臺灣博碩士論文加值系統

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.

中文摘要
英文摘要
致謝
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

參考文獻

1.Frank C, Pari G, Rossiter JP. Approach to diagnosis of Parkinson disease. Can Fam Physician. 2006;52:862-868.
2.Ashburn A, Fazakarley L, Ballinger C, Pickering R, McLellan LD, Fitton C. A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease. J Neurol Neurosurg Psychiatry. 2007;78(7):678-684.
3.Alves Da Rocha P, McClelland J, Morris ME. Complementary physical therapies for movement disorders in Parkinson's disease: a systematic review. Eur J Phys Rehabil Med 2015;51(6):693-704.
4.Huang CY, Hwang AC, Liu LK, et al. Association of Dynapenia, Sarcopenia, and Cognitive Impairment Among Community-Dwelling Older Taiwanese. Rejuvenation Res. 2016;19(1):71-78.
5.Landi F, Cruz-Jentoft AJ, Liperoti R, et al. Sarcopenia and mortality risk in frail older persons aged 80 years and older: results from ilSIRENTE study. Age Ageing. 2013;42(2):203-209.
6.Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: the evidence. CMAJ. 2006;174(6):801-809.
7.Shih MC, Wang RY, Cheng SJ, Yang YR. Effects of a balance-based exergaming intervention using the Kinect sensor on posture stability in individuals with Parkinson's disease: a single-blinded randomized controlled trial. J Neuroeng Rehabil. 2016;13(1):78.
8.Brey PAE. Virtual Reality and Computer Simulation. The Handbook of Information and Computer Ethics. 2008:361-384.
9.Sveistrup H. Motor rehabilitation using virtual reality. J Neuroeng Rehabil. 2004;1(1):10.
10.Weiss PL, Rand D, Katz N, Kizony R. Video capture virtual reality as a flexible and effective rehabilitation tool. J Neuroeng Rehabil. 2004;1(1):12.
11.張佑瑄、劉雅甄。體感遊戲Wii和Kinect在技術特性與使用效果之比較。中華體育季刊。2015;29(3):237-245。
12.姜義村、陳上迪。數位體感遊戲對於促進高齡族群之健康效益。中華體育季刊。 2012;26(1):41-49。
13.張哲千。遊戲機Wii的運動體驗。大專體育。2008(98):88-93。
14.Galna B, Barry G, Jackson D, Mhiripiri D, Olivier P, Rochester L. Accuracy of the Microsoft Kinect sensor for measuring movement in people with Parkinson's disease. Gait Posture. 2014;39(4):1062-1068.
15.周宛嬋、方進隆。體感遊戲對於坐式生活者健康促進之可能貢獻。中原體育學報。2013(2):1-8。
16.翁漢騰。體感式電玩於醫療復健成效之開發研究。新竹市: 應用藝術研究所, 國立交通大學; 2013。
17.dos Santos Mendes FA, Pompeu JE, Modenesi Lobo A, et al. Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study. Physiotherapy. 2012;98(3):217-223.
18.Holden MK. Virtual environments for motor rehabilitation: review. Cyberpsychol Behav. 2005;8(3):187-211.
19.曾菁英。台灣地區帕金森氏症之流行病學研究。高雄市: 醫學研究所碩士班, 高雄醫學大學; 2007。
20.施旭姿。藉由健保資料庫探討帕金森氏症在台灣地區的流行病學和疾病特性: 中國醫藥大學環境醫學研究所碩士班學位論文, 中國醫藥大學; 2009。
21.Wirdefeldt K, Adami HO, Cole P, Trichopoulos D, Mandel J. Epidemiology and etiology of Parkinson's disease: a review of the evidence. Eur J Epidemiol. 2011;26 Suppl 1:S1-58.
22.Davie CA. A review of Parkinson's disease. Br Med Bull. 2008;86:109-127.
23.Braak H, Ghebremedhin E, Rub U, Bratzke H, Del Tredici K. Stages in the development of Parkinson's disease-related pathology. Cell Tissue Res. 2004;318(1):121-134.
24.Reichmann H. Clinical criteria for the diagnosis of Parkinson's disease. Neurodegener Dis. 2010;7(5):284-290.
25.Parsons TD, Rizzo AA, Rogers S, York P. Virtual reality in paediatric rehabilitation: a review. Dev Neurorehabil. 2009;12(4):224-238.
26.Barry G, Galna B, Rochester L. The role of exergaming in Parkinson's disease rehabilitation: a systematic review of the evidence. J Neuroeng Rehabil. 2014;11:33.
27.Harris DM, Rantalainen T, Muthalib M, Johnson L, Teo WP. Exergaming as a Viable Therapeutic Tool to Improve Static and Dynamic Balance among Older Adults and People with Idiopathic Parkinson's Disease: A Systematic Review and Meta-Analysis. Front Aging Neurosci. 2015;7:167.
