遊戲式學習融入輔助溝通教學方案對腦性麻痺學童溝通行為之成效

Abstract

溝通是人類與生俱來的本能，也是人類得以在日新月異的社會中生存的關鍵。腦性麻痺學童礙於肢體與構音上的限制，導致他們的溝通行為常常無法被旁人適當地理解，倘若伴隨著其他的障礙限制，無疑將導致他們的溝通表達雪上加霜。本研究的實驗設計為「單一受試研究法之多探試跨受試實驗設計」，實驗自變項為「遊戲式學習融入輔助溝通教學方案」，依變項共為五項，分別是「總溝通行為」、「表達需求/想要」、「發展社會互動親密性」、「交換訊息」，以及「實踐社交禮節」。本研究針對臺灣北部某特殊教育學校國小部三位平均年齡為八歲之腦性麻痺學童的溝通現況，以跨專業團隊合作的方式，結合物理治療師、語言治療師，以及研究對象家長共同評估進而擬定個別化的輔助溝通系統，觀察經由實驗教學介入之後，三位研究對象在依變項的學習情形。研究過程中，研究者亦與上述團隊人員進行資料的交互檢核。

研究結果顯示三位研究對象經由「遊戲式學習融入輔助溝通教學方案」介入以後，他們的總溝通行為正確反應比例皆出現明顯的立即效果，並且維持期的表現亦顯現良好的維持成效。同時，他們在「表達需求/想要」、「發展社會互動親密性」、「交換訊息」，以及「實踐社交禮節」四個溝通向度的溝通行為正確反應比例也都出現明顯的立即效果，維持期的成效亦良好。此外，本研究亦針對三位研究對象於實驗過程中溝通圖卡的選擇方向偏好（左邊、右邊）以及提示策略給予的層次進行分析，提示策略層次依序為直接口語提示、手勢示範提示、部分肢體提示、完全肢體提示。結果顯示研究參與者小森與小安經由實驗教學介入之後，他們能夠選擇不同方向的溝通圖卡，並且所需的提示層次由原先集中在第一層的直接口語提示提升至不需要提示。然而，小晴經由實驗教學介入之後，研究者發現她對於溝通圖卡的選擇方向偏好與個人意願有關，其所需的提示層次仍以第一層的直接口語提示為主。本研究亦針對三位研究對象的重要他人進行社會效度的建立，整體來說三位研究對象的介入結果皆具有良好的社會效度。最後，本研究亦根據研究結果進一步提出相關的建議，包含教學以及研究兩方面。

Communication is the basic ability and need for every human beings, and it makes us survive as society rapidly change. Children with cerebral palsy have disabilities on movements, changing their body positions, and articulation, resulting in the difficulty that other people trying to know their communication behaviors. If children with cerebral palsy accompany other disabilities ( e.g. mental retardation), they may have more difficulties and problems when they try to perform communication behaviors.The experimental design of this study is single-case research design of multiple probe design across participants, and this study try to observe the increase of the percentage of overall communication behaviors and increase in four communication dimensions after the intervention. The independent variable is a game-based augmentative and alternative communication systems intervention, and the dependent variable is the correct reaction percentage of communication behaviors, including overall communication behaviors and the ability to express needs and wants, exchanging information, developing social closeness, and participating as required in social etiquette routines. This study aims to conduct assessments and make individualized AAC plans with transdisciplinary team for three participants average aged eight, studying in the department of elementary school of a special education school in northern Taiwan. The team members contain physical therapist, occupational therapist, speech therapist, and parents. The researcher also check the data with other members.The results show that there are obvious effects of overall communication behaviors in the phase of intervention and maintenance, and the three participants perform greatly increasing correct reactions. There are also obvious effects in the phase of intervention and maintenance in four dimensions, and the three participants also perform greatly increasing correct reactions. Additionally, this study analyze the choosing preference (right or left) of the communication symbols and the prompts level for the three participants after intervention. The results show the case 1 and case 2 can choose different preference communication symbols, and their prompts mainly based on the level 1 (direct oral prompts) to no prompts. However, the choosing preference of the case 3 is personal intention, and the prompts mainly based on the level 1 (direct oral prompts) .This study build social validity through collecting intervention information from significant others of the three participants, and they all perform high validity. Finally, suggestions are proposed according to the results of this study, including “teaching” and “research” dimensions.