中風病患在不同狀況下維持坐姿平衡時軀幹生理性震顫之探討

The Physiology Tremor of Trunk in Different Condition with Sitting Balance Maintains at Stroke Patients

陳右杰(Yu-Chieh Chen)

指導教授 ： 王淳厚

中山醫學大學/醫學院/醫學研究所/碩士(2007年)

https://doi.org/10.6834/CSMU.2007.00050

摘要

人體的任一部位均存在不自主且連續之震顫。生理性震顫雖然很早就被發現，但因經常為人所忽視，相關的研究非常有限，是以在動作上的成因及形成的機制尚不十分清楚。但近來學者發現生理震顫高週期性之訊號與大腦皮質神經活動有高度的關聯性。因此，在目前生理性震顫被認為是探討大腦簡化動作控制程序上的重要線索。眾多研究將各種不同震顫特徵之辨認與臨床診斷作關連，但未將震顫量測使用於中風病患，並且生理性震顫的研究至今尚未有對頭頸、軀幹部份加以探討，因此，我們想要了解，生理性震顫對於靜態軀幹平衡之動作控制及軀幹與肢體間之協調扮演何種角色。材料與方法：33位中風之病患參與本研究，男性21位，女性12位。每位受試者均接受PASS-TC 量表、動、靜態坐姿平衡能力、動、靜態站姿平衡能力之評估以代表軀幹控制能力之程度。受試者坐在高腳椅上，將三軸加速規固定於受測者軀幹五個不同位置，在十二種姿勢擺位下收集二次加速規量測水平及垂直方向之震動訊號各二十秒。本實驗使用SPSS 11.0版之統計軟體。使用單因子變異數分析(univariate ANOVA)、重複量數多變異因子分析(repeated measures multiple ANOVA) 做多重比較分析，並以事後分析(Post-Hoc tests) 比較其差異程度。研究結果：不同支撐狀況在五個加速規的震顫平均均方根均有明顯差異(p<0.000)；

關鍵字

生理震顫 ； 中風 ； 坐姿平衡 ； 軀幹控制

並列摘要

Background：Each of body position have involuntary and continuous tremor. Physiology tremor found long ago but there were little relevant research. The origin cause of formation of Physiology tremor and mechanism of forming are not clear yet. Scholar recently found that the periodic signal of Physiology tremor has been closely related with cerebral cortex activity. Now Physiology tremor is the important clue that considered to probe into the brain simplifies control movements. Many studies apply the result of measure all kinds of physiology tremor to clinical diagnosis. But no one uses the form of tremor to assess the stroke patient. There are no study about Physiology tremor of head, neck and trunk yet. So, we wonder to know what role Physiology tremor is acted in static trunk control and coordination between trunk and limbs. Material and method: 33 stroke patients participate in this research, there are 21 man and 12 women. Each experimenter was assessed to PASS-TC scale, the ability of sitting/standing balance in static/dynamic state. The outcome of those evaluation represents the truck control ability. Experimenters sit on the high stool and Triple-axis accelerometers is fixed in five different parts of experimenter's truck. Experimenters under the 12 kinds of conditions and we collect Triple-axis accelerometers vibrations signals of competence and vertical direction for 20 seconds twice. This study uses SPSS 11.0 editions of statistics software. It uses univariate ANOVA and repeated measures multiple ANOVA for multiple comparative analysis. Then compare its difference outcome with Post-Hoc tests. Results：Different to support state have obvious difference average of root square (signal of tremor) in five triple-axis accelerometers (p<0.000). Air pillow condition cause five triple-axis accelerometers average of root square(signal of tremor) difference (α=0.000). Secondly, Eye condition in five triple-axis accelerometers average of root square (signal of tremor) do not have obvious difference in statistics. Three kinds of different postural pointing task have obvious differences in five triple-axis accelerometers average of root square. In three kinds of states ,raise one hand make Triple-axis accelerometers average of root square in frontal region have obvious difference in statistics (α= 0.004 and 0.006). Raise left hand have obvious difference in statistics for parameter of R' t inferior angle of scapular (α=0.013).
Raise left hand have obvious difference in statistics for parameter of L' t inferior angle of scapular (α=0.012). Raise the right hand has obvious difference in statistics for parameter of R' t PSIS (α=0.007). Discussion and Conclusion： This result of study shows that seatpad support surface and raise upper limbs will cause trunk tremor to obviously become severe to hemiplegia stroke patients in static sitting. But visual feedback has not influenced to hemiplegia stroke patients in static sitting balance. This tell us that the seatpad offers a firm support which have very great help and influence to stroke patient in sitting balance. Raise the hand can be a treatment program in sitting balance and activity of daily living in clinical therapy of Stroke patient. In order to understand the relationship between quantity of physiology tremor examines and trunk control ability, we propose to do more related studies abut normal person and other neural disease patient further.

並列關鍵字

Physiology Tremor ； stroke ； sitting balance ； trunk control

參考文獻

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