糖尿病患者常受長期及進展性的併發症所苦，而神經病變即為常見的糖尿病併發症之ㄧ，其好發於四肢，極具破壞性且造成永久性的神經損傷。在文獻回顧中發現，許多關於糖尿病神經病變的研究大多針對糖尿病足做病理性及功能性的討論，對於負責執行功能性活動的手卻很少提及，然而，在回顧其他疾病導致的手部感覺異常相關研究中發現，麻木、疼痛和敏感性不佳等神經病變之感覺異常併發症會導致運動功能及功能性動作表現不佳，甚至是改變患者的生活型態進而導致生活品質的降低，因此本論文的第一個研究目的為探討糖尿病神經病變患者手部靈巧度、功能性表現與生活品質的關係，藉由客觀性與主觀性的操作測驗與自填式問卷之功能性評量以釐清手部神經病變、手功能與生活品質之間的相關性，進而探討手部神經病變對患者手部靈巧度、功能性動作表現與生活品質的影響，此亦為本論文的第二個研究目的，本論文的第三個研究目的為確認單一及多發性手部神經病變是否對糖尿病患者手部靈巧度、手部功能性表現與生活品質造成影響，在瞭解由糖尿病引起的神經病變影響患者手功能與生活品質之後，本論文的第四個研究目的為運用生物回饋再教育系統設計的治療性介入，設計針對改善及預防手部神經病變的生物回饋感覺動作訓練計畫，並探究此訓練對糖尿病患者手部功能表現之成效。
由第一個研究結果顯示糖尿病神經病變患者手部靈巧度和大部分的功能性表現項目呈現輕中度相關，然而在手部靈巧度與部分生活品質項目的相關性則較弱，此外，手部的功能性表現和生活品質為負相關，在能量、行動及焦慮度呈現輕到中度相關；第二個研究結果顯示手部神經病變影響患者的手部靈巧度、功能性動作表現與生活品質；第三個研究結果顯示多發性手部神經病變患者相較於單一神經病變者其手部靈巧度、手部功能性表現與生活品質受到較大的影響；第四個研究結果顯示運用生物回饋再教育系統設計的治療性介入，手部神經病變的糖尿病患者在兩點區辯覺及手部靈巧度獲得改善。
本論文包含由客觀性之功能性感覺評估與手部靈巧度的操作性量測和主觀性之手功能與生活品質自填式問卷之功能性評量以及生物回饋再教育系統訓練計畫的治療性介入，藉此研究成果幫助臨床工作者和患者更瞭解糖尿病手部神經病所引起的功能性損傷與生活層面之干擾，透過訓練計畫以重新教育患者之手部操作表現之策略，並正視手部周邊神經病變對於手部功能及日常生活表現上之影響。

Diabetes mellitus (DM), a chronic, progressive and lifelong condition if without proper control of the disease, usually makes the patients present various complications. Neuropathy, one of the common and bothersome DM-related complications, is usually seen in patients’ extremities and often results in permanent impairments. Most of the research works focus on the understanding of pathology and functional interference of diabetic foot; rare investigations however explore the effect of diabetic hand on the same facets. Numerous prior works have proven that abnormal sensory functions from several neurological diseases may lead to poor motor performance and quality of life as well, but few studies reported the relevant issues on diabetic hand. Thus, the first purpose of this dissertation aims to explore the relationships among dexterity, hand functioning and quality of life in diabetic patients with objective and patient-perceived measurements. The second purpose is to investigate the impact of hand neuropathies on the DM patients’ hand dexterity, functional hand performance and quality of life. The third aim is to identify whether there are differences in hand dexterity, hand functional performance and quality of life between diabetes hands with mononeuropathy and polyneuropathy. The fourth aim is to investigate the efficiency of a novel biofeedback sensorimotor training program for improving hand dexterity and hand functional performances of neuropathic hands in diabetic patients.
The results of the first part in this dissertation showed that objective hand dexterity had mild to moderate relationships with most of the MHQ results, but only weak associations with some dimensions of the D-39 results. The MHQ results were negatively correlated with the D-39 scores, with mild to moderate relationships in the domains of energy/mobility and anxiety. The results in the second part showed that lesions related to neural functioning in the diabetic hand may negatively influence dexterity and functional hand performance and thus also affect the quality of life. The third part indicates the patients with polyneuropathy suffer from more negative impacts on hand functional performance and life quality than those with mononeuropathy and without neuropathy. The results in the fourth part indicate the efficiency of a novel biofeedback sensorimotor training program could improve the static and moving two-point discrimination and hand dexterity in diabetic patients.
Functional assessments of this dissertation composes of functional sensibility tests via a pinch-hold-up activity (PHUA) and the Purdue pegboard test for objective instruments as well as Michigan Hand Outcomes Questionnaire (MHQ) and Diabetes-39 (D-39) for patient-perceived measurements. In addition, a novel biofeedback sensorimotor training program for therapeutic intervention is also involved. Through the results of this dissertation may contribute to help the clinicians and patients realize more about the relationship between functional hand performance and life quality of patients with hand neuropathy and even improve or prevent the aggravation of neuropathic hand as the result of diabetes mellitus.

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