急性與亞急性中風患者的上肢痙攣問題與功能性表現之相關性探討

The Correlation between Spasticity of Upper Limbs and Functional Performance in Acute and Subacute Stroke Patients

徐宛伶(Wan-Ling Hsu) ； 黃珮榕(Pei-Jung Huang) ； 張維修(Wei-Hsiu Chang) ； 馮紀慈(Chi-Tzu Feng)

《台灣復健醫學雜誌》 46卷1期 (2018/06) Pp. 19-25

https://doi.org/10.6315/TJPMR.201806-46(1).03

摘要

本研究嘗試探討急性與亞急性中風患者的上肢痙攣程度與其動作功能、生活獨立程度與生活品質的相關性。本研究採方便取樣，納入本醫院之急性與亞急性中風患者22位，使用改良式艾斯渥氏量表(Modified Ashworth Scale, MAS)、傅格－梅爾評估量表(Fugl-Meyer Assessment, FMA-UE)、木箱與積木測驗(Box and block test, BBT)、功能獨立量表(Functional Independence Measure, FIM)，與中風影響量表(Stoke Impact Scale, SIS)等工具來進行全面性的評估，以了解患者的痙攣程度、上肢動作功能、生活獨立性與生活品質表現，並使用相關性分析來探討痙攣程度與各參數間的相關性。結果顯示，上肢痙攣表現(MAS)與上肢動作表現(FMA-UE、BBT)，以及SIS生活品質問卷的肌力、手部功能分項有顯著的負相關存在(p＜0.5)；MAS 與生活獨立性(FIM)則無顯著相關存在。事後根據參與者痙攣表現分組也可發現無痙攣～輕度痙攣者的上肢動作功能也明顯較中度～嚴重痙攣者佳，表示上肢痙攣問題可能會影響中風患者的動作功能，以及動作相關的生活品質表現，應將其納入復健計畫中。結論：急性與亞急性中風患者的上肢痙攣表現與其動作表現，以及上肢相關生活品質分項有顯著負相關存在，顯示上肢痙攣問題會影響其動作表現；上肢痙攣對於生活獨立性的影響則須未來研究進一步探討。

關鍵字

相關性(correlation) ； 急性與亞急性中風患者(acute and subacute stroke patients) ； 上肢痙攣(upper limbs spasticity) ； 改良式艾斯渥氏量表(Modified Ashworth Scale) ； 功能性表現(functional performance)

並列摘要

Objective: This study attempted to investigate the correlation between severity of spasticity and functional recovery in acute and subacute stroke patients. Methods: A total of 22 acute and subacute stroke patients were analyzed. Methods used to evaluate outcomes included Modified Ashworth Scale (MAS) for assessing upper limbs spasticity; Fugl-Meyer Assessment (FMA-UE), Box and Block Test (BBT) for assessing the motor ability of upper limbs; Functional Independence Measure (FIM) for assessing independent of daily life, and Stoke Impact Scale (SIS) for evaluating the quality of life. Results: Correlation was found between MAS and FMA-UE (p=.01), BBT (p=.02) and two subtests of SIS (strength and hand function, p=.035 and p=.013). The subgroup of no spasticity~mild spasticity had better motor performance than the subgroup of moderate~severe spasticity. There was no signifficant coorelation between MAS and FIM. Conclusion: spasticity of upper limbs in acute and subacute stroke patients could influence their upper motor ability and their quality of life. It is necessary to consider the spasticity problem in the rehabilitation progroms.

並列關鍵字

correlation ； acute and subacute stroke patients ； upper limbs spasticity ； Modified Ashworth Scale ； functional performance

參考文獻

11. Hsu W, Lien YC, Chang WH, et al. A Preliminary Evaluation on the Correlation between Severity of Hand Spasticity and Functional Recovery in Chronic Stroke Patients. Tw J Phys Med Rehabil 2015;433: 181-9.

15. Hsu WL, Chang WH, Lien YC, et al. The Effect of a Hand-Stretching Device on Hand Spasticity in Chronic Stroke Patients. Journal of Occupational Therapy Association R.O.C. 2015;33:98-117.

1. Brainin M. Poststroke spasticity: Treating to the disability. Neurology 2013;80:S1-4.

2. Zorowitz RD, Gillard PJ, Brainin M. Poststroke spasticity: sequelae and burden on stroke survivors and caregivers. Neurology 2013;80:S45-52.

3. Kong KH, Lee J, Chua KS. Occurrence and temporal evolution of upper limb spasticity in stroke patients admitted to a rehabilitation unit. Arch Phys Med Rehabil 2012;93: 143-8.