------- 53

5.3.1 確立設計方向 ----------------------------------------------------------- 53

5.3.2 設計要點 -------------------------------------------------------------- 54

5.3.3設計概念–Reh-hand touching --------------------------------------------- 55

5.4 第二階段：數位上肢復健產品設計之可行性評估 ------------------------------------ 60

5.4.1 研究目的 -------------------------------------------------------------- 60

5.4.2 研究方法 -------------------------------------------------------------- 60

5.4.3 研究對象 -------------------------------------------------------------- 60

5.4.4 研究過程 -------------------------------------------------------------- 61

5.4.5 調查內容 -------------------------------------------------------------- 61

5.4.6 數據分析 -------------------------------------------------------------- 61

5.5 研究結果與討論 ----------------------------------------------------------- 62

5.6 小結 ------------------------------------------------------------------- 65



第六章 討論與結論 ------------------------------------------------------------ 66

6.1 討論 ------------------------------------------------------------------- 66

6.2 結論 ------------------------------------------------------------------- 73

6.3 建議 ------------------------------------------------------------------- 75

6.4 未來研究方向 ------------------------------------------------------------- 76



參考文獻 -------------------------------------------------------------------- 77



附錄 ----------------------------------------------------------------------- 84

附錄1 上肢復健產品現況調查10個產品的使用問題 ---------------------------------- 85

附錄2 上肢復健產品的使用需求調查問卷內容 -------------------------------------- 86

附錄3 中山醫學大學之人體試驗委員會核發之臨床實驗計畫許可書 ------------------------ 91

附錄4 The Fugl-Meyer Assessment of motor function ----------------------- 92

附錄5 Box and Block Test of Manual Dexterity ---------------------------- 99

附錄6 FIM self-care score ----------------------------------------------- 100

附錄7 Upper extremity range-of-motion ----------------------------------- 101

附錄8 Wii 組與XaviX 組患者使用遙控器的姿勢 ----------------------------------- 102

附錄9 本研究TAM調查問卷的各問項內容 ------------------------------------------ 103

附錄10 本研究TAM調查問卷 ---------------------------------------------------- 104

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