• 期刊

【論文摘要】Effectiveness of Hip Motor Control Training in Young Dancers With Ankle-Foot Injury

Background and Purpose: Ballet movement requires a great movement range and control of the hip joint. It has been shown that hip joint control bears an important role in balance strategy, and is associated with ankle-foot injury. However, few studies have assessed the differences in hip musculoskeletal characteristics between the injured dancers and healthy dancers, and the effectiveness of hip motor control training in dancers with ankle-foot injury. Therefore, the aim of this study was to compare the hip musculoskeletal characteristics between the dancers with and without ankle-foot injury, and to determine the effectiveness of hip motor control training on lower extremity muscle performance. Methods: Thirty-three young dancers with ankle-foot injury and 12 healthy dancers were enrolled. All participants received the measurement of muscle activation (gluteus maximus, gluteus medius, biceps femoris, rectus femoris, tibialis anterior, peroneal longus and soleus), compensated turnout, lower extremities muscle length and muscle strength. The multivariate analysis of variance (MANOVA) was used to compare differences in lower extremity musculoskeletal characteristics (muscle strength, muscle length and muscle activation) between the injured group and healthy group. The independent t-test was used to compare differences in compensated turnout between the injured and healthy group. Participants in the injured group were then randomized to either the hip motor control training group (experimental group [EG], n = 16) or the control group (CG, n = 17) and received 4 weeks of training (EG: hip motor control training, CG: regular training). The outcome measures were lower extremity muscle strength, muscle length, compensated turnout, and muscle activation during jump landing. Two-way repeated-measure ANOVAs were used to examine the intervention effect. A statistical significance was set at p ＜ 0.05. Results: The injured group demonstrated higher compensated turnout (47.36 ± 13.18 vs. 36.29 ± 12.62, p = 0.019), and lower gluteus maximum muscle activation compared to the healthy group (affected side 34.13 ± 9.83 vs. non-affected side 39.26 ± 11.09 vs. healthy group 41.35 ± 7.56, p = 0.046). The hip control training resulted in significant improvement in lower extremity muscle strength including affected side hip muscles and ankle dorsiflexors, and nonaffected side hip and ankle muscles and knee flexors. The experimental group also showed improved calf muscle length and rectus femoris muscle activation during jump landing (50.13 ± 14.88 vs. 51.52 ± 10.16, p = 0.026) compared to the control group after 4-week intervention. Conclusion: Young dancers with anklefoot injury showed bigger compensated turnout and lower gluteus maximus muscle activation compared to the healthy group. Hip motor control training was effective in improving lower extremity muscle strength. Clinical Relevance: Our results provide important information to help the design of intervention program for dancers with ankle-foot injury.

• 期刊

【論文摘要】肌電訊號回饋訓練於肩峰下夾擠族群做肩胛平面抬臂及功能性任務之效果

背景與目的：肩胛骨運動學(scapular kinematics)以及相關肌肉活性的改變被認為是肩峰下夾擠症候群(subacromial impingement syndrome)的可能機制，因此肩胛骨的控制在此族群的復健治療計畫中扮演重要的角色。而肌電訊號回饋 (electromyographic [EMG] biofeedback)可直接影響肌肉活性，進而引導患者對於肩胛動作控制的學習，但肌電訊號回饋對於肩胛骨動作的調控與肌肉活動層面的改善效果目前尚無定論。因此本實驗之目的為探討肌電訊號回饋對於肩峰下夾擠族群在執行肩胛平面抬臂以及功能性任務時，在肩胛骨運動學以及肌肉活性平衡比值(muscle activity balance ratios)的影響。方法：本實驗徵召20位肩峰下夾擠症候群伴隨肩胛骨動作異常（肩胛骨內側緣向後凸起）之受試者，進行三次肌電訊號回饋的訓練。並於三個時間點（訓練前、訓練後保留回饋、訓練後移除回饋）收集肩胛骨動作角度（內外轉、前後傾、上轉）以及肌肉活性平衡比值（上斜方肌／下斜方肌、上斜方肌／前鋸肌）做分析。結果：經由訓練後，對於肩胛骨內外轉以及前後傾的角度，在三個時間點下均無顯著差異。但上轉角度在抬臂60度（3.9度，p = 0.001）及90度（2.7度，p = 0.005）時，訓練後無論保留或移除回饋均顯著較訓練前減少。上斜方肌／下斜方肌比值於手臂上抬初期(1.6, p = 0.005)和下放中段(1.1, p = 0.005)，在訓練後移除回饋時較訓練前顯著降低，而上斜方肌／前鋸肌比值則是於手臂上抬超過30度(0.3, p ＜ 0.008)以及下放90度至120度(0.3, p ＜ 0.008)之間，訓練後均顯著較訓練前減少。結論：肌電訊號回饋可立即的影響肩峰下夾擠族群之肩胛骨動作及肌肉活性平衡比值。上斜方肌／下斜方肌和上斜方肌／前鋸肌的比值均獲得改善，然而肩胛骨上轉角度的減少，可能造成肩峰下空間的減少而導致夾擠現象。臨床意義：肩峰下夾擠族群的復健治療計畫，可使用肌電訊號回饋訓練立即改善肌肉活性平衡，但須留意肩胛上轉角度不足而引起更進一步的夾擠。

