沉浸式虛擬實境遊戲訓練對思覺失調症患者功能改善之成效

Abstract

思覺失調症是一種嚴重的精神疾病，慢性化思覺失調症患者的認知與身體功能缺損越來越明顯，導致患者在日常生活、活動參與、就業遭遇限制進而影生活品質。過去的研究發現，個別進行認知與身體功能訓練確實能提升病患在兩方面的功能，但是沒有研究探討經由訓練而提升的認知與身體功能是否能反映在參與社會與社區活動的功能性表現。虛擬實境的遊戲訓練成功地將認知、身體活動以及娛樂三者結合，讓使用者可以在虛擬的但愉悅的情境中重複的運用認知與身體活動能力，過去研究顯示，在一段時間的訓練後，病患的部分認知能力與體適能有所改善。近年發展出頭戴式虛擬實境技術，提供使用者更真實的感受，研究者認為，這一類沈浸式的遊戲對思覺失調症患者的影響相較以往桌上型顯示器所呈現的虛擬實境遊戲更加顯著。但目前尚沒有研究探討這種高度沈浸是虛擬實境遊戲訓練對思覺失調症認知、身體功能與功能性表現的影響。本研究使用實驗研究法，將受試者分為實驗組及控制組，控制組接受傳統工作訓練，實驗組則透過頭戴式顯示技術接受沉浸式虛擬實境的音樂及益智遊戲訓練，進行為期十二週，每週兩次，每次30分鐘的訓練，並藉由彩色路徑描繪測驗、積木與盒子測驗、起立走測驗、慢性精神病患者工作行為量表蒐集結果參數，搜集資料的時間點包括：訓練前（前測）、訓練六週後（後測一）、訓練十二週後（後測二）。使用SPSS 23進行以下統計分析：敘述性統計、獨立t 檢定、混合設計重複量數二因子變異數分析、配對t 檢定、單因子共變數分析，回答研究問題。統計顯著性定為p<.05或p<.025。 結果共有二十二位完成整個試驗（實驗組12位、控制組10位），統計分析結果發現，不論沉浸式虛擬實境遊戲訓練或是社區復健中心的傳統工作訓練，同樣對於思覺失調症患者在認知與身體功能上有所助益，沈浸式虛擬實境遊戲訓練對病患的注意力有高於社區工作訓練趨勢。此外，為期十二週、每週兩次、每次三十分鐘的訓練並未對病患的功能性行為表現產生立即的影響。 沈浸式虛擬實境訓練與社區工作訓練對思覺失調症患者的認知與身體功能有所助益，但這些功能的提升，無法反映在功能性行為表現，文中針對結果進行了可能原因分析，並對未來研究與臨床應用提出建議。Schizophrenia is a severe mental illness. The cognitive and physical function impairment of patients with schizophrenia is becoming more and more obvious with the chronicity development of the illness, which causes their restrictions in daily life, activity participation, and employment , and affects their quality of life. Previous studies have found that cognitive and physical function training can indeed improve patients' functions in those two aspects, but there is no research exploring whether the cognitive and physical functions improved through training can be reflected in the functional performance when they participated in social and community activities. Virtual reality game training successfully combines cognition, physical activity, and entertainment, allowing users to repeatedly use their cognitive and physical abilities in a virtual but pleasant context. Previous studies have shown that after a period of training, some of the patients’ cognitive abilities and physical fitness have improved. In recent years, head-mounted virtual reality technology has been developed to provide users with a more realistic experience. Researchers believe that this type of immersive game has a greater impact on patients with schizophrenia than the previous virtual reality presented by desktop monitors. However, there is no research to explore the effect of this kind of high immersive virtual reality game training on the cognition, physical function and functional performance of patients with schizophrenia.This is an experimental research design study. All participants were divided into an experimental (n=12) and a control (n=10) group. The control group received traditional work training, and the experimental group received immersive virtual reality music and puzzle game training through head-mounted display technology. The training lasted for twelve weeks and there were two 30-minute training sessions in each week. The outcome measures included Color Trail Test, Box and Block test, Timed-up-and-go test, and the Work Behavior Index. The outcome measures were measured at the time before training, six weeks after training, and twelve weeks after training. SPSS 23 was used to perform the following statistical analysis to answer the research questions: descriptive statistics, independent t-test, mixed-design repeated measure two-way analysis of variance analysis, paired t-test, one-way analysis of covariate analysis. The statistical significance was defined as p<.05 or p<.025. A total of 22 participants completed the entire experiment (12 in the experimental group and 10 in the control group). The results of the statistical analysis showed that both immersive virtual reality game training or traditional work training in community rehabilitation centers is effective in improving the cognitive and physical functions in patients with schizophrenia In addition, the training lasted for 12 weeks, twice a week, 30 minutes each session, did not have an immediate effect on the patient's functional behavior. Immersive virtual reality training and community work training are helpful to the cognitive and physical functions of patients with schizophrenia, but the improvement of these functions cannot be reflected in the performance of functional behavior. The possible rationales supporting the results were discussed and the suggestions for future research and clinical applications were provided.