2020-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/712711摘要：雙重作業行走為行走時同時進行另一項活動，牽涉到複雜的大腦注意力資源課題。巴金森患者因動作自動化控制受損與注意力資源容量下降，而容易導致雙重作業行走困難。尤其在有凍凝步態的巴金森患者，因行走自動化與認知執行功能受損更顯著，更容易在雙重作業行走時喪失平衡而跌倒，因此有效的雙重作業行走訓練是提升巴金森患者行走安全的重要關鍵。注意力聚焦策略包含「內聚焦」與「外聚焦」策略，是影響動作學習的重要因子。內聚焦為執行動作時將主要注意力集中在自身的肢體動作，雖可提升對動作的意識控制但卻會破壞動作自動化控制；而外聚焦為執行動作時將主要注意力集中於動作外在目標，可藉由降低動作控制所需的注意力資源，促進動作自動化控制。一般訓練巴金森患者行走時，常請患者注意自己的腳、盡量跨大步行走，此屬於內聚焦策略，但研究顯示這樣的注意力模式可能會導致巴金森患者步態變異量增加、更破壞行走自動化，並且造成大腦注意力資源更大的負擔。過去研究尚未探討將注意力聚焦策略應用於巴金森患者雙重作業行走的適用性，此外，有、無凍凝步態巴金森患者其行走自動化與認知執行功能受損程度不同，可能會影響注意力策略的適用性。因此，本計畫目的為探討有、無凍凝步態之巴金森患者，以「行走內聚焦」、「行走外聚焦」進行雙重作業行走訓練，何種注意力策略會有較佳的訓練成效。除雙重作業行走表現、凍凝步態發生頻率、跌倒發生頻率與跌倒風險評估，本研究將藉由腦波圖量測，以深入瞭解訓練前後，巴金森患者在雙重作業行走時的大腦注意力資源徵召與調控變化。本計畫完成將可瞭解注意力聚焦策略對巴金森患者雙重作業行走訓練之適用性與其大腦神經塑性變化，並可做為臨床雙重作業訓練與防跌衛教之參考。<br> Abstract: Dual-task walking is defined as walking and performing another task concurrently, which requires appropriate attention modulation to achieve task goals and maintain walking safety. Due to impaired motor automaticity and attentional resource, patients with Parkinson disease (PD) have difficulty in dual-task walking. Especially for PD with freezing of gait (FoG), because they had greater severity of walking de-automatization and executive dysfunction than PD without FoG, PD with FoG often loss balance and fall at dual-task situations. Therefore, effective dual-task walking training is important to patients with PD for fall prevention and increasing independence in daily life. Attentional focus strategies include internal focus and external focus, which is the critical factor for both motor control and motor learning. Internal focus means that performer’s attention is directed toward components of body movement (e.g. limb segments), which increases conscious control for motor control but deteriorates movement automaticity. In contrast, external focus means that performer’s attention is directed toward the effect of movement on the environment or the end goal, which reduces the requirement of attentional resource for motor control, and facilitates movement automaticity. In clinic, patients with PD are asked to focus on their feet with taking big step while walking; it belongs to internal focus strategy. However, previous research showed focusing on feet during walking increased walking variability and deteriorated walking automaticity. In addition, walking with internal focus may make brain attentional resource overload. The appropriate strategy for dual-task walking training has not been investigated. Besides, because the severity of walking de-automatization and executive dysfunction are different between PD with FoG and PD without FoG, the appropriate strategy for dual-task walking training might be varied. The present study will characterize attentional focus effect (internal focus vs. external focus) on dual-task walking training, with a special focus on PD with FoG and PD without FoG, respectively. Besides dual-task walking performance, FoG severity, falling event and fall risk, the modulation of brain activity will be investigated by electroencephalogram (EEG) measurement. The present project is expected to have significant contributions not only to gain a better insight to neural correlates of dual-task walking training with different attentional focus strategies, but to optimize treatment strategy for PD patients with and without FoG.注意力雙重作業行走巴金森凍凝步態腦波圖AttentionDual-task WalkingParkinsonFreezing of gaitEEG