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

10.6172/BSE.201307.3802005

林珮如(Pei-Ju Lin)；林真悌(Chen-Ti Lin)

極重度多重障礙 ； 電動輪椅 ； 輔助科技設備 ； 輔助科技服務 ； profound and multiple disabilities ； powered wheelchairs ； assistive technology device ； assistive technology service

特殊教育研究學刊

38卷2期（2013 / 07 / 01）

99 - 125

繁體中文

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 assistive 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.

1. Bottos, M.,Bolcati, C.(2001).Powered wheelchair and independence in young children with tetraplegia.Developmental Medicine & Child Neurology,43,769-777.
2. Butler, C.(1986).Effects of powered mobility on self-initiated behavious of very young children with locomotor.Developmental Medicine & Child Neurology,28,325-332.
3. Butler, C.,Okamoto, G. A.,McKay, T. M.(1983).Powered mobility for very young disabled children.Developmental Medicine & Child Neurology,25,472-474.
4. Cook, A. M.,Hussey, S. M.(2002).Assistive technology: Principles and practice (2nd ed.).Baltimore:Mosby.
5. Davies, A.,De Souza, L. H.,Frank, A. O.(2003).Changes in the quality of life in severely disabled people following provision of powered indoor/outdoor chairs.Disability and Rehabilitation,25,286-290.
6. Deitz, J.,Swinth, Y.,White, O.(2002).Powered mobility and preschoolers with complex developmental delays.The American Journal of Occupational Therapy,56,86-96.
7. Dicianno, B. E.,Cooper, R. A.,Coltellaro, J.(2010).Joystick control for powered mobility: Current state of technology and future directions.Physical Medicine and Rehabilitation Clinics of North American,21(1),79-86.
8. Dicianno, B. E.,Spaeth, D. M.,Cooper, R. A.,Fitzgerald, S. G.,Boninger, M. L.(2006).Advancements in power wheelchair technology-effects of isometric joysticks and signal conditioning on driving performance.The American Journal of Physical Medicine & Rehabilitation,85,631-639.
9. Evans, S.,Neophytou, C.,De Souza, L.,Frank, A. O.(2007).Young people's experiences using electric powered indoor-outdoor wheelchairs (EPIOCs): Potential for enhancing users' development?.Disability and Rehabilitation,29,1281-1294.
10. Furumasu, J.,Guerette, P.,Tefft, D.(1996).The development of powered wheelchair mobility program for young children.Technology and Disability,5,41-48.
11. Hardy, P.(2004).Powered wheelchair mobility: An occupational performance evaluation perspective.Australian Occupational Therapy Journal,51,34-42.
12. Harrison, A.,Derwent, G.,Enticknap, A.,Rose, F. D.,Attree, E. A.(2002).The role of virtual reality technology in the assessment and training of inexperienced powered wheelchair users.Disability and Rehabilitation,24,599-606.
13. Huhn, K.,Guarrera-Bowlby, P.,Deutsch, J. E.(2007).The clinical decision-making process of prescribing power mobility for a child with cerebral palsy.Pediatric Physical Therapy,19,254-260.
14. Jones, M. A.,McEwen, I. R.,Neas, B. R.(2012).Effects of power wheelchairs on the development and function of young children with severe motor impairments.Pediatric Physical Therapy,24,131-140.
15. Lahm, E. A.,Sizemore, L.(2002).Factors that influence assistive technology decision making.Journal of Special Education Technology,17(1),15-26.
16. Law, M.,Finkelman, S.,Hurley, P.,Rosenbaum, P.,King, S.,King, G.,Hanna, S.(2004).Participation of children with physical disabilities: relationships with diagnosis, physical function, and demographic variables.Scandinavian Journal of Occupational Therapy,11,156-162.
17. Lynch, A.,Ryu, J. C.,Agrawal, S.,Galloway, J. C.(2009).Power mobility training for a 7-month-old infant with Spina bifida.Pediatric Physical Therapy,21,362-368.
18. Montesano, L.,Diaz, M.,Bhaskar, S.,Minguez, J.(2010).Towards an intelligent wheelchair system for users with cerebral palsy.IEEE Transactions on Neural Systems and Rehabilitation Engineering,18,193-202.
19. Nilsson, L. M.,Eklund, M.(2006).Driving to learn: Powered wheelchair training for those with cognitive disabilities.International Journal of Therapy and Rehabilitation,13,517-527.
20. Nilsson, L. M.,Nyberg, P. J.(2003).Driving to learn: A new concept for training children with profound cognitive disabilities in a powered wheelchair.The American Journal of Occupational Therapy,57,229-233.
21. Nisbet, P. D.(2002).Assessment and training of children for powered mobility in the UK.Technology and Disability,14,173-182.
22. Ragonesi, C. B.,Chen, X.,Agrawal, S.,Galloway, J. C.(2010).Power mobility and socialization in preschool: A case study of a child with cerebral palsy.Pediatric Physical Therapy,22,322-329.
23. Schenker, R.,Coster, W.,Parush, S.(2005).Participation and activity performance of students with cerebral palsy within the school environment.Disability and Rehabilitation,27,539-552.
24. Sprigle, S.,Cohen, L.,Davis, K.(2007).Establishing seating and wheeled mobility research priorities.Disability and Rehabilitation: Assistive Technology,2,169-72.
25. Wiart, L.,Darrah, J.(2002).Changing philosophical perspectives on the management of children with physical disabilities: Their effect on the use of powered mobility.Disability and Rehabilitation,24,492-498.
26. Wiart, L.,Darrah, J.,Hollis, V.,Cook, A.,May, L.(2004).Mothers' perceptions of their children's use of powered mobility.Physical & Occupational Therapy in Pediatrics,24(4),3-21.
27. 周宜璟(2006)。國立臺灣師範大學特殊教育學系=National Taiwan Normal University。
28. 林珮如(2004)。國立陽明大學復健科技輔具研究所=National Yang-Ming University。
29. 林淑玟(2001)。e 世代的「無障礙」觀。特殊教育季刊，78，8-16。
30. 倪小平(2004)。國立屏東師範學院國民教育研究系=National Pingtung Teachers College。
31. 張欣如、廖華芳(2007)。痙攣型腦性麻痺兒童之痙攣處理及其療效。物理治療，32，138-146。
32. 鈕文英(2009)。教育研究方法與論文寫作。臺北=Taipei:雙葉=Yeh Yeh Book Gallery。

1. 洪儷瑜,王晴瓏(2021)。由身障學生的自我表達談特殊教育相關專業人員的服務思維。身心障礙研究季刊，19(1＆2)，11-24。
2. 孟瑛如、朱惠甄(2014)。資訊科技融入特殊教育現況與趨勢探討。特教論壇，17，52-71。