• 期刊

【論文摘要】Effect of Decompression Surgery on Postural Stability and Functional Performance in Patients With Cervical Spondylotic Myelopathy

Background and Purpose: Cervical spondylotic myelopathy (CSM) may develop postural instability due to compression of spinal cord. Decompression surgery is one of the treatment for CSM; however, whether the postural stability and the functional performance are improved after surgery is still unclear. This study was to examine the surgical effect on the postural stability and functional performance in CSM. Methods: Thirty-six patients with CSM (CSM group) and 26 healthy adults (healthy group) were recruited. Assessments were performed before surgery (baseline), 3 months (T3), 6 months (T6), and 12 months (T12) after surgery. All participants were asked to stand on a force plate for 35 seconds under eyes-open (EO) and eyes-closed (EC) conditions. The mean distance (MDIST) and mean velocity of the center of pressure (MVELO) were calculated. The 10-second step test and the lower extremity function of JOACMEQ (JOACMEQ-LL) were also assessed for functional performance. Results: In the EO condition, the MDIST and the MVELO were significantly decreased at T6 when compared to the baseline and T3. The MDIST was significantly higher in CSM group than in healthy group at baseline and at T3. The MVELO was significantly higher in CSM group than in control group at baseline, T3 and T12. In EC condition, both the MDIST and the MVELO were no significant difference between 4 time points. Both the MDIST and MVELO were significantly higher in CSM group than in control group before surgery at T3, T6 and T12. JOACMEQ-LL was significantly improved from T3 to T12, but the 10-second step test showed no difference after surgery. Conclusion: The functional performance was improved after surgery in CSM. The postural stability improved at the first 6 months, but was still unstable compared to the healthy people. Clinical Relevance: The postural stability of CSM is not fully recovered as healthy people. Therefore, the post-surgery patients need further intervention in balance training for optimizing the postural stability.

