• 期刊

【論文摘要】Effects of High-Intensity Interval Training and Moderate- Intensity Continuous Training on Circulating MicroRNAs in Sedentary Males

Background and Purpose: Circulating microRNAs (c-miRs) serve as the reliable biomarkers for intracellular mediators of processes inherent in exercise adaptation. The present study aimed to clarify the relationships between changes of c-miRs expressions and aerobic capacity/hemodynamic functions caused by various exercise regimens in men. Methods: Twenty-four healthy sedentary males were randomly engaged in either high-intensity interval training (HIIT, 3-minute intervals at 40% and 80% of VO_(2max), n = 12) or moderate-intensity continuous training (MICT, sustained 60% of VO_(2max), n = 12) for 30 minutes/day, 5 days/week for 6 weeks. Various c-miRs involved in angiogenesis (miR-126), cardiac hypertrophy (miR- 222, miR-221), and hypoxia/ischemia adaptation (miR- 21, miR-146a) were measured by quantitative real time polymerase chain reaction (qRT-PCR), respectively. Results: The analyzed results showed that both 6-week HIIT and MICT significantly enhanced VO_(2max), which were accompanied by increased stroke volume and cardiac output during exercise. Moreover, both HIIT and MICT increased expressions of miR-126 (1.49 ± 0.03 and 1.27 ± 0.09 folds) and miR-222 (1.32 ± 0.10 and 1.25 ± 0.15 folds), respectively. Furthermore, HIIT elevated miR-146a expression (1.33 ± 0.09 folds), whereas MICT upregulated miR-21 (1.32 ± 0.08 folds). However, no significant changes in plasma miR-221 level was occurred after both HIIT and MCT. Conclusion: We conclude that the exercise-induced cardiovascular adaptions are associated with the changes of angiogenesis/inflammation-related c-miRs following either HIIT or MICT. Clinical Relevance: We expect that this study can aid in determining appropriate exercise intervention for simultaneously improving aerobic fitness.

• 期刊

【論文摘要】Circulating MicroRNAs Response After Exercise-Induced Muscle Damage

Background and Purpose: Intense exercises lead to decreasing muscle strength, thus depressing exercise performance. Circulating microRNAs (c-miRs) may control muscle synthesis and recovery following intense exercises. Our study aimed to find the relationships between c-miR responses and muscular fatigue after the exercise-induced muscle damage test. Methods: Fifteen healthy sedentary males were enrolled, and then involved the exercise-induced muscle damage test (i.e., quadriceps muscle concentric and eccentric contractions to fatigue) in isokinetic dynamometry. The levels of various c-miRs stand for inflammatory thrombosis (miR-21, miR- 150), muscular damage (miR-146a, miR-499a), and vascular endothelial function (miR-221, miR-222) were measured by quantitative real time polymerase chain reaction (qRT-PCR), individually. Results: Our results showed that the concentrations of miR-21, miR-150, miR-146a, miR-499a, miR-221, and miR- 222 in plasma were significantly increased 4 h after the exercise-induced muscle damage test. Nevertheless, the levels of muscular fatigue-related c-miRs reversed back to the baseline 24 h after the exercise-induced muscle damage test. Conclusion: Consequently, we conclude that the c-miRs related to inflammatory thrombosis, muscular damage, and endothelial function may serve as the novel indicators of muscle damage caused by the exercise-induced muscle damage test. Clinical Relevance: Our results provide important information to help rapid screening for individual muscle-fatigue characteristics.

• 期刊

【論文摘要】應用智慧型行動裝置對於唐氏症之平衡障礙檢測

背景與目的：平衡障礙是神經疾病患者高跌倒風險之常見因素，在臨床對於易跌倒之高風險族群中，如能使用檢測平衡功能和跌倒風險的工具，對於預防或減少跌倒的發生率將甚為重要。然而，客觀的平衡檢測需要昂貴的設備和臨床專業知識，對於高跌倒族群之平衡功能之評估方法仍然有所缺陷。隨著穿戴式行動裝置的發展，或許能利用智慧型行動裝置來量化平衡損傷之參數。本研究目的為檢測智慧型行動裝置是否可以在不同平衡狀態下，有效的量測姿勢穩定性以及生物力學參數。方法：本研究徵招39名唐氏綜合症兒童（27男生和12女生；平均年齡 ± 標準差為17.15 ± 0.9歲）並完成了四項平衡測試任務。在受試者進行平衡測試時，我們同時收集智慧型手持行動裝置和力板之各項力學參數，並計算兩者數據知相關性。結果：在比較力板所收取之數據後發現智慧型行動裝置在路徑長度、95%橢圓面積、峰對峰值、標準差與平均值的相關係數(r^2)落在0.60 ~ 0.99之間。結論：我們發現智慧型行動裝置能提供準確的力學參數來量化唐氏症之姿勢穩定性數值。臨床意義：藉由智慧型行動裝置的客觀性、便利性和容易攜帶等因素，此方式或許能成為在臨床環境中檢測平衡功能之工具，進而降低唐氏症或其他神經病患跌倒的風險。

