資訊科技於銀髮族及殘障者復健照護應用

Abstract

台灣已步入老年化社會，發展好用與易用的健康照護科技輔具將可以提升銀髮族與殘障者自我健康照護的功能。本研究之目的為應用資訊科技於健康照護，並分就兩個主題探討如何以使用者為中心的主軸使科技可成功運用於健康與復健照護。主題一為發展以銀髮族為中心之健康照護應用程式互動介面；主題二為探討市售虛擬實境遊戲於中風個案的動機及運動學上的影響。 主題一為以活動導向理論為架構，以快速人種誌方法，探討15名50歲以上銀髮族的自我健康照護活動流程。將活動中所產生的問題分析後，以人物誌發展典型使用者，以故事板發展系統功能與互動介面。最後以快速雛型進行使用性分析。結果發現: 銀髮族的五大自我健康照護問題，發展出四大系統功能。功能包括健康提醒、通訊與緊急連絡、醫療照護與生活資訊等功能群。介面互動行為包括情境察覺為操控主軸、活動導向為顯示順序及簡潔顯示畫面等。使用性測試結果發現雛形操作錯誤率非常的低、主觀工作負荷評量低，與認知易用性與有用性量表分數高。總結而言，系統提供銀髮族以低認知與動作負荷的方式達成自我健康照護。 主題二嘗試了解市售虛擬實境遊戲，以Wii系統為例，如何影響中風個案的動機與上肢動作。本研究終極目的為探討市售虛擬實境遊戲的優缺點，以對未來治療系統提出建議。本主題研究設計為隨機對照試驗，共有20名中風個案被分配到四組: Wii組、傳統職能治療組、桌上遊戲組與無治療組。四組都進行三周(每周三次，每次60分鐘)的治療。療效測驗分三次於治療前、後與追蹤(治療三周後)評量。測驗包括內在動機量表、伸手時表面肌電圖肌肉達收縮高峰時間、手部動作測驗(Jebsen Taylor Hand Function Test )與生活品質量表(Stroke Impact Scale)。結果發現治療後，Wii組的動機顯著較其他三組高；Wii組表面肌電圖肌肉達收縮高峰時間於二頭肌與屈腕肌立即效果顯著(p < .05)，但持續效果不顯著；四組治療後於手部動作測驗與生活品質量表差異並不顯著。總結而言，市售虛擬實境遊戲的優點為符合有趣遊戲設計的三大要素，可成功提升治療動機，於上肢動作療效仍需以大樣本與延長治療時間來進一步研究。

This research reported applying information technology to help elders and people with disabilities in healthcare. We conducted two studies to explore the user-centered design in information technology. Study one introduced the design process of an mobile application, Health Pal; Study two discovered the effects of an affordable off-the-shelf virtual reality (OTSVR) gaming treatment on participants’ intrinsic motivation and their upper arm motor functions. Specifically, in study one, the design of Health Pal was conducted according to the activity-oriented design (AOD) approach. By following AOD approach, we divided the design of Health Pal into five distinct steps: (1) analysis of healthcare activities within the target user group, (2) identification of user’s needs, (3) identification of necessary functions to meet the user’s needs, (4) design of physical appearance and user interfaces and (5) conducting usability evaluation. After learning the 5 basic needs of 15 elders over age 50 years, we transformed user needs into 4 groups of system functions. User interface characteristics included large legible display, simple screen layout, a combination of circular menu and fish-eye display, activity-oriented interactive flow and personalized presentation sequence. In the usability evaluation, error rates for test scenarios were very low. In the Subjective Workload Assessment Technique assessment, processing demands did not exceed available capacity of elders. In the Perceived Usefulness and Perceived Ease of Use questionnaire, most elders gave high scores to Health Pal. In summary, Health Pal was a user-friendly tool to meet elders’ needs in healthcare management. In study two, the ultimate goals were to address the advantages and disadvantages of the OTSVR, Wii system as an example, and to apply them to the design of future systems. Twenty participants completed the experiment. Four parallel groups received treatments for three-week: 1) Wii gaming; 2) conventional therapy; 3) board game; 4) no treatment. The training effects were evaluated immediately after and four weeks after treatment by identifying the intrinsic motivation scores and time-to-peak contractions of electromyography performance in reaching. Functional gains were evaluated by the Jebsen Taylor Hand Function Test and the Stroke Impact Scale. The Wii group showed higher intrinsic motivation than those in other groups (p = .016). The Wii group demonstrated an immediate significantly shorter TTP contraction in their biceps and flexor carpi radialis compared to the board game and no treatment groups (p < .05). The TTP contraction change favored the Wii group but did not show any significant difference when compared to conventional therapy. Retention effects was not significant among groups (p = .059). In this pilot study, OTSVR gaming seems to have immediate effects on motor recovery and provides a motivational way of increasing treatment compliance in stroke patients.