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研究生： 呂軒慧
Lu, Shiuan-Huei
論文名稱： 探討精細動作訓練結合擴增實境對失憶型輕度認知障礙在記憶能力之療效
The Effects of Fine Motor Training with Augmented Reality on Memory in elder adults with Amnestic Mild Cognitive impairment (aMCI)
指導教授： 蘇芳慶
Su, Fong-Chin
共同指導教授: 白明奇
Pai, Ming-Chyi
郭立杰
Kuo, Li-Chieh
學位類別： 碩士
Master
系所名稱： 工學院 - 生物醫學工程學系
Department of BioMedical Engineering
論文出版年： 2019
畢業學年度： 107
語文別： 英文
論文頁數： 65
中文關鍵詞： 失憶型輕度認知障礙 (aMCI) 、精細動作 、手指按壓 、擴增實境(AR)
外文關鍵詞： amnestic mild cognitive impairment (aMCI), fine motor training, finger tapping, augmented reality (AR)
相關次數： 點閱：117  下載：1 
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    • 全球失智症患者數量逐年增加，最常見的失智症為阿茲海默症 (Alzheimer’s disease, AD)，其臨床前期為失憶型輕度認知障礙 (amnestic mild cognitive impairment, aMCI)，為情節記憶缺陷。研究發現失憶型輕度認知障礙的預設模式網絡 (default mode network, DMN)異常區域與類澱粉蛋白斑塊 (beta amyloid, Aβ) 堆積腦區有高度重疊，像是運動輔助區 (supplementary motor area, SMA)、前額葉 (prefrontal, PF) 以及頂葉，可以在執行手指按壓動作時被活化。此外，擴增實境技術 (augmented reality, AR)可提升使用者的學習表現及記憶力。
    本研究探討精細動作訓練結合擴增實境對aMCI族群在記憶力的療效，以及訓練後腦部活化的改變。30位aMCI分為兩組各15位，實驗組 (AR-mPETS group) 使用改良式手指按壓評估訓練系統結合擴增實境技術，進行4到6周精細動作訓練，每次30分鐘，一周2到3次，共12次，控制組未進行精細動作訓練，且在此研究期間沒有參與其他研究實驗。全部受試者在前測和4到6周後的後測評估霍普金斯語言學習測驗修改版 (Hopkins Verbal Learning Test- Revised, HVLT-R)、普渡手功能測驗 (Purdue Pegboard Test)以及近紅外光譜儀器 (Near-infrared spectroscopy, NIRS)。
    訓練組在HVLT-R以及普渡手功能測驗相較於控制組有顯著進步，在AR- (modified pressing and evaluation training system, mPETS)且顳葉皮質區的腦部活化經過訓練後，進行AR-mPETS困難任務與簡單任務的差異有顯著活化。本研究發現，aMCI在AR-mPETS訓練後，情節記憶力以及手功能都有明顯的進步，而且與認知及記憶力相關的顳葉區域在執行困難任務時也有明顯的活化。研究中的訓練策略以及內容可以提升aMCI注意力以及記憶力。未來研究可以增加樣本數量、更嚴謹的實驗設計以及增加後續追蹤評估，以擴展研究發現。

    The number of people with dementia rapidly increased over the world. The most common disease of dementia is Alzheimer’s disease (AD), which preclinical stage is amnestic mild cognitive impairment (aMCI) deficient in episodic memory. It is found that aberrant functional connectivity within the default mode network (DMN) is in a high degree of spatial overlap with patterns of beta amyloid (Aβ) plaque deposition in aMCI. The aberrant functional connectivity within DMN of brain regions, such as SMA (supplementary motor area), PF (prefrontal) and parietal lobe, could be activated by finger tapping tasks. Furthermore, the technology of augmented reality (AR) had the great potential for users to increase their performance and retention.
    The study was to investigate the effects of fine motor training with AR on memory for aMCI, and to examine the change of brain activation after the fine motor training with AR. Thirty elders with aMCI were recruited and divided into experimental group and control group. The experimental group conducted training program by using the modified Pressing Evaluation and Training Systems with AR (AR-mPETS) twice or thrice a week, for a total of 12 training sessions. The control group did not receive any other research during this period. All participants performed Hopkins Verbal Learning Test- Revised (HVLT-R), Purdue Pegboard Test and the Near-infrared spectroscopy (NIRS) evaluation at the intervals of 4 to 6-weeks.
    Both between-group and within-group comparisons revealed highly effects of AR-mPETS training on episodic memory. The brain activation of the temporal cortex significantly increased in the difference between hard mode and easy mode of AR-mPETS at the post-evaluation between groups. Our findings suggested that aMCI patients could enhance episodic memory and increase the brain activation of the primary auditory cortex in the temporal lobe after AR-mPETS training. The strategies of our training program might enhance the attentional functions and memory ability. Further investigations with a larger sample, more controlled trial, and adding follow-up evaluation are needed to extend these findings.

    摘 要 I Abstract IV List of Figure IX List of Table XI Chapter 1 Introduction 1 1.1 Background 1 1.2 The amnestic mild cognitive impairment (aMCI) 2 1.3 Default mode network (DMN) in aMCI 3 1.4 The possibility of fine motor training applied to the cognitive impairment patients 4 1.5 The technology of augmented reality (AR) 5 1.6 Motivation 6 1.7 Purpose 7 Chapter 2 Materials and Methods 8 2.1 Participants 8 2.2 Experimental equipment for augmented reality technology with modified Pressing Evaluation and Training Systems (AR-mPETS) 9 2.3 Experimental setting and procedure 12 2.3.1. The experimental setting 12 2.3.2. The experimental procedure 12 2.4 AR-mPETS training 14 2.5 Outcome measures 16 2.5.1. Primary outcome measure 17 2.5.2. Secondary outcome measures 18 2.5.2.1 Purdue Pegboard Test 18 2.5.2.2 Near-infrared spectroscopy (NIRS) 19 2.6 Data Analysis 20 2.7 Statistical Analysis 21 Chapter 3 Results 23 3.1 Participant characteristics 23 3.2 Effects of fine motor training with AR in clinical assessments 26 3.2.1. Primary outcome 27 3.2.1.1. HVLT-R total recall score 27 3.2.1.2. HVLT-R delay recall score 28 3.2.1.3. HVLT-R retention (%) 29 3.2.1.4. HVLT-R RDI 30 3.2.2. Secondary outcomes 31 3.2.2.1. Purdue right hand 31 3.2.2.2. Purdue left hand 32 3.2.2.3. Purdue both hands 33 3.2.2.4. Purdue assembly 34 3.3 Effects of fine motor training with AR in cortical activation evaluated from NIRS 35 3.3.1. Prefrontal cortex (PF) 37 3.3.2. Premotor cortex (PM) 39 3.3.3. Supplementary motor area (SMA) 41 3.3.4. Primary motor cortex (M1) 43 3.3.5. Primary auditory cortex (A) 45 3.3.6. Somatosensory cortex (S) 47 Chapter 4 Discussions 50 4.1. The effect of fine motor training with AR on HVLT-R 50 4.2. The effect of fine motor training with AR on Purdue 51 4.3. Brain activations before and after fine motor training with AR 52 4.4. Limitations 55 References 57

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