小魚也能開潛水艇：極重度多重障礙學生電動輪椅介入之行動研究

Small Fish Can Also Drive the Submarine: Action Research for Powered Wheelchair Intervention for a Student with Profound and Multiple Disabilities

本研究旨在經由行動研究的歷程，解決極重度多重障礙學生在行動參與上的困難。參與學生就讀特殊教育學校國小部一年級，疑罹患脊髓型肌肉萎縮症，全身肌肉萎縮無力，移行與操作活動均需他人協助，且因動作嚴重受限，使得學生在校園行動與參與活動時遭遇困難。本研究有系統地運用輔助科技服務的流程來提供電動輪椅的介入，包括學生各項能力和需求的評估、電動輪椅的評估、選配、試用、修改、電動輪椅個別操控訓練、電動輪椅融入校園和校外真實情境等，以解決學生在行動參與上的困難，並探討電動輪椅介入的歷程和成效。研究結果發現：一、透過行動研究的歷程，團隊合作有系統地運用輔助科技服務的流程來提供電動輪椅的介入，以解決極重度多重障礙學生在行動參與上所遭遇到的困難；二、電動輪椅介入對學生的影響包括有校園行動能力與參與度提升、主動探索環境的意願提升、動作控制的能力日趨進步、主動與同儕互動的頻率增加、自我決策的意識提高、成就感與自信心提升、表達意願與詞彙增加、生活經驗拓展等表現；三、電動輪椅介入的行動歷程對家長和主要照顧者均有正面的影響，且能促進特教工作者的教學省思與成長。

Purpose: This study suggests a method for assisting students with profound and multiple disabilities to overcome their difficulties in mobility through the process of active research. Methods: The participant in this study was a first grade elementary student of a special education school who was diagnosed with spinal muscular atrophy, which causes muscle atrophy and muscle weakness throughout the participant’s body, limiting his ability to ambulate and participate in activities within the school. Therefore, we conducted a series of systematic processes to provide the participant with an appropriate assistive device to aid in mobility. This process included evaluations to identify the skills and needs of the participant, modifications of the assistive device to fit the participant’s needs, training sessions in the use of the device, and practice sessions in real-life contexts. Results/Findings: The results of this study indicated that (1) through the process of action research, a systematic collaboration between professions to provide powered wheelchair services can help students with profound and multiple disabilities overcome difficulties in mobility; (2) the use of a powered wheelchair can help students increase their level of participation within school, and the willingness to explore the environment, motor control abilities, active interactions between peers, awareness of self-determination, level of confidence and self-fulfillment, willingness to express themselves, and life experience; (3)the use of a powered wheelchair can make parents and foreign caregivers have a positive attitude toward the powered wheelchair, learned to let go gradually, and believing in their child; and (4) the use of a powered wheelchair can encourage special educators to reflect on and improve their work, including changes to the environment, the importance of as sistive technology service and parental participation, the struggle between letting go and offering assistance, the dilemma of pull-out and integration, and the importance of a barrier-free environment. Conclusion/Implications: Through the process of action research,we provided systematic powered wheelchair intervention to help a student with profound and multiple disabilities overcome difficulties in mobility. The use of a powered wheelchair can help students in all aspects of development. The use of a powered wheelchair can have positive influences on parents and foreign caregivers, and can encourage special educators to reflect on and improve their work. Based on the results of this study, suggestions for future practice and research are proposed. This study suggests that we can use teamwork to provide assistive technology services and emphasizes parental participation. In addition, powered wheelchair intervention enhances mobility and all aspects of development of students with profound and multiple disabilities. The powered wheelchair driving training is provided by the related departments of university interns or volunteers, caregivers, and parents. Suggestions for the research design are provided for future research.