結合虛擬實境之身體活動訓練對慢性思覺失調症患者之效益探討

Abstract

研究背景與研究動機：慢性思覺失調症因疾病本身及所需抗精神病藥物之副作用影響，造成患病者多重生、心理機能障礙，包括肢體動作能力下降、認知障礙、動機低落，以致整體身體活動量低、功能性活動參與效能差、肥胖及新陳代謝疾病等問題，進而影響生活品質。因此，如何提升或維持患者健康及生活品質是近年來精神醫療及復健專業人員所關心與重視的。電腦及科技的大幅普及，休閒娛樂的選項中己多出了「虛擬實境」(Virtual Reality, VR)的選擇，此外頭戴式顯示器(HMD)提供虛擬實境遊戲之使用者高度的沉浸感；活動分析結果證實，虛擬實境遊戲具備多重任務的特質；研究者因而合理的假設，參與虛擬境身體活動遊戲，除了因活動量增加所帶來健康改善外，也可能對認知功能有所助益；有限的證據也顯示，虛擬實境不僅能提升病患參與復健治療的動機，也可能有助於提升病患的活動量，但尚未有研究探討使用頭戴式顯示器的虛擬實境遊戲對慢性思覺失調症患者的效益。 研究目的：本研究的目的為探討頭戴式顯示器之虛擬實境遊戲介入，對慢性思覺失調症患者之影響，測量虛擬遊戲介入前及介入後，患者在身體功能與結構、活動與參與、環境、個人因素之改變，並與傳統身體活動訓練做比較；同時也初步瞭解患者對此頭戴式顯示虛擬實境之使用舒適性及接受程度。研究結果可作為未來常規應用頭戴式顯示器之虛擬實境遊戲於思覺失調症患者功能復健可行性之參考。 研究方法：本研究採隨機分組實驗-對照組前-後測研究設計，招募21名慢性思覺失調症患者隨機分為兩組，實驗組使用頭戴式顯示器虛擬實境遊戲提供身體活動訓練，對照組則進行傳統一般的身體活動訓練，介入時間為一週2次、每次40分鐘、持續訓練十二週，並在訓練前及十二週訓練後分別進行上肢動作功能（積木與盒子測驗）、功能性移動能力（計時起立走測驗）、動態平衡能力（功能性伸臂測驗）、認知功能（彩色路徑描繪測驗）、體適能、一般功能性行為能力（COTE）、一般自我效能感（GSES）、生活品質（QoL）、科技接受度等的評估。所得資料，依資料性質與所要回答問題，採用採用獨立及相依樣本t檢定、卡方檢定、或混合設計重複量數二因子變異數分析之統計方法，所有統計方法使用套裝統計軟體SPSS 22 for Mac 進行分析，統計顯著性設在 p< .05。 研究結果：兩組受試者在基本資料及前測功能無顯著差異。分析組別、測驗時間對各評估結果參數的影響，發現上肢慣用手操作速度、動態平衡、一般行為部分達顯著交互作用，且實驗組具測驗時間的單純主效果，實驗組與對照組，在認知功能、體適能、生活品質、工作行為、自我效能，達部分的顯著進步，而且實驗組相較於對照組的進步趨勢更為明顯。 結論：不論是進行頭戴式虛擬實境訓練，或是一般傳統的身體活動訓練，對慢性思覺失調症患者的身、心理功能與功能性行為，都有部份的顯著影響。進行頭戴式虛擬實境訓練，對於患者的慣用手動作功能、動態平衡、一般行為表現，具有較顯著的效果。患者對於此虛擬實境設備的使用上，除了覺得操作需要他人協助之外，在臨場感、娛樂性等都是可以接受的。建議之後的研究可以增加樣本數，或是增加訓練的強度及時間，或是可以選擇更適合的遊戲，以達到訓練目的。

Background: Patients with chronic schizophrenia spectrum disorders (CSSD) are affected by the disease itself and the side effects of long-term use of antipsychotic drugs, resulting in low motivation, low overall activity, and problems such as obesity and metabolic diseases, which in turn affect their quality of life. Therefore, how to assist patients to improve their health and quality of life is a matter of concern and important for mental health and rehabilitation professionals in recent years. Due to the advancement of computer science and technology, the choice of entertainment in virtual environment has become more and more popular. It can be a medium for treatment, is useable and user friendly. In addition, the current virtual reality game technology provides users with a high degree of immersion, and has a strong sense of reality, hoping to further increase users’ motivation and thus increase activity level during gaming, and thereby promoting users’ functional improvement. Purpose: The purpose of this study was to investigate the effects of virtual reality game interventions using head-mounted displays (VRHMD) on the physical& psychological function, activities and participation, environment adaptation and personal function of patients with CSSD. At the same time, the patient's comfort and acceptance of the VRHMD are also measured. Methods: This study was a randomized control trial with pre-post-test. Twenty-one patients with SSD were recruited and randomly assigned into two groups. The patients in experimental group participated in VRHMD training, while the patients in control group participated in traditional physical training. Training regimen in both groups was 2 times a week, 40 minutes at a time and lasts for 12 weeks. Outcome measures included upper limb motor function (Box& Block Test), functional mobility (Timed Up-andGo Test), dynamic balance (Functional Reach Test), cognitive function (Colored Trail-Making Test), physical fitness, quality of life (Qol short form), general functional behavior (COTE), general Self-efficacy (GSES), and technology acceptance. Independent and dependent t-test, Chi-square test, and/or the mixed design repeated measure two-way ANOVA were used when appropriated to answer the research questions. SPSS 22 software package for Mac was used for all statistical analysis. The statistical significance was set at p< .05. Results: There were no significant difference between the two groups in the demographic data and pre-test functions. The results showed significant interaction between group and assessment time on several outcome measure. Subsequent analysis showed significant improvement of upper limb function, dynamic balance the general functional behaviors of patients in the experimental group. All participants showed significant improvement in cognitive function, physical fitness, quality of life, work behavior, and self-efficacy, no matter to which group the participant were assigned. Conclusion: Patients with schizophrenia spectrum disorder improved physical, psychological and functiuonal behavior after either VRHMD or training. Participattion in VRHMD activities tended to improve quality of life and motivation of activity participation more than the traditional activity training. Furthermore, only VRHMD training improved the patient's dominant hand motor function, mobility, and general functional behavior significantly. In general, the use of this virtual reality device is acceptable by the patient in terms of level of immersion and entertainment. However, participants reported needs of assistance during the gaming process. Further studies with larger sample size and higher intensity of training and using alternative games are suggested.