臺灣博碩士論文加值系統

背景：老化會減低執行功能（executive function），進而導致雙重任務表現漸差，並影響老年人參與日常生活的雙重任務情境。常見老人之執行功能測驗為路徑描繪測驗及史楚普叫色測驗，但此兩種測驗尚未建立中文版本之施測再測信度。先前研究發現，複合式運動介入能提升高齡族群的運動表現，但並無研究探討結合體感遊戲之雙重任務訓練對於提升高齡族群執行功能以及雙重任務表現的效果。
目的：建立中文版路徑描繪測驗及史楚普叫色測驗之施測再測信度，並探討結合體感遊戲之雙重任務的介入模式對高齡族群在執行功能與雙重任務表現的效果。
方法：實驗一納入20名年齡65歲以上之健康高齡者，於不同天接受中文版路徑描繪測驗及史楚普叫色測驗各一次，以驗證中文版路徑描繪測驗以及史楚普叫色測驗對於65歲以上高齡族群之施測再測信度。實驗二納入20名年齡65歲以上居住於社區的高齡者，這些高齡者須符合無神經性疾病、心臟疾病、骨折或是過去六個月內曾經接受過運動訓練，受試者隨機分成兩組，一組為實驗組，一組為對照組。實驗組施予結合體感遊戲之雙重任務訓練12週，每週三次，每次60分鐘，對照組則施予居家複合式運動訓練12週，每週三次，每次60分鐘。受試者於介入前後皆會進行中文版執行功能面談、中文版路徑描繪測驗、中文版史楚普叫色測驗、雙重任務表現以及社區行走測試，以評估介入前後的差異。本研究使用無母數的統計方法針對所有的評估結果進行分析。
結果：實驗一中文版路徑描繪測驗A部分施測再測信度為0.82；中文版路徑描繪測驗B部分施測再測信度為0.95；中文版史楚普叫色測驗一致性色字部分及非一致性色字部分施測再測信度皆為0.92。實驗二結合體感遊戲之雙重任務訓練組經過12週訓練之後，中文版執行功能面談、中文版路徑描繪測驗A及B、史楚普叫色測驗一致性及非一致性、動作型和認知型雙重任務表現以及社區行走測試於訓練後顯著進步；對照組進行居家複合式運動訓練後只有中文版執行功能面談於訓練後達到顯著差異。經過12週介入之後，實驗組與對照組之間，中文版執行功能面談、中文版路徑描繪測驗A部分、史楚普叫色測驗一致性色字部分、動作型和認知型雙重任務以及社區行走測試皆達到顯著差異。
結論：本研究結果顯示中文版路徑描繪測驗及史楚普叫色測驗應用於台灣健康高齡族群有良好的施測再測信度。對於居住於社區的健康老年人而言，12週結合體感遊戲之雙重任務訓練相較於居家式複合式運動更能夠顯著的增進執行功能、雙重任務表現及社區行走表現。

Background: Aging progressively decreases executive function, which results in a reduction of dual-task performance and affects the ability of older adults to engage in everyday dual-task scenarios. Trail making test and Stroop color and word test are well-known tools to measure executive function in older adults. However, test-retest reliability of Chinese version of these two tools are not yet been established. Previous studies reported that multicomponent exercise program improved physical performance in elderly. However, few literatures presented that dual-task training with exergame enhances executive function and dual-task performance, which are more close to activities of daily living in older adults.
Purpose: The aims of this study are to establish test-retest reliability of Chinese version of Trail making test and Stroop color and word test and to investigate the effects of dual-task training with exergame on executive function and dual-task performance in community-dwelling older adults.
Methods: There were two experiments in this study. Experiment 1 recruited 20 older adults. They received two times measurement of Chinese version of trail making test and Stroop color and word test. Experiment 2 recruited 20 community-dwelling people older than 65 years without neurological disorder, heart disease, bone fracture or receiving exercise training in 6 months. They were allocated randomly into either the experimental group accepting dual-task training with exergame three times a week for 12 weeks or comparison group accepting multicomponent exercise home program three times a week for 12 weeks. Participants receive assessment of executive function (The Executive Interview EXIT-25, Trail making test and Stroop color and word test), Timed Up and Go with dual-task (motor and cognitive tasks), community walking test before and after the intervention. Non-parametric statistics were used to analyze all dependent variables.

