跑步機行走對中風患者下肢恆定性步態表現之影響

Effect of Treadmill Walking on the Lower Extremity Certainty of Gait Performance in Stroke Patients

陳世銘(Shih-Ming Chen) ； 黃英修(Ing-Shiou Hwang) ； 陳嘉炘(Chia-Hsin Chen) ； 蕭世芬(Shih-Fen Hsiao) ； 林昭宏(Jau-Hong Lin)

《物理治療》 30卷3期 (2005/06) Pp. 116-123

摘要

背景與目的：本研究的目的是探討跑步機訓練模式對中風患者下肢肌群之肌電訊號恆定性的影響。方法：本研究主要徵召5位中風患者為實驗組及10位正常受試者為對照組，採用基準(baseline)－介入干擾(intervention)－移除干擾(withdraw) (A-B-A)的實驗方式，介入干擾為改變速度（二倍自選舒適速度）。受試者個別進行12分鐘訓練模式，包含4分鐘的基準階段、4分鐘介入干擾階段及4分鐘移除干擾階段。過程中連續記錄雙側下肢經前肌(tibialis anterior)及內側腓腸肌(medial gastrocnemius)之表面肌電訊號，轉換為近似熵值(Approximate Entropy, ApEn)，用以說明肌肉誘發型態恆定性之意涵並且觀察適應現象。兩組間不同階段之間差異性使用多變項變異數分析檢測。結果：中風患者與正常人脛前肌與內側腓腸肌恆定性顯示出不同變化的趨勢：中風患者脛前肌肌電訊號熵值變化有增加的趨勢，即肌肉收縮變異性隨速度增加而變大。然而，兩者內側腓腸肌恆定性表現相對穩定。整體而言內側腓腸肌恆定性和適應現象皆較脛前肌明顯。結論：本研究初步結果可以提供做為探討中風病患跑步機步行訓練的參考指標。

關鍵字

跑步機訓練 ； 中風 ； 步態 ； 恆定性 ； 近似熵值

並列摘要

Background and Purpose: The purpose of this study was to examine the influence of treadmill walking on the lower extremity certainty of gait performance in stroke subjects. Methods: Five stroke patients and 10 healthy subjects were recruited for this baseline- intervention-withdraw (A-B-A) study. The intervention was two-fold of the self-selected free comfortable speed. Subjects were asked to perform 12 minutes' walking on treadmill once they were familiar with the environment and protocol, including 4-minute baseline, 4-minute intervention, and 4-minute withdraw phases. The surface electromyographic (SEMG) profiles of the bilateral anterior tibialis (TA) and medial gastrocnemius (MG) were simultaneously recorded and then converted into Approximate Entropy (ApEn) in terms of the certainty of muscle firing patterns and adaptation phenomenon. Multivariate analysis of variance was used to examine the ApEn differences among phases for two groups. Results: The trends of the certainty variation of TA and MG differed between stroke patients and normal subjects; the increase of ApEn of TA for the stroke patients indicated that faster speed induced TA variability. However, the trends of the MG certainty variation were relatively stable. In general, the certainty variation and adaptation phenomenon of MG were more consistent than those of TA. Conclusion: The preliminary results of this study may provide a new reference on treadmill ambulatory training for stroke patients.

並列關鍵字

Treadmill training ； Stroke ； Gait ； Certainty ； Approximate Entropy