2014-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/650642摘要：腦性麻痺是一種造成兒童生理失能常見的原因，此疾病通常會因為無力、痙攣或肌肉無法選擇性活化而使上肢功能受損，進而限制兒童日常生活、教育及玩耍的參與。根據腦部神經可塑性及動作學習理論設計的密集式動作訓練計畫，例如：侷限誘發療法及雙側上肢訓練療法被證實可提升腦性麻痺兒童之上肢功能。然而，這些訓練計畫有一些缺點，包括兒童的動機、訓練服從度有限及不可避免的治療師勞力密集度，此將影響此類訓練之應用及療效。透過虛擬實境的居家遠距復健治療可改善上述缺點，或許可成為腦性麻痺兒童上肢復健的替代方案。此外，因為遠距虛擬實境復健以電腦軟體為媒介，與面對面的傳統治療相比，結合評估與治療於同一系統相對容易，此將有助於建立具成本效益之復健模式。然而，因為遠距復健及虛擬實境之技術持續發展，有關遠距虛擬實境復健之執行方案建立與療效驗證之文獻仍有限。因此，本研究目的為建立一腦性麻痺兒童之遠距虛擬實境復健系統（體感上肢動作遠距復健系統， Kinect-based ULMTS），並探究其在腦性麻痺兒童動作表現及功能性評估結果之療效。我們的復健系統將包含兩個部份，分別是動作訓練遊戲及運動學評估，多功能系統之建置將有助於提升臨床應用。此外，我們的訓練遊戲是根據腦性麻痺兒童動作復健目標而設計，此將有助於提升療效。 在三年計畫的第一年中，我們將建置 Kinect-based ULMTS之復健遊戲，包含雙側及單側腦性麻痺兒童動作訓練遊戲。此外，也將發展此系統動作擷取功能，並利用動作分析領域常用的 Vicon系統當作黃金標準作驗證。將招募 15個健康年輕人及發展正常之兒童以建置系統，這些使用者的經驗將有助於設計好玩有趣的復健遊戲。 第二年，我們將建置 Kinect-based ULMTS的腦性麻痺兒童之運動學分析系統。為了建立評估腦性麻痺兒童運動學參數並探究其動作表現模式，將招募 30個不同種類的腦性麻痺兒童。此外，我們將加入遠距功能，並建立個案及治療師端平台。至此，Kinect-based ULMTS完整建立。 第三年，我們將探究 Kinect-based ULMTS對腦性麻痺兒童動作表現及功能性評估結果之療效。將招募 45個單側偏癱之腦性麻痺兒童，並將其分成單手訓練、雙手訓練及合併單雙手訓練組。此結果將有助於驗證 Kinect-based ULMTS是否可行，是否能有效提升動作功能，此外，我們也將比較此三組的療效，釐清哪種治療模式對於增進腦性麻痺兒童動作表現療效最好。 <br> Abstract: Cerebral palsy (CP), a common cause of physical disability in children, often impairs upper limb function through weakness, spasticity and loss of selective muscle activation, which limits children’s participation in activities of daily living, education and play. Based on the theories of cortical neural plasticity and motor learning, intensive motor training programs, such as constraint-induced therapy (CIT) and bilateral arm training (BAT), have been proposed to improve upper limb function in children with CP. However, several disadvantages, including limited motivation and compliance of children and the inevitably labor intensity, affect application and effectiveness of these programs. Home-based telerehabilitation through virtual reality system (VR telerehabilitation), improving the aforementioned disadvantages of CIT and BAT, may be an alternative approach for upper limb rehabilitation in children with CP. Moreover, VR telerehabilitation, a computer-based intervention, is relatively easy to combine treatment and assessment in the same system, which helps develop cost-effectiveness rehabilitation protocols. Since technologies of telerehabilitation and VR are developing, studies on protocol development and effectiveness evaluation of VR telerehabilitation on motor performance for children with CP are limited. Therefore, the purposes of the present study are to develop a VR telerehabilitation (i.e. Kinect-based upper-limb motor telerehabilitation system, Kinect-based ULMTS) for children with CP and to evaluate the effectiveness of this system on motor performance and functional outcomes. Our Kinect-based ULMTS will consist of two parts, namely treatment (i.e. motor training games) and assessment (i.e. kinematic analysis), which would improve the clinical utility. Moreover, our training games will be designed based on the motor rehabilitative goals of children with CP, which would improve its effectiveness. In the first year of the three-year project, rehabilitation games of the Kinect-based ULMTS, including unilateral and bilateral motor games for children with CP will be developed. Moreover, motion capture system of the Kinect-based ULMTS will also be developed and validated by Vicon system, a gold standard in motor analysis field. Fifteen healthy adults and children with typical development will be recruited to develop the system. User experience of these participants will be helpful for designing playful rehabilitative games. In the second year, kinematic analysis system of the Kinect-based ULMTS for children with CP will be developed. To define CP-specific kinematic variables, 30 children with varied types of CP will be recruited and their motor patterns will be investigated. Moreover, the telecommunication networks, platforms for clients and therapists will be added to the Kinect-based ULMTS. At the end, the Kinect-based ULMTS will be well established. In the third year, the effectiveness of Kinect-based ULMTS on motor performance and functional outcomes will be investigated. 45 children with hemiplegic CP will be recruited and allocated to three intervention groups, namely unilateral, bilateral and combined training groups. Results from this year will help us clarify whether our VR telerehabilitation protocol is feasible and effectiveness for motor improvement in children with hemiplegic CP. Furthermore, comparisons of effectiveness among three intervention groups will also help us clarify which type of intervention is the best one for motor improvement in children with hemiplegic CP.腦性麻痺遠距復健虛擬實境上肢動作訓練運動學分析cerebral palsytelerehabilitationvirtual realityupper-limb motor trainingkinematic analysis