Results: The test-retest reliability of Chinese version of Trail making test A and B was 0.82 and 0.95, respectively. The test-retest reliability of Chinese version of Stroop color and word test in both congruent and incongruent was 0.92.The results in experiment 2 showed that EXIT-25, Chinese version of Trail making test (A and B), Stroop color and word test (congruent and incongruent), dual task performance (motor and cognitive tasks) and community walking test were improved significantly after 12-week exergame based dual-task training. However, in the comparison group, only EXIT-25 improved after 12-week multicomponent exercise. After the 12-week intervention, significant between group differences were observed in EXIT-25, Trail making test A, Stroop color and word test (congruent), dual task performance (motor and cognitive), and community walking test.
Conclusion: Chinese version of Trail making and Stroop color and word test have excellent test-retest reliability in Taiwanese older adults. The 12-week exergame-based dual task training is better than home-based multicomponent exercise in improvement of executive function and dual task performance for community dwelling older adults.

目錄
致謝 i
中文摘要 ii
英文摘要 iv
目錄 vi
圖目錄 ix
表目錄 x
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
第三節、研究假設 2
第四節、研究的重要性 3
第二章、文獻回顧 4
第一節、執行功能 4
第二節、雙重任務 5
第三節、高齡族群之執行功能與雙重任務表現 6
第四節、提升高齡族群執行功能及雙重任務表現之介入 7
第五節、結論 8
第三章、研究方法 10
第一節、實驗一 10
一、研究設計 10
二、受試者 10
三、實驗流程 10
四、評估項目 10
1.中文版路徑描繪測驗 10
2.中文版史楚普叫色測驗 11
五、統計分析 11
第二節、實驗二 12
一、研究設計 12
二、受試者 12
三、研究流程 13
四、訓練模式 13
1.結合體感遊戲之雙重任務訓練 13
2.居家複合式運動 14
五、評估項目 16
1.中文版執行功能面談 16
2.中文版路徑描繪測驗 16
3.中文版史楚普叫色測驗 16
4.雙重任務表現 16
5.社區行走測試 17
六、統計分析 17
第四章、結果 18
第一節、實驗一 18
一、受試者基本資料 18
二、中文版路徑描繪測驗及史楚普叫色測驗之測驗結果及施測再測信度18
第二節、實驗二 18
一、受試者基本資料與前測值 18
二、執行功能 19
三、雙重任務表現 20
四、社區行走表現 20
第五章、討論 22
第一節、受試者基本資料與前測值 22
第二節、中文版路徑描繪測驗及史楚普叫色測驗之施測再測信度 22
第三節、結合體感遊戲之雙重任務訓練對於高齡族群執行功能的影響23
第四節、結合體感遊戲之雙重任務訓練對於高齡族群雙重任務表現的影響 24
第五節、結合體感遊戲之雙重任務訓練對於高齡族群社區行走能力的影響 25
第六節、居家複合式運動對於高齡族群的影響 25
第七節、研究限制與未來建議 26
第六章、結論 27
參考文獻 28
附錄 47
附錄一、實驗一之同意人體研究證明書 47
附錄二、實驗一之受試者同意書 48
附錄三、中文版路徑描繪測驗 52
附錄四、中文版史楚普叫色測驗 57
附錄五、實驗二之同意人體研究證明書 59
附錄六、實驗二之受試者同意書 60
附錄七、運動訓練實施記錄表 64
附錄八、中文版執行功能面談 65

圖目錄
圖一、結合體感遊戲之雙重任務訓練建立架構示意圖 35
圖二、動作型體感遊戲介面與遊戲簡介 36
圖三、認知型體感遊戲介面與遊戲簡介 37
圖四、實驗一之受試者與實驗流程圖 38
圖五、實驗二之受試者與實驗流程圖 39

表目錄
表一、實驗一之受試者基本資料 40
表二、中文版路徑描繪測驗及史楚普叫色測驗之施測再測信度 41
表三、實驗二之受試者基本資料組間比較 42
表四、實驗二之受試者各項評估前測之組間比較 43
表五、結合體感遊戲之雙重任務訓練組前後測之組內比較 44
表六、居家複合式運動組前後測之組內比較 45
表七、實驗二之受試者各項評估後測之組間比較 46

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