以內在實證取向為腦性麻痺個案選擇合適點選輔具成效之研究

Selecting an Appropriate Pointing Device or Individuals with Cerebral Palsy by Using an Internal Evidence-based Approach

電腦是身心障礙者進入主流社會，以及追求學業與職業目標的重要工具。然而，傳統的電腦點選設備，例如鍵盤和滑鼠，無法滿足像腦性麻痺這樣重度肢體障礙個案的需求。因此，為腦性麻痺個案選擇合適的點選輔具一直都是重要的課題，但實務上始終缺乏有系統以客觀資料來協助點選輔具選用的做法。近來實證本位介入成為關注的議題，因此如何收集內在實證以決定合適之點選輔具是值得探討的課題。因此，本文旨在探討結合單一受試設計與評估工具之內在實證資料蒐集過程對腦性麻痺個案選用點選輔具的成效。本研究以三位腦性麻痺患為對象，利用單一受試交替處理來收集以及比較個案使用不同點選設備的表現。以「肢體障礙者電腦輔具評估量表」以及「電腦化評估」兩種工具來收集資料，並以視覺分析法分析個案使用點選設備的表現。研究結果顯示，利用單一受試交替處理結合前述兩種工具的內在實證過程，三位腦性麻痺患者都獲得了合適的點選輔具。因此，本研究結果支持利用內在實證取向可以協助復健及教育專業人員收集客觀的實證資料，為腦性麻痺個案選擇合適的點選輔具。這樣的過程可作為點選輔具選用實務之參考。

Purpose: Computers have become a crucial tool for accessing new information, maximizing human potential, and redefining power and control in the twenty-first century. Computers are essential to the successful integration of persons with disabilities into the mainstream community and for these persons to pursue academic and vocational objectives. However, standard personal computing systems, such as regular keyboards and mice, cannot meet the needs of individuals with severe disabilities, particularly individuals with physical impairments such as cerebral palsy. Assisting individuals with cerebral palsy in selecting the most appropriate device to meet their personal needs remains a challenge during rehabilitation. This study explored the effect of an internal evidence collecting procedure, which involved integrating a single subject research design and scientific tools, on selecting appropriate pointing devices for individuals suffering from cerebral palsy. Methods: To provide a concrete procedure for simulating the pointing device selection process in this study, a Computer Access Assessment framework was proposed. The Computer Access Assessment framework comprises five major steps for selecting appropriate devices: needs identification, assessment, candidate device selection, training, and follow-up. Three clients with cerebral palsy participated in this study. A single sub ject alternative treatment design was adopted to collect and compare the performance of pointing devices for clients with cerebral palsy. Two instruments, the Computer Access Assessment for Persons with Physical Disabilities and Computerized Assessment Tool, were used to collect data. Visual analysis was conducted to analyze the performance of each device in the experiment. The major criterion for assessing performance was accuracy. The other parameters, namely speed, ratio of path to distance, and movement units, were auxiliary when making the final decision. Findings: According to the results of the visual analysis, all three clients with cerebral palsy acquired an appropriate pointing device by using the internal evidence-based process. Conclusions/Implications: The results of the experiment indicated that the scientific tools, the Computer Access Assessment for Persons with Physical Disabilities and Computerized Assessment Tool, can be employed to collect objective evidence. The process of collecting internal evidence proposed in this study exhibited effectiveness in facilitating the selection of an appropriate pointing device for individuals with cerebral palsy. Finally, future studies are suggested to verify that the device can perform effectively in real situations.