臺灣博碩士論文加值系統

本研究採單一個案研究的撤回設計，以量化分析（圖示法、目視分析、簡化時間系列C統計和迴歸效果量）及質性分析方式，探討提供選擇的活動分析，對增進一位在家教育的國中極重度多重障礙（智能障礙合併肢體障礙）學生刷牙意願（刷牙意願強度與分段刷牙反應時距）之成效。
本研究歷經基線期、介入期和追蹤期三個階段，基線期時不提供任何選擇，介入期加入「提供選擇的活動分析」介入方案，介入期間隔一週後進入追蹤期，並褪除介入方案，本研究結果如下：
1.提供選擇的活動分析對增加極重度多重障礙學生刷牙意願之強度具有立即成效與維持成效。
2.提供選擇的活動分析對極重度多重障礙學生分段刷牙之反應時距具有立即成效與維持成效。
3.重要他人對提供選擇的活動分析介入之成效有正面評價。
縱使極重度多重障礙者生理限制多，但其實他們是有能力作選擇，家長與教師應盡量的找出其優勢能力，不斷的提供機會作選擇以提升自主能力。

The purpose of the study was to investigate the effects of the activity analysis of providing choice on promoting tooth-brushing motivation for a student with profoundly multiple disabilities. Understanding the effects of intensity of tooth-brushing motivation and interresponse time of each tooth-brushing section. The withdrawal design of single-case research design was adopted. The participant was a junior-high-school student with intellectual disabilities and physical disabilities placed at homebound educational setting. The analytic methods of the programs included quantitative analysis (graphical method, visual analysis, simplified time series C statistic, and regression effect size) as well as qualitative analysis which aimed to understand the effects of this program from this participant’s significant others.
The research contained baseline, intervention and follow-up phases. In the baseline phase, the participant wasn’t given any choices. In the intervention phase, the participant was given choices in the activity of tooth-brushing. A week after withdrawing intervention, the participant accepted post-test assessment on tooth-brushing motivation. The major findings were summarized as follows:
1. The activity analysis of providing choice had immediate and maintenance effects on increasing the intensity of tooth-brushing motivation for a student with profoundly multiple disabilities.
2. The activity analysis of providing choice had immediate and maintenance effects on reducing the interresponse time of the each tooth-brushing section for a student with profoundly multiple disabilities.
3. The participant’s grandmother and home care worker showed that they confirmed
the effects of this program.
Even though persons with profoundly multiple disabilities have physical limitations, they still have ability to choose. Parents and teacher should find their strengths , and providing choices to increase the ability of autonomy.

目 錄
表 次 iii
圖 次 iv
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與問題 5
第三節 名詞解釋 5
第二章 文獻探討 9
第一節 極重度障礙者口腔清潔方式及其重要性 9
第二節 活動分析的意涵 19
第三節 作選擇對重度障礙與極重度障礙者的意涵及其相關研究 32
第三章 研究設計與實施 43
第一節 研究方法 43
第二節 研究參與人員 50
第三節 介入方案 55
第四節 研究工具 62
第五節 研究過程 65
第六節 資料分析 68
第四章 結果與討論 71
第一節 提供選擇的活動分析對增加國中極重度多重障礙 71
學生刷牙意願強度成效之分析 71
第二節 提供選擇的活動分析對減少國中極重度多重障礙學生分段刷牙反應時距成效之分析 75
第三節 重要他人對提供選擇的活動分析成效的觀感 79
第四節 提供選擇的活動分析對提升國中極重度多重障礙學生刷牙意願成效之綜合討論 81
第五章 結論與建議 87
第一節 研究結論 87
第二節 研究建議 88
參考文獻 93
附錄 105
附錄一 刷牙意願強度等級紀錄表 105
附錄二 分段刷牙反應時距紀錄表 107
附錄三 提供選擇之刷牙活動分析結果訪談題綱 109
附錄四 刷牙活動分析選擇設計表 110
附錄五 家長同意書 111
附錄六 刷牙意願活動分析介入完整性評量表 112
附錄七 專家修改意見一覽表 113
附錄八 小安刷牙觀察記錄 114
附錄九 介入前刷牙現況訪談題綱 115
附錄十 提供選擇之刷牙活動分析介入方案 116
附錄十一 單一個案研究後設分析之研究品質評鑑表 118


表 次
表2-1 活動成分的分析 26
表2-2 刷牙活動成分之分析 28
表2-3 傑森科學課的「功能─生態取向」評量 30
表2-4 作選擇在不同階段應具備之能力 34
表2-5 2003至2012年重度與極重度障礙者作選擇相關文獻 39
表3-1 可能威脅研究內在效度的來源與因應方法 48
表3-2 可能威脅研究生態效度的來源與因應方法 50
表3-3 小安基本資料 51
表3-4 小安的「功能─生態取向」評量分析 59
表3-5 小安刷牙活動成分之分析 60
表3-6 增進刷牙意願強度之行為等級界定表 63
表4-1 小安刷牙意願強度之目視分析 74
表4-2 小安分段刷牙反應時距之目視分析 77



圖 次
圖2-1 口腔按摩去敏感法 13
圖2-2 貝氏刷牙法步驟 17
圖2-3 生態評量實施步驟 21
圖2-4 教導作選擇技能以處理行為問題的步驟 37
圖3-1 研究設計圖 44
圖3-2 本研究架構圖 45
圖3-3 居家環境空間示意圖 53
圖3-4 研究流程圖 67
圖4-1 提供選擇的活動分析對國中極重度障礙學生之刷牙意願強度成效 73
圖4-2 提供選擇的活動分析對國中極重度障礙學生之分段刷牙反應時距成效 77

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