• 期刊

【論文摘要】腰椎手術對慢性下背痛患者的姿勢控制之影響－縱貫性研究

背景與目的：慢性下背痛(chronic low back pain)是指持續至少12個星期的下背部疼痛，其是接受腰椎手術中最常見之脊椎疾患。研究指出慢性下背痛患者與同齡之健康成人相比下，除了有功能受限、失能與疼痛症狀出現，也會伴隨姿勢 控制受損的問題。然而，目前對於患者接受腰椎手術後之姿勢控制改善的研究有限，因此本篇研究將探討腰椎手術後對於慢性下背痛患者的姿勢控制之長期影響。方法：本篇研究分為慢性下背痛組(n = 52)與健康成人控制組(n = 27)。所有慢性下背痛個案是經由神經外科醫師，依據影像檢查及症狀診斷患有腰椎滑脫、椎間盤突出或腰椎狹窄症之需接受腰椎手術患者。慢性下背痛組會分別在手術前與手術後3、6、12個月進行評估，而控制組只進行一次評估。評估項目包括姿勢控制能力、視覺類比量表(Visual Analogue Scale, VAS)、歐氏失能量表(Oswestry Disability Index, ODI)與羅蘭─摩理斯下背痛生活障礙問卷(Roland-Morris Low Back Pain Disability Questionnaire, RMDQ)。在姿勢控制能力測試部分，受試者須閉眼站在力板上完成以下兩種各35秒的測試項目：(1)雙腳與肩同寬站立及(2)雙腳併攏站立。在資料分析的部分，會計算壓力中心的位移速度(mean velocity of center of pressure)反應受試者的姿勢控制能力。結果：在姿勢控制能力部分，慢性下背痛組的受試者在執行兩個姿勢控制測試項目時，其壓力中心的平均位移速度在術後6個月與術前情況相比較，皆顯著下降，而術後12個月與術前則無顯著差異。再者，慢性下背痛組之姿勢控制能力不論是在術前或術後3、6、12個月皆明顯地比控制組差。此外，慢性下背痛組在術後3、6、12個月的視覺類比量表、歐氏失能量表與羅蘭─摩理斯下背痛生活障礙問卷，與術前相較之下皆有顯著進步。結論：本研究顯示慢性下背痛患者其症狀在腰椎手術後有顯著地改善，且其姿勢控制能力在術後6個月內也有進步，但在術後一年的進步幅度趨緩，且姿勢控制能力仍低於健康成人。臨床意義：慢性下背痛患者經腰椎手術後，雖下背痛之症狀皆有改善，但仍不及健康成人，尤其手術1年後姿勢控制能力趨近術前狀況，故建議及早進行術後平衡訓練與姿勢矯正以改善姿勢控制能力。

• 期刊

【論文摘要】Perturbation-Based Balance Training for Gait Performance in Patients With Cervical Spondylotic Myelopathy After Surgery

Background and Purpose: Cervical spondylotic myelopathy (CSM) is one of the most common degenerative disorders in elderly. Although after the management of surgery, patients may still demonstrate symptoms of clumsy gait, poor functional performance, and increased risk of fall. Thus, these patients might benefit from the perturbation-based balance training, which can improve the gait and functional performance. The purpose of this study was to investigate the effects of perturbation-based balance training using a custom-made treadmill on gait performance for patients with CSM after surgery. Methods: Nine participants aged between 40 to 80 years old, diagnosed with CSM were recruited into the study after six months of the surgery. All participants received the 4-week perturbation-based balance training using a custom-made treadmill once per week. A 3-D motion analysis system (VICON Nexus software, version 1.8.5, Oxford Metrics Ltd., Oxford, UK) was used to collect kinematic and kinetic data. The outcome measures for gait parameters included gait speed, stride length, and cadence; for functional parameters were the Neck Disability Index (NDI), and the Timed Up and Go (TUG) test. Results: Regarding to the gait parameters, only cadence increased significantly (p = 0.027), but the gait speed and stride length did not improve significantly (p = 0.055; p = 0.380). For the functional parameters, the time of TUG test significantly decreased (p = 0.021), but NDI showed no significant changes after the training (p = 0.595). Conclusion: The perturbation-based balance training had shown the potential for improving the gait performance in patients with CSM after surgery. However, insufficient sample size, the large within-group variance, and the rather long duration after surgery might be the limitations to detect statistical significant changes. Clinical Relevance: Our study provided important information about the potential balance intervention for gait impairments in patients with CSM after surgery.

