本論文探討利用虛擬實境開發的新型上肢復健方法，虛擬實境生成式雙手協同任務導向中風復健系統 (VRGBCTO)，我們設計十種模擬日常生活的任務，透過鏡像手模擬雙手協同動作，評估其對於手部精細運動功能、雙手協調性提升的有效性，與既有的虛擬實境鏡像治療（VRMT）之單手視覺回饋方式進行比較。招募30名慣用手為右手的健康受試者，隨機接受VRGBCTO及VRMT兩種介入，每次介入持續17分鐘，每種介入都包含10種任務導向情境，皆使用慣用手進行操作，並利用腦電圖（EEG）記錄運動執行及休息階段的大腦活動變化。評估指標包含手部功能測試以及腦電圖分析。在手部功能測試結果顯示，VRGBCTO 能有效改善抓握提舉測試（平均力比值改善: p < .001, 總體峰值力量改善: p < .001, 最高力比值改善: p < .001）、明尼蘇達手動敏捷測試（放置: p < .001, 翻轉: p < .001）、單絲測試（大拇指: p = .009）等多項評估指標，但與單純VRMT相比，未達統計上的差異。而在普渡釘板測試中VRGBCTO 在雙手協調與組裝測試中顯著優於VRMT（p = .005, p < .001）。腦電圖分析表明，VRGBCTO與VRMT呈現相似的腦部活化程度，但未達統計上的差異，而在腦區間的連結性，VRGBCTO在Mu與Beta頻段呈現更多跨半球連結顯著提升，特別是在右顳葉（T4）與左前額葉（FP1）、右額葉（F4）與左頂葉（P3）、左枕葉（O1）與右枕葉（O2）間之連結（如T4-FP1: p = .045, F4-P3: p = .039, O1-O2: p = .036）皆顯著高於VRMT，顯示其在促進左右腦整合與感知動作協調上的潛力。結果表明，VRGBCTO 不僅在同側感覺運動皮質的活化程度上與 VRMT 相當，亦更有效促進雙手協同操作與左右腦區間的功能連結，為未來應用於中風患者之上肢復健提供具潛力的新型模式。

This thesis explores a novel upper limb rehabilitation approach developed using virtual reality: A Virtual Reality-Based Generative Bimanual Cooperative Task-Oriented System for Stroke Rehabilitation (VRGBCTO). We designed ten daily life–inspired tasks to simulate bimanual coordination through mirrored hand movements. The system’s effectiveness in improving fine motor function and bimanual coordination was evaluated and compared with the existing virtual reality mirror therapy (VRMT) featuring unilateral visual feedback. Thirty right-handed healthy participants were recruited and randomly assigned to receive either VRGBCTO or VRMT. Each intervention lasted 17 minutes and included 10 task-oriented scenarios, all performed using the participants' dominant hand. Electroencephalography (EEG) was recorded throughout both motor execution and resting phases to assess neural activity. Outcome measures included standardized hand function tests and EEG-based brain activity analysis. The results of hand function assessments demonstrated that the VRGBCTO intervention effectively improved several performance metrics, including the Pinch Holding Up Activity (improvements in mean force: p < .001; peak force: p < .001; maximum force: p < .001), the Minnesota Manual Dexterity Test (placing: p < .001, turning: p < .001), and the Two-Point Discrimination (thumb: p = .009). However, no statistically significant differences were observed when compared to the VRMT group. In contrast, the Purdue Pegboard Test revealed that VRGBCTO significantly outperformed VRMT in tasks requiring bimanual coordination and assembly (bimanual coordination: p = .005; assembly: p < .001). EEG analysis revealed comparable levels of brain activation between the two groups, without significant differences. However, functional connectivity analysis showed that the VRGBCTO group exhibited significantly greater interhemispheric coherence in both Mu and Beta bands, particularly between the right temporal lobe (T4) and left prefrontal cortex (FP1), right frontal cortex (F4) and left parietal cortex (P3), and between the left and right occipital lobes (O1–O2) (e.g., T4–FP1: p = 0.045; F4–P3: p = 0.039; O1–O2: p = 0.036). These findings suggest that VRGBCTO may enhance bilateral cortical integration and visuomotor coordination. In conclusion, VRGBCTO not only achieved comparable cortical activation in the ipsilateral sensorimotor areas as VRMT but also showed superior potential in promoting bimanual coordination and interhemispheric functional connectivity. This novel rehabilitation model may offer a promising direction for future upper limb rehabilitation in stroke patients.

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