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研究生(外文):LIN, JIA-YI
論文名稱(外文):Effects of exergaming-based exercise training program in patients with Parkinson’s disease and the institutional elderly
指導教授(外文):WU, YU-ZU
外文關鍵詞:Parkinson's diseaseThe elderlyLong term careExergamingPhysical therapy
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以電玩運動遊戲作為復健輔助使用的一種工具,引起人們的興趣。這種高科技方法使我們生活方式更加豐富,以及可能有助於促進身體活動的治療用途,包括平衡,活動性和肌肉力量。本研究分為兩個單元,第一單元為探討四位巴金森氏症患者在居家透過電玩運動遊戲訓練後,以了解其對於身體功能之影響,同時探討患者使用電玩運動遊戲進行訓練是否安全與可行。以單組時間序列(One-group time series design)為設計研究,共為期三個月運動計畫介入。以中位數(四分位距)呈現量測結果。結果顯示身體功能表現在前、後測差異值皆無達最小可偵測變化值。患者對於電玩運動遊戲介入的使用接受度相當高,且無任何不良事件發生。總結來說,巴金森氏病患以電玩運動遊戲為基礎的居家訓練,是可行性與安全,但在功能性活動表現上仍需取得更大樣本數的資訊及臨床實證。第二單元為探討單一機構長者進行結合互動式體感運動遊戲與全身性團體體能活動的混合式運動介入(hybrid intervention)對身體功能的影響,同時探討長者使用混合式運動介入訓練是否安全與可行。本研究依機構長者的意願來參與及分組,40位符合收案標準的長者中,有17位長者有意願參與本研究,依長者意願分成8位參加為期三個月、每週2次,每次90分鐘之中等強度的混合式運動介入的實驗組,及9位僅接受身體功能評估的控制組。控制組與拒絕參與本研究的長者需說明不參與本次運動介入的理由。身體功能評估內容包括:肌力、行走速度、計時起身行走測試、五次坐站、六分鐘行走測試等身體功能表現。三個月後,實驗組有1人因病退出研究,控制組有3人因拒絕後測退出研究。結果顯示,在手握力及計時起身行走測試上,實驗組有統計顯著的改善(P<0.05)。其中,手握力超過肌少症診斷切點者,實驗組有4位,控制組僅有1位。走路速度改善超過最小臨床重要差異者,實驗組有4位,控制組僅有1位。此外,機構長者對於混合式運動介入的使用接受度相當高,且無任何不良事件發生。總結來說,結合互動式體感運動遊戲與全身性團體體能活動的混合式運動介入對機構長者是可行與安全,並且可以延緩或預防老年人失能。不過,本研究也發現約有三成(13位)的機構長者屬於缺乏規律運動的坐式生活型態。機構長者不參與運動的主要理由有懶得運動、沒有興趣及運動太麻煩等。對於沒有規律參與運動的長者,要如何改變其坐式生活型態,是未來必須面臨的問題。
The use of exergaming as a rehabilitation tool is gaining interest. This high-tech approach promotes an active lifestyle and may be useful for promoting physical activity for therapeutic uses, including for balance, mobility, and muscle strength. The current study included two parts. The first explored the safety and feasibility of Parkinson's patients at home through playing exergames. The effects on physical function were compared. One-group time series design was adopted, and a total of three months of exercise was applied. The median (interquartile range) was used to present the measurement results. The results showed that there was no minimum detectable change after the exergaming intervention. The patient's intervention in the exergaming was all positive and there were no adverse events. In conclusion Parkinson's patient training with exergaming is feasible and safe in home. However, the effects of exergaming on functional activities still need to collect information and clinical evidence with larger sample size. The second part of this study was to compare the impact of physical functions for the elderly in a long term care (LTC) facility combining exergaming and group exercise (hybrid intervention), and to explore whether the hybrid intervention was safe and feasible. The elderly were assigned based on their preferences. Of the 40 eligible elderly, 17 were willing to participate in this study, eight of whom engaged in the experiment group. The experimental group offered a moderate level hybrid intervention for 90 minutes, twice a week for 12 weeks. Nine of the eligible elderly were willing to engage in the control groups that received assessment only. Those who declined to participate in this study and those who were interested in participating but unwilling to engage in the hybrid intervention were asked to give their reasons for non-participation by spontaneous answers. Outcomes were assessed by muscle strength, walking speed and endurance, timed up and go test (TUG), five time sit-to-stand test, Berg Balance Scale, and questionnaire. After 12-week hybrid intervention, of all the participants, four dropped in the posttest; three of whom were in the control group. The handgrip strength and TUG score were significantly improved in the experiment group (P<0.05). The increased number of the participants that handgrip strength exceeded the cutoff value for sarcopenia as well as the improved scores that exceeded the minimal detectable change of the TUG and the minimum clinically significant difference of walking speed were greater in the experiment group than in the control group. No significant adverse events were reported, and all participants experienced flow state during the hybrid intervention. Furthermore, 32.5% of the residents were physical inactivity due to laziness (77%), lack of interest (69%) and troublesome (46%). These problems should be anticipated in further studies, thereby effectively increasing the physical activity levels among the elderly living in LTC facilities.
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第二章 文獻回顧 4
第一節 虛擬實境系統應用 4
第二節 巴金森氏疾病與症狀 10
第三節 虛擬實境在巴金森氏症患者應用 11
第四節 高齡者相關的身體功能變化 14
第五節 虛擬實境在高齡者應用 14
第六節 總結與實驗問題 17
第三章 研究架構與設計 18
第一節 巴金森氏症患者居家使用電玩遊戲的方法 18
第二節 機構長者運動介入的方法 23
第四章 結果 32
第一節 巴金森氏症患者居家使用電玩運動遊戲的影響 32
第二節 混合式運動介入對機構長者的影響 33
第五章 討論 37
第一節 巴金森氏症患者居家使用電玩運動遊戲的影響 37
第二節 混合式運動介入對機構長者的影響 40
第六章 結論 44
圖表 45
參考文獻 59


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