想飛的蝴蝶--「一位在家教育肢體障礙學童的輔助性科技運用研究」

Abstract

本研究旨在蒐集一位極重度肢體障礙學童，接受在家教育巡迴服務的十年間，運用輔助性科技協助生活與學習的經驗，探討輔助性科技介入的歷程、成功運用的相關因素及對個案產生的影響。採個案研究的方法並以質性的分析方式，對相關專業人員、家庭重要成員及輔導老師進行深度訪談，輔以十年間的教學輔導記錄、相關文件檔案、研究者的觀察及省思記錄等進行研究。 研究結果發現，輔助性科技介入的歷程有其時間脈絡可循，分別為：醞釀期、中低科技介入期、高科技介入期、電腦學習萌芽期、關鍵期--懸吊系統介入期、網路狂飆期及電腦語音學習期等七個階段。 輔助性科技的運用方面，分別探討專業團隊、個案管理員、家長及社會資源等相關因素，結果發現：一、專業團隊：（一）評估：職能治療從診斷瞭解、生態考慮、情境調整、時序向度及適用的輔具等角度出發；物理治療則從生理狀態、心理特質、活動功能、優勢能力及輔具需求等方向著手。（二）服務：職能治療的宗旨是「給你幸福」，服務內容包括：製作副木、特殊擺位、提升心肺功能及運用輔具；物理治療則以「讓你舒服」為職志，服務定位在評估及設計輔具、擺位、肢體復健、設計運動課程、提升心肺功能等。（三）運作：分別是以個管員為中心、釋放專業及互相補位等。二、個案管理員：具有關鍵他人（key person）、溝通協調、資源整合及教學輔導的功能。三、家長：爸爸擔負著經濟支持、居家復健及穩定重心的角色；媽媽則具備生活照顧、學習伙伴、資源取得及心理輔導的功能。四、社會資源：其功能發揮在設備提供、人力支援及經費補助等方面。 輔助性科技對個案的影響方面，研究顯示：介入個案的輔助性科技共有呼吸器、特製輪椅、海灣型學習桌、懸吊系統及電腦相關輔具（特殊開關、軌跡球滑鼠、語音輸入系統）等；從不同向度分析其成長與改變時發現，輔助性科技對其影響正面者為多，部分持平，有些則因病情變化受到影響；探討其限制與需求時發現，生理條件、心理環境及輔具使用是生態上的限制；年齡、安置現況及巡迴輔導辦法則是制度上的限制。未來發展需求包括生理、心理、學習、社會適應及其他等方面。This research aims to gather experiences of a student with profoundly physical disability, who receives homebound education for ten years and takes advantage of assistive technology to live and learn, to discuss the progress of assistive technology intervention, the successful application of relative factors and influences on the case. This research adopts case study and qualitative research method to interview relative specialists, important family members and teachers, in combination with the references to the teaching counseling record, important correlative documents, researcher’s observation and reflection. The finding of this research is that assistive technology intervention follows a certain track, which contains seven stages, including incubating period, mid-low technology intervention period, and high-technology period, computer-learning budding period, critical period—suspension style intervention period, Internet wild whirlwind period and computer voice learning period. In terms of the usage of assistive technology, this researchdiscusses relative factors such as disciplinary teamwork, case managers, parents and social resources, respectively. The results are followings: Ⅰ, disciplinary teamwork: (1) Evaluation: conducting occupation therapy according to viewpoints of diagnosis comprehension, ecological consideration, environment adjustment, time sequence aspect and appropriate assistive devices. Physical therapy is conducted according to viewpoints of physical status, metal character, activity function, strength ability and assistive devices needs. (2) Service: the purpose of occupation therapy is “bring you wellness”. It includes making splints, specific positioning, reinforcing cardiovascular function and using assistive devices. Physical therapy aims to “comfort you”. It serves to evaluate and design assistive equipments, positioning, limbs and trunk rehabilitation, design exercise curriculum, reinforcing cardiovascular function, etc. (3) Operation: case manager-centered, specialty release, mutual cover, etc. Ⅱ, case manager: function as a key person, communication and negotiation, resource coordination and teaching counseling. Ⅲ, parents: father plays the role of financial support, homebound rehabilitation and stabilization. Mother is the care taker, learning partner, resource gainer and psychology counselor Ⅳ, social resource: provides equipments, human resource supply and financial support. According to the results of this research, influences of assistive technology on case are: assistive technology on case intervention includes respirator, specific wheelchair, sea-gulf type learning table, suspension system and relative computer assistive equipments (special switch, trackball, voice input system) etc. Analyzing her growth and changes from different aspects, the findings are that the impacts on assistive technology are mostly positive, and some are neutral. Some, however, are affected by patient’s condition. By discussing her limitations and needs, findings are that physical conditions, psycho environment and usage of assistive equipments are restricted by physiology. Age, placement condition, tour counseling regulations are restricted by system. Further development needs include physical, psychological, learning, social accommodation and other aspects.