• 期刊

【論文摘要】視覺導引對健康人與巴金森病患者步態起始預期性姿勢調整之影響

背景與目的：預期性姿勢調整(anticipatory postural adjustments, APA)是在主動動作產生前用來維持身體平衡的機制並與大腦基底核(basal ganglia)的調節有關，基底核病變的病人如巴金森氏病(Parkinson disease, PD)患者的APA異常被認為是步態起始(gait initiation)困難的機制。視覺導引常被用以治療PD患者步態起始但是否能影響APA則未知。本研究目的欲探討PD患者步態起始的APA變化以及視覺導引對PD患者APA之影響。方法：本研究為一個橫斷式研究(cross-sectional study)。招募10位健康受試者與10位PD患者在非藥物作用(off-states)時進行測量，使用GAITRite (CIR Systems Inc., Clifton, NJ, USA) 在舒適行走速度下紀錄行走步長，並以舒適行走步長之平均距離做一導引線表示步態起始需跨步之距離，透過患者步出力板(force plates)的第一步觀察步態起始的APA變化，包括APA的持續時間與足底壓力中心(center of pressure, COP)的前後(anterior-posterior, AP)以及左右(medial-lateral, ML)位移與位移速度(velocity)的變化。使用雙因子變異數分析(two-way analysis of variance, two-way ANOVA)進行比較各組間步態起始之APA變化，使用單因子變異數分析(one-way ANOVA)檢定視覺導引是否影響APA的改變。結果：視覺導引的使用可顯著降低PD的APA持續時間(p ＜ 0.05)，但健康受試者則不受影響(p ＞ 0.05)。PD的COP位移速度顯著低於健康受試者(AP, p ＜ 0.01; ML, p ＜ 0.01)。視覺導引可以增加兩組的COP前後位移量(p = 0.03)，但對COP的左右位移量與位移速度沒有效果(p ＞ 0.05)。結論：本研究發現PD患者表現出多個步態起始時的APA異常特徵。使用視覺導引可改善步態起始前的APA持續時間，但對其他如位移量與速度相關的APA異常沒有效果。臨床意義：對於PD的步態起始相關治療，單純提供視覺導引可能不足，未來應發展與APA左右位移量與位移速度相關的物理治療。

• 期刊

【論文摘要】健康成人於雙重任務測試的站立平衡與認知之再測信度

背景與目的：日常生活常同時執行動作與認知任務，此時容易因分心而跌倒，因此雙重任務能力的訓練與評估，對高跌倒風險族群如中風、巴金森氏症、老年人等非常重要。目前已有許多介入及評估皆納入雙重任務，但由於不同的評估方法無法進行效果比較，亦缺乏評估方法之再測信度，使前後測的結果無法排除隨機誤差的測量差異，及更具信度量測雙重任務能力。本研究目的為藉由測試與再測試，評估不同組合的認知─站立雙重任務之再測信度，以探討較佳測量一致性及較小測量誤差的雙重任務站立測試方式。方法：本研究共召募25名健康成年人（年齡：26.24 ± 7.55歲；7女18男），進行雙重任務測試與間隔一週的再測試，動作任務包括睜眼站在堅固地面及泡棉軟墊維持靜態站立平衡，認知任務包含簡單反應時間、選擇反應時間、史楚普(Stroop)、聽覺史楚普(auditory Stroop)、空間記憶及連續減三任務。站立平衡表現參數為搖晃係數，認知表現參數為正確率與反應時間之複合分數。相對信度指標為組內相關係數(intraclass correlation coefficient, ICC)，絕對信度指標為測量標準誤百分比(standard error of measurement%, SEM%)及95%信賴區間下之最小可偵測變化值百分比(minimal detectable change%, MDC95%)。結果：相對信度方面，堅固地面站立執行六項認知任務時的搖晃係數的相對信度為中等程度（ICC = 0.48至0.65）；堅固地面站立執行認知任務的複合分數之相對信度為中等至良好程度（ICC = 0.64 至0.88）。而泡棉軟墊站立執行六項認知任務的搖晃係數及認知複合分數的相對信度則皆為中等至良好程度（搖晃係數ICC = 0.58至0.84，認知複合分數ICC = 0.68 至 0.90）。絕對信度方面，堅固地面及軟墊站立執行認知任務的搖晃係數的絕對信度指標SEM%皆大於10%及MDC95%大於30%；但堅固地面及軟墊站立下執行空間記憶、視覺史楚普、及聽覺史楚普的複合分數之SEM%在10%以下且MDC95%在30%以下，均可被接受（堅固地面站立SEM%：3.50%至9.15%，MDC95%：9.72%至25.35%；軟墊站立SEM%：2.15%至9.31%，MDC95%：5.96%至25.82%）。結論：本研究顯示雙重站立任務於泡棉軟墊相較於堅固地面之搖晃係數有較好的相對與絕對信度，而認知複合分數的相對與絕對信度又比搖晃係數好。認知雙重任務站立平衡測試、站立時執行空間記憶、視覺史楚普及聽覺史楚普的認知複合分數，有良好的再測信度。臨床意義：良好再測信度之雙重任務站立評估可作為評估介入後雙重任務站立能力的改善效果。

