慢性思覺失調症患者之手功能及上肢動作分析

研究目的：本研究探討慢性思覺失調症患者的手功能及上肢動作和正常人之差異，及在不同的感覺刺激對上肢動作協調的影響。研究方法：20位慢性思覺失調症患者及20位正常人參與研究，使用簡易上肢手功能測驗(Simple Test for Evaluating Hand Function，STEF)、互動式聲光手眼協調訓練系統及應用三維Zebris超音波動作分析儀器，收集受測者之手功能及不同的感覺刺激引導上肢動作的運動學參數。比較慢性思覺失調症患者與正常人在手功能及動作協調上的差異。研究結果：患者手功能測驗的動作時間(91.45±32.61s)與正常人(65.07±4.73s)有顯著的差異(p=0.001)。慣用手完成測驗的所需時間(76.17±25.38s)比非慣用手(80.35±27.99s)短。慢性思覺失調症患者與正常人的上肢動作分析中，在反應時間、動作時間、最大速度及動作單元均有顯著的差異(all p≤0.001)。三種不同刺激對慢性思覺失調症患者動作協調的影響，光刺激相較於無刺激的第一反應時間短(p<0.001)，而聲音刺激相較於光刺激及無刺激的動作時間長(p<0.001)。結論及建議：慢性思覺失調症患者有較差的手功能表現及動作協調度不佳，動作較慢及不順暢，此外，以光刺激引導的上肢動作不管在反應時間和動作時間都較短。故建議臨床治療師加強慢性思覺失調症患者手功能及動作協調度的訓練，且訓練患者動作協調時，可以多增加視覺刺激或提示。

Objective : The purposes of this study were 1) to examine the differences of hand function and upper-extremity movement between normal subjects and patients with chronic Schizophrenia, and 2) to examine the effects of different types of sensory stimulation on motor coordination in patients with schizophrenia. Method : Twenty patients with chronic schizophrenia and 20 healthy control subjects participated in this study. Hand function was measured by the STEF (Simple Test for Evaluating Hand Function). Upper-extremity movement was measured by Zebris motion analysis system when performing reaching movement in response to different types of stimulation (visual, auditory or none) using the Interactive Sound and Light Eye-Hand Coordination Training.Result : Hand function in patients with chronic schizophrenia was significantly poorer than the healthy control subjects (p=0.001). The movement time of dominant hand was significantly shorter than non-dominant hand (p<0.001). The differences of upper extremity movement in response to light stimulation between patients and control subjects were on reaction time, movement time, peak velocity, percentage of time where peak velocity occurred and movement units (all p≤0.001). The first reaction time in response to light stimulation was significantly shorter than that in response to no stimulation (p<0.001). However, movement time guided by sound stimulation was significantly longer than guided by light and no stimulation (p<0.001).Conclusion and Suggestion: Hand function and upper-extremity coordination were poor in patients with chronic schizophrenia that was demonstrated by slow movement and less fluency. In addition, the reaction time and movement time of upper-extremity movement guided by light stimulation were all shorter than by sound or no stimulation. Thus, we suggest that clinical therapist should strengthen hand function and movement coordination in patients with chronic schizophrenia. Furthermore, visual stimulation or visual cue was better to added to enhance performance when training movement coordination.