以鏡像療法合併電刺激改善中風後動作與日常生活功能的安慰劑對照試驗

Improving motor and daily functions after stroke using mirror therapy combined with mesh-glove electrical stimulation: a placebo-controlled trial

廖瑾華(Ching-Hua Liao)

指導教授 ： 林克忠

國立臺灣大學/醫學院/職能治療研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.01943

摘要

目的：比較鏡像療法合併電刺激、鏡像療法合併安慰劑刺激及鏡像療法對慢性中風患者感覺動作功能、日常生活功能和動作控制的療效。
設計：隨機分派，前測後測比較，安慰劑控制組試驗
環境：10家醫院
受試者：44位慢性中風門診個案，動作損傷程度位於中度至重度。
介入：每週五天，每天1.5小時，為期四週的療程。
成效評量：主要評估工具包含傅格-梅爾動作評估量表（Fugl-Meyer Assessment）、沃夫動作功能測驗（Wolf Motor Function Test）、功能獨力量表之動作項目（motor items of Functional Independence Measure）、運動學分析；次要評估工具為修訂版諾丁漢感覺動作評估量表（revised Nottingham Sensory Assessment）、十公尺步行測驗（10-Meter Walking Test）。採用疲勞視覺類比量表（Visual Analogue Fatigue Scale）來監測各種療法的副作用。
結果：四周治療後，所有組別在傅格-梅爾動作評估量表總分和修訂版諾丁漢感覺動作評估量表總分均有顯著進步。鏡像療法合併電刺激組在沃夫動作功能測驗的表現時間（performance time）和十公尺步行測驗的步長（stride）有顯著的組內差異。鏡像療法合併電刺激組和鏡像療法合併安慰劑刺激組在功能獨力量表之動作項目的轉位（transfer）和移行（locomotion）顯著優於鏡像療法組。感覺復原方面，修訂版諾丁漢感覺動作評估量表的溫度覺和辨位覺有高度效果值，但樣本數較小（N = 23）。運動學方面，鏡像療法合併電刺激組在尖峰速度和達終端尖峰速度所占時間百分比有較佳的療效。鏡像療法合併安慰劑刺激組在沃夫動作功能測驗的表現時間、十公尺步行測驗的步長及功能獨力量表之動作項目的轉位和移行有優於鏡像治療的趨勢。
結論：鏡像療法合併全手型感覺電刺激是可行的，並且在改善慢性中風患者的動作功能、動作控制和日常生活功能有較佳的療效。未來需要收入更大的樣本數來探討鏡像療法合併電刺激在感覺復原的療效。在符合倫理的狀況下，臨床上可使用安慰劑治療來誘發安慰劑效應。

關鍵字

鏡像治療 ； 感覺電刺激 ； 中風神經復健 ； 安慰劑對照試驗 ； 安慰劑效應

並列摘要

Objective: To compare the effects of mirror therapy combined with mesh-glove stimulation (MGS), mirror therapy with placebo stimulation (MTP), and mirror therapy (MT) on sensorimotor functions, daily functions and motor control for patients with chronic stoke.
Design: A randomized, pretest-posttest, placebo-controlled trial
Settings: Ten hospitals
Participants: Outpatients with chronic stroke (N = 44) with sever to moderate motor impairment.
Interventions: The MGS group received mirror therapy program combined with mesh-glove stimulation. The MTP group received mirror therapy program combined with placebo stimulation. The MT group received mirror therapy program. The intensity for both groups was 1.5 hours/day, 5 days/week, for 4 weeks.
Main measures: Primary outcomes were Fugl-Meyer Assessment (FMA), Wolf Motor Function Test (WMFT), motor items of Functional Independence Measure (FIM), and kinematic analysis. Secondary outcomes were revised Nottingham Sensory Assessment (rNSA), 10-Meter Walking Test (10MWT). Visual Analogue Fatigue Scale (VAFS) was used to detect adverse effects of each treatment.
Results: After four week treatment, all groups significant improved on overall FMA scores and overall rNSA scores. MGS showed better outcome on WMFT Time and 10MWT. MGS and MTP had significant improvement on transfer and locomotion subscale of FIM than MT. In rNSA, temperature sense and localization sense had large effect size, however, the sample size (N = 23) was small. In kinematic analysis, MGS tend to improved more on PV and PPV. There is a trend that MTP improved more than MT on WMFT Time, 10MWT, and transfer and locomotion subscale of FIM.
Conclusions: Mesh-glove stimulation is feasible to combine with mirror therapy. The application of MGS after stroke might result in beneficial effects on motor functions, motor control, and daily functions. A larger sample size is needed to explore the effects of MGS on improving sensory recovery. Ethical use of placebo treatments could be delivered in the clinic to stimulate placebo effects.

並列關鍵字

mirror therapy ； somatosensory electrical stimulation ； stroke neurorehabilitation ； placebo-controlled trial ； placebo effect

參考文獻

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