• 期刊

【論文摘要】健康成人於雙重行走任務評估之再測信度

背景與目的：雙重任務為同時執行兩項任務，如邊走路邊講話。近年來雙重任務研究多應用於老年人及神經疾病患者，以改善其行走及認知功能為目標。但評估訓練成效應著重雙重任務能力，並比較單一與雙重任務表現之差異，可較全面評估整體行走能力。行走時執行不同認知任務可能產生不同干擾。因此，於雙重行走任務評估時使用測量一致性較高之行走及認知任務甚為重要。本研究目的為比較不同雙重行走任務評估之相對及絕對信度。方法：25位健康成人（26.24 ± 7.55歲；18男7女）參與研究。10 m行走測試分為一般速度及快速行走。認知任務包含簡單反應時間、連續往後減三、史楚普(Stroop)、聽覺史楚普(auditory Stroop)、空間記憶、及選擇反應時間等六項測試。所有測試皆重複評估，包括測試及一週後再測試。主要成效評估於行走表現為行走速度；認知表現為回答正確率及反應時間之複合分數；次要成效評估為雙重任務虧損值。成效評估的相對信度以組內相關係數(intraclass correlation coefficient, ICC)表示。行走速度與認知複合分數的絕對信度以測量標準誤百分比(standard error of measurement%, SEM%)、95%信賴區間下最小可偵測改變值百分比(minimal detectable change%, MDC95%)、及布蘭德—奧特曼分析(Bland-Altman analysis)表示。結果：於一般行走速度下同時執行認知任務，除空間記憶測試之外(ICC = 0.73)，同時執行其餘五種認知任務的行走速度皆有良好程度之相對信度(ICC ＞ 0.75)；且行走速度的絕對信度皆為可接受(SEM% ＜ 10%, MDC95% ＜ 30%)。以布蘭德—奧特曼分析顯示皆無系統性誤差。雙重任務一般速度行走的認知複合分數之相對信度僅連續往後減三測試及史楚普測試有較佳相對信度(ICC ＞ 0.80)；在絕對信度方面，僅史楚普測試的認知複合分數為可接受(SEM% = 3.63%, MDC95% = 10.06%)，且無系統性誤差。於雙重任務快速行走下，行走速度之相對信度在所有雙重任務情境下皆為良好程度(ICC ≥ 0.75)；行走速度的絕對信度顯示皆為可接受(SEM% ＜ 10%, MDC95% ＜ 30%)；布蘭德—奧特曼分析顯示除簡單反應時間測試外，快走同時執行其餘五種認知任務的行走速度皆無系統性誤差。雙重任務快走下認知複合分數的相對信度僅簡單反應時間及連續往後減三測試較佳(ICC ＞ 0.75)，考量絕對信度後僅簡單反應時間測試較佳(SEM% = 8.4%, MDC95% = 23.29%)。雙重任務虧損值以行走及認知面向之相對信度皆屬中等程度(ICC = -0.44 ~ 0.74)。結論：執行雙重行走任務評估時應優先以行走速度為主要測量參數，並配合史楚普、連續往後減三、及空間記憶測試，可有較佳測試一致性及穩定性。臨床意義：發展具良好再測信度之雙重行走任務評估以檢測介入後成效。

