頸痛患者坐姿向前取物的上半身動作策略

Upper Body Movement Strategies During Sitting Forward Reaching in Subjects With Neck Pain

羅德祥(Te-Hsiang Lo) ； 施怡芬(Yi-Fen Shih)

《物理治療》 44卷2期 (2019/06) Pp. 37-52

https://doi.org/10.6215/FJPT.201906_44(2).0001

摘要

背景與目的：本篇研究目的為探討頸痛於執行坐姿向前取物任務時，上半身關節動作角度、起始時間及協調性之影響。方法：本研究收取20位慢性頸痛患者（12男，8女；30.35 ± 10.02歲）及20位年齡、性別配對的健康受測者（29.95 ± 10.34歲）。電磁場動作軌跡儀記錄坐姿執行簡單（無負重，正常速度）和困難（負重2 kg、快速）向前取物任務時的運動學資料。關節動作範圍、關節動作的交叉相關性係數及時間延遲，以二因子重複測量變異數分析；關節動作起始時間以三因子重複測量變異數分析。結果：坐姿向前取物主要以肩屈曲（80.64°）和髖屈曲（19.23°）來完成；腰椎最先啟動，肩部最慢啟動。腰椎以外，各關節動作呈現一致的互動關係。困難取物任務時，頸痛患者呈現較不協調的頭頸部矢狀面動作和肩胛骨冠狀面動作（-0.94 ± 0.12，p = 0.03）。關節動作及起始時間無組間差異或交互作用。結論：頸痛患者呈現肩胛骨動作控制偏差的現象。因此，除了頭頸部之外，肩胛骨區動作策略評估也相當重要的。

關鍵字

頸痛 ； 動作策略 ； 運動學 ； 肩胛

並列摘要

Background and Purpose: Poor alignment has been suggested as a contributing factor for neck pain. Researchers have identified altered spinal control in both the head-neck and the thoracolumbar regions in individuals with neck pain. However, the movement coordination between various segments of the spine has not been investigated thoroughly. Therefore, the purpose of this study was to examine and compare the upper body movement patterns in individuals with and without neck pain during the sitting forward reach task. Methods: Twenty patients with chronic neck pain (12 males and 8 females, 30.35 ± 10.02 years old) and 20 age- and gender-matched control subjects (29.95 ± 10.34 years old) were recruited. Participants were asked to perform the sitting forward reach tasks under 2 conditions: simple reaching condition (2 sec to reach the target, without extra load) and difficult reaching condition (1 sec to reach the target, with 2 kg hand load). Three-dimensional kinematic data of the head/neck, thoracic spine, lumbar spine, sacrum, femur, scapula, and humerus were recorded by Liberty Electromagnetic Tracking System during these 2 reaching conditions. Joint angular motion, joint onset latency, and temporal coordination were analyzed and compared between the 2 groups using repeated measures analysis of variance (ANOVA). The level of significance was set at α = 0.05. Results: Subjects used mainly the shoulder (80.64°) and hip (19.23°) motion to complete the forward reach task. Lumbar spine motion preceded the head/neck, thoracic, hip, and scapular motion, and the shoulder joint was the last to move in both reaching conditions in both groups. Subjects with chronic neck pain demonstrated less coordinated pattern between head flexion/extension and scapular upward/downward rotation in the difficult reaching condition (maximal cross correlation = -0.94 ± 0.12, p = 0.03). No significant difference was found in joint movement range and timing of movement initiation between subjects with and without chronic neck pain. Conclusions: Individuals with chronic neck pain exhibited a different movement control strategy in the head/neck and scapula regions during the sitting forward reaching task, which should be taken into account when assessing this group of patients.

並列關鍵字

Neck pain ； Movement strategy ； Kinematics ； Scapula