28.楊文傑、盧大為、林光華。虛擬實境平衡訓練應用於巴金森症患者：文獻回顧。物理治療。 2015;40(3):121-128。
29.Liao YY, Yang YR, Cheng SJ, Wu YR, Fuh JL, Wang RY. Virtual Reality-Based Training to Improve Obstacle-Crossing Performance and Dynamic Balance in Patients With Parkinson's Disease. Neurorehabil Neural Repair. 2015;29(7):658-667.
30.Panel on Prevention of Falls in Older Persons AGS, British Geriatrics S. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59(1):148-157.
31.Granacher U, Zahner L, Gollhofer A. Strength, power, and postural control in seniors: Considerations for functional adaptations and for fall prevention. Eur J Sport Sci. 2008;8(6):325-340.
32.Chen LK, Liu LK, Woo J, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95-101.
33.Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-156.
34.Booth FW, Roberts CK, Laye MJ. Lack of exercise is a major cause of chronic diseases. Compr Physiol. 2012;2(2):1143-1211.
35.Park EC, Kim SG, Lee CW. The effects of virtual reality game exercise on balance and gait of the elderly. J Phys Ther Sci. 2015;27(4):1157-1159.
36.Bateni H. Changes in balance in older adults based on use of physical therapy vs the Wii Fit gaming system: a preliminary study. Physiotherapy. 2012;98(3):211-216.
37.Kim J, Son J, Ko N, Yoon B. Unsupervised virtual reality-based exercise program improves hip muscle strength and balance control in older adults: a pilot study. Arch Phys Med Rehabil. 2013;94(5):937-943.
38.Nagano Y, Ishida K, Tani T, Kawasaki M, Ikeuchi M. Short and long-term effects of exergaming for the elderly. Springerplus. 2016;5(1):793.
39.Beaulieu-Boire L, Belzile-Lachapelle S, Blanchette A DP, Lamontagne-Montminy L, et al. . Balance Rehabilitation using Xbox Kinect® among an Elderly Population: A Pilot Study. J Nov Physiother 2015;5(2).
40.Qutubuddin AA, Pegg PO, Cifu DX, Brown R, McNamee S, Carne W. Validating the Berg Balance Scale for patients with Parkinson's disease: a key to rehabilitation evaluation. Arch Phys Med Rehabil. 2005;86(4):789-792.
41.Bloem BR, Marinus J, Almeida Q, et al. Measurement instruments to assess posture, gait, and balance in Parkinson's disease: Critique and recommendations. Mov Disord. 2016;31(9):1342-1355.
42.Nocera JR, Stegemoller EL, Malaty IA, et al. Using the Timed Up & Go test in a clinical setting to predict falling in Parkinson's disease. Arch Phys Med Rehabil. 2013;94(7):1300-1305.
43.Powell LE, Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol A Biol Sci Med Sci. 1995;50(28-34).
44.吳英、邱馨儀、王瑞瑤、楊雅如。台灣版的特定活動平衡信心量表應用於中風患者之再測信度。物理治療。 2008;33(4):239-245。
45.Combs SA, Diehl MD, Filip J, Long E. Short-distance walking speed tests in people with Parkinson disease: reliability, responsiveness, and validity. Gait Posture. 2014;39(2):784-788.
46.Harrison JK, McArthur KS, Quinn TJ. Assessment scales in stroke: clinimetric and clinical considerations. Clin Interv Aging. 2013;8:201-211.
47.Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14(5):377-381.
48.Conradsson M, Lundin-Olsson L, Lindelöf N, et al. Berg Balance Scale: Intrarater Test-Retest Reliability Among Older People Dependent in Activities of Daily Living and Living in Residential Care Facilities. Phys Ther. 2007;87(9):1155-1163.
49.van Iersel MB, Munneke M, Esselink RA, Benraad CE, Olde Rikkert MG. Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients. J Clin Epidemiol. 2008;61(2):186-191.
50.Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000;80(9):896-903.
51.Peters DM, Fritz SL, Krotish DE. Assessing the reliability and validity of a shorter walk test compared with the 10-Meter Walk Test for measurements of gait speed in healthy, older adults. J Geriatr Phys Ther. 2013;36(1):24-30.
52.Camarri B, Eastwood PR, Cecins NM, Thompson PJ, Jenkins S. Six minute walk distance in healthy subjects aged 55–75 years. Respir Med. 2006;100(4):658-665.
53.Morie M, Reid KF, Miciek R, et al. Habitual physical activity levels are associated with performance in measures of physical function and mobility in older men. J Am Geriatr Soc. 2010;58(9):1727-1733.
54.Scena S, Steindler R, Ceci M, Zuccaro SM, Carmeli E. Computerized Functional Reach Test to Measure Balance Stability in Elderly Patients With Neurological Disorders. J Clin Med Res. 2016;8(10):715-720.
55.Smith R. Validation and Reliability of the Elderly Mobility Scale. Physiotherapy. 1994;80(11):744-747.
56.Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. Journal of gerontology. 1994;49(2):M85-94.