• 期刊

【論文摘要】頸痛患者其顳頷關節失能之初步探討

背景與目的：顳頷關節病變可影響顳頷關節及周邊組織，也可能伴隨頸部失能的現象。但頸部疼痛及失能者是否出現顳頷關節失能的相關研究仍然有限。因此，本研究主要目的欲以臨床功能評估探討頸痛患者潛在之顳頷關失能的程度與分 類。方法：本研究為以20歲以上的成年人為對象，依自述頸部疼痛之有無，分為頸痛組與無頸痛組。評估測量項目包括以視覺類比量表(Visual Analogue Scale, VAS)及壓覺疼痛閾值進行評估頭頸部疼痛及敏感程度；頸部失能量表(Neck Disability Index, NDI)評估頸部失能程度；顳頷關節失能診斷標準評估量表進行顳頷關節失能的相關評估及分類，包括臨床評估與症狀問卷、下頷功能、並進行五分鐘動態咀嚼耐力測試。統計分析以描述性統計如平均值及標準差，並進行Mann-Whitney分析兩組間的差異。結果：共計納入受試者10位（5女5男），其中頸痛組（3女2男，平均身高167.1 ± 11.3 cm、體重66.4 ± 17.4 kg及年齡24.0 ± 2.9歲），自述其頸痛程度為VAS平均3.9 ± 1.3分，平均疼痛發生時間10.8 ± 5.0月，並伴有輕度頸部失能（NDI平均7.3 ± 3.2分）。頸痛組經評估發現四位出現顳頷關節失能的現象，其中一位屬於顳頷關節失能，一位屬於疼痛失能，有兩位為混合型失能。然而無頸痛組（2女3男，平均身高166.6 ± 6.5 cm、體重61.8 ± 8.6 kg及年齡23.0 ± 1.9歲）中僅有一位為混合型的顳頷關節失能。在下頷功能限制方面，頸痛組大於無頸痛組（頸痛者：平均1.0 ± 1.2分；無頸痛者：平均0.2 ± 0.3分），但無達到顯著差異。在生理症狀中則僅有一位頸痛者出現中度症狀。頸痛組中有兩位出現憂鬱及焦慮情況，並有一人達到中等程度。而無頸痛組超過半數有輕度憂鬱情況，兩位出現輕度焦 慮。在壓覺疼痛閾值方面，兩組間肌肉施測點閾值皆無顯著差異，頸痛組以左側顳頷關節閾值為最低（平均1.77 ± 0.67 kg/cm^2），而無頸痛組在右側咬肌閾值為最低（平均1.68 ± 0.44 kg/cm^2）。不論頸痛之有無，上斜方肌閾值都較其他施測點高。僅有一位頸痛者無法完成五分鐘咀嚼測試。結論：輕度頸部失能的頸痛患者可能會伴隨不同類型的顳頷關節失能。大部分參與者均無咀嚼耐力的問題。頸痛之有無尚無影響頭頸區域的壓覺疼痛閾值。因此，仍需要進一步研究。臨床意義：本研究之發現可提供頸痛患者其顳頷關節評估之參考。

• 期刊

【論文摘要】Effects of Kinetic Chain Exercise Intervention on Pain and Motor Performance in Volleyball Players With Scapular Dyskinesia: A Pilot Study

Background and Purpose: Shoulder is the 3rd-most commonly injured segment in volleyball players, with the majority resulting from chronic overuse. Since the scapula is both the base of upper extremity and the linkage between upper trunk, its abnormal position and movement could lead to dyskinesia (SICK scapula), causing further shoulder girdle injuries (e.g., instability and impingement). Therefore, scapular motor performance (including kinematics, muscles' activation and movement consistency) is critical for volleyball players, especially in those with scapular dyskinesia. This pilot study aimed to investigate between-days intra-rater reliability and compare scapular movement consistency in 30-spike task between players with and without scapular dyskinesia and shoulder pain. Methods: Ten subjects were recruited mainly from universities in Taipei. According to their symptoms and signs, evaluation of physical therapist would confirm the criteria and then divided them into scapular dyskinesia with shoulder pain group (SDG, 3 males and 3 females, age: 22.17 ± 2.32) and healthy group (HG, 3 males and 1 female, age: 23.50 ± 1.00). Subjects would execute a 30-spike task after warm-up and maximal voluntary isometric contraction (MVIC) test. The electromagnetic wireless tracking system (LIBETYTM, Polhemus, Colchester, VT, USA) and the wireless surface electromyographic (sEMG) system (TeleMyo 2400T G2, Noraxon USA Inc., Scottsdale, AZ, USA) were used to collect kinematics and muscle’ activation data respectively. The proprioceptive feedback magnitude (PFM) was calculated for measuring scapular movement consistency. The data at timing of maximal shoulder flexion during spikes was analyzed. Results: The between-days intra-rater reliability were all good, including in scapular anterior tilt, internal rotation, upward rotation (ICC = 0.87, 0.93 and 0.93, respectively), and in upper trapezius, lower trapezius, serratus anterior (ICC = 0.96, 0.93 and 0.97, respectively). Additionally, SDG showed poorer scapular movement consistency (19.42° ± 7.56°) than HG (10.45° ± 3.59°) (p = 0.03). Conclusion: The between-days intra-rater reliability were good in both scapular kinematics and sEMG. Volleyball players with scapular dyskinesia and shoulder pain showed poorer scapular movement consistency than healthy players in 30-spike task. Clinical Relevance: Poor scapular movement consistency is also a significant feature in volleyball players with scapular dyskinesia and shoulder pain, which revealed their scapular dynamic stability is important in series of spikes. Future study in this field may use scapular movement consistency for one of their outcome measures.

• 期刊

【論文摘要】Different Biofeedback Cues Applying in Ergometer Cycling Exercise for Selective Muscle Activation of the