• 期刊

【論文摘要】表面電剌激對慢性下背痛鎮痛療效的系統性回顧和統合分析

背景與目的：慢性下背痛是物理治療常見的慢性疼痛之一。目前臨床上廣泛使用表面電刺激(surface electrical stimulation, SES)治療慢性下背痛患者，且先前研究建議電刺激為物理治療運動的輔助療法，但表面電刺激療效仍然是未知的。本研究藉由探討單獨使用表面電刺激對慢性下背痛患者或表面電刺激輔助運動療法對疼痛的改善情形。方法：本篇研究使用CINAHL、Medline、PubMed、SDOL、Scopus等9個資料庫，以電刺激(electrical stimulation)與背痛(back pain)作關鍵字搜尋後，進一步平行使用：(1)下背部肌肉關鍵字群組，如：多裂肌(multifidus)等、(2)電刺激種類關鍵字群組，如：經皮電神經刺激(transcutaneous electrical stimulation; TENS)等、(3)電刺激參數關鍵字群組，如：可忍受的(tolerant)等，搜尋後加總。搜索至2017年12月已發表的文章。結果：經主題或摘要檢視篩選後共獲得7篇。其中單獨使用SES有6篇，這6篇中有2篇排除，僅4篇文獻納入統合分析。使用SES輔助運動療法有2篇，有1篇排除。結果顯示單獨使用表面電刺激比較控制組或安慰劑組的疼痛改變在視覺類別量表（0 ~ 10分）上的標準差平均值改變差為-1.34分，95%信賴區間為-2.16分至-0.52分，達統計上顯著差異，證據強度為B等級。在次組群分析的部分，使用經皮神經電刺激比較控制組或安慰劑組的疼痛改變效果顯示標準差平均值改變差為-1.9分，95%信賴區間為-2.75分至-0.15分，達統計上顯著差異，證據強度為B等級。單獨使用神經肌肉電刺激或使用表面電刺激輔助運動療法因只有1篇文獻而無法從事統合分析。結論：單用表面電刺激治療慢性下背疼痛具有證據B等級的改善效果，進一步分析顯示單用經皮電神經刺激治療慢性下背疼痛具有證據B等級的改善效果。單用神經肌肉電刺激或表面電刺激輔助運動療法的疼痛改善效果則需更多研究證據確認。所有文獻的研究品質仍然需要提升，未來需進一步以品質佳的實驗設計研究不同種類表面電刺激應用於慢性下背痛鎮痛的療效。臨床意義：慢性下背痛患者單用表面電刺激的介入可以降低疼痛不適感，但其輔助運動療法的效果需要更多研究證據，表面電刺激可建議為慢性下背痛物理療法鎮痛的選擇之一。

• 期刊

【論文摘要】急性腦傷老年住院患者PASS與身體功能表現之關係

背景與目的：腦傷是老人急性住院及失能的主要原因之一。急性住院的老人是功能衰退的高危險群。功能退化會伴隨不良的預後，如：長期無法達到生活獨立、增加入住機構或復健病床的機會或需求、增加死亡率。住院患者的重要治療目標之一是能達到日常生活功能(activities of daily living, ADL)或步行之獨立。在急性住院階段如能預測未來患者ADL或步行恢復的狀況，有助於醫療人員規劃合適的醫療照護計畫及出院後照顧計畫之安排。過去研究發現中風患者姿勢評估量表(Postural Assessment Scale for Stroke Patients, PASS)與患者日後步行能力與ADL恢復有關，但沒有僅針對老人族群的驗證，且對於住院期間PASS改變的相關因子的探討也有限。本研究之目的在探討急性腦傷老人住院患者，入院時的PASS得分與入院及出院時身體功能（ADL與步行速度）的關係及與住院期間PASS改變的相關因子。方法：2017年9月1日起到2017年12月31期間在某醫學中心急性病房的物理治療室收案，以醫師轉介物理治療的神經內外科患者且年滿65歲為收案對象，排除下列情況者：認知混淆，無法溝通或遵從指令、接受安寧療護者、病情惡化轉加護病房者、等待轉長照機構者。共23名符合條件，在取得同意及簽署同意書後，蒐集基本資料，入院及出院時PASS量表、步行速度(usual gait speed, UGS)、及ADL的評估。結果：入院的PASS分數與入院及出院的ADL (r = 0.72 ~ 0.77)及UGS (r = 0.591 ~ 0.56)有正相關。住院期間PASS的改變量也與ADL (r = 0.66)及UGS (r = 0.42)的改變量呈正相關。住院期間PASS的改變與慢性病負擔(Charlson comorbidity index, CCI)呈負相關(r = -0.42)。結論：在急性腦傷住院的老人患者，入住時的PASS與入住及出院的ADL及UGS相關，住院期間PASS改變量也與ADL、UGS改變量相關。CCI高者，住院期間PASS的改變量少。臨床意義：PASS可反應急性腦傷老年住院患者入院及出院時的功能(ADL, UGS)狀態(MOST 106-2314-B-040-019-)。