57.Clarke MN, Ni Mhuircheartaigh DA, Walsh GM, Walsh JM, Meldrum D. Intra-tester and inter-tester reliability of the MicroFET 3 hand-held dynamometer. Physiotherapy Practice and Research. 2011;32(1):13-18.
58.Mentiplay BF, Perraton LG, Bower KJ, et al. Assessment of Lower Limb Muscle Strength and Power Using Hand-Held and Fixed Dynamometry: A Reliability and Validity Study. PLoS One. 2015;10(10):e0140822.
59.張棋興、梁忠詔、劉翊勳、陳家慶。手握式測力器於台灣東部原住民女性老年人肌力之再測信度－以花蓮縣秀林鄉某社區部落為例。物理治療。2014;39(2):74-84。
60.楊書響、王子娟、陳宏儒。手握式測力器對健康受試者下肢肌力之信度研究。物理治療。2009;34(3):194-200。
61.唐翔威、林珮欣、鄭惠信、劉栩含、劉守莊、黃美涓。台灣地區不同健康狀況社區居住老年人下肢膝伸直肌力和三十秒坐站測試之間的關係。物理治療。2008;33(5):287-293。
62.Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69-74.
63.Abizanda P, Navarro JL, Garcia-Tomas MI, Lopez-Jimenez E, Martinez-Sanchez E, Paterna G. Validity and usefulness of hand-held dynamometry for measuring muscle strength in community-dwelling older persons. Archives of gerontology and geriatrics. 2012;54(1):21-27.
64.邱宜君、林宜萱、李庭蓁、胡名霞。使用Jamar握力器評估抓握動態耐力之再測信度。物理治療。2009;34(6):357-363。
65.Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing. 2011;40(4):423-429.
66.Neuls PD, Clark Tl Fau - Van Heuklon NC, Van Heuklon Nc Fau - Proctor JE, et al. Usefulness of the Berg Balance Scale to predict falls in the elderly. J Geriatr Phys Ther. 2011;34(1539-8412).
67.Huang SL, Hsieh CL, Wu RM, Tai CH, Lin CH, Lu WS. Minimal Detectable Change of the Timed “Up & Go” Test and the Dynamic Gait Index in People With Parkinson Disease. Phys Ther. 2011;91(1):114-121.
68.Esculier JF, Vaudrin J Fau - Beriault P, Beriault P Fau - Gagnon K, Gagnon K Fau - Tremblay LE, Tremblay LE. Home-based balance training programme using Wii Fit with balance board for Parkinsons's disease: a pilot study. J Rehabil Med. 2012;44:144-150.
69.Schlenstedt C, Brombacher S, Hartwigsen G, Weisser B, Möller B, Deuschl G. Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease. Physical Therapy. 2016;96(4):494-501.
70.Atterbury EM, Welman KE. Balance training in individuals with Parkinson’s disease: Therapist-supervised vs. home-based exercise programme. Gait & Posture. 2017;55:138-144.
71.King LA, Wilhelm J, Chen Y, et al. Does Group, Individual or Home Exercise Best Improve Mobility for People With Parkinson's Disease? J Neurol Phys Ther. 2015;39(4):204-212.
72.Dal Bello-Haas V, Klassen L, Sheppard MS, Metcalfe A. Psychometric Properties of Activity, Self-Efficacy, and Quality-of-Life Measures in Individuals with Parkinson Disease. Physiother Can. 2011;63(1):47-57.
73.Paker N, Bugdayci D, Goksenoglu G, Demircioglu DT, Kesiktas N, Ince N. Gait speed and related factors in Parkinson's disease. J Phys Ther Sci. 2015;27(12):3675-3679.
74.Ferreira CB, Teixeira PDS, Alves Dos Santos G, et al. Effects of a 12-Week Exercise Training Program on Physical Function in Institutionalized Frail Elderly. J Aging Res. 2018;2018.
75.Auyeung TW, Lee SW, Leung J, Kwok T, Woo J. Age-associated decline of muscle mass, grip strength and gait speed: a 4-year longitudinal study of 3018 community-dwelling older Chinese. Geriatr Gerontol Int. 2014;14 Suppl 1:76-84.
76.Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Muller S, Scharhag J. The intensity and effects of strength training in the elderly. Dtsch Arztebl Int. 2011;108(21):359-364.
77.Zhuang J, Huang L, Wu Y, Zhang Y. The effectiveness of a combined exercise intervention on physical fitness factors related to falls in community-dwelling older adults. Clin Interv Aging. 2014;9:131-140.
78.Lacroix A, Kressig RW, Muehlbauer T, et al. Effects of a Supervised versus an Unsupervised Combined Balance and Strength Training Program on Balance and Muscle Power in Healthy Older Adults: A Randomized Controlled Trial. Gerontology. 2016;62(3):275-288.
79.Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. N S W Public Health Bull. 2011;22(3-4):78-83.
80.Joshua AM, D'Souza V, Unnikrishnan B, et al. Effectiveness of progressive resistance strength training versus traditional balance exercise in improving balance among the elderly - a randomised controlled trial. J Clin Diagn Res. 2014;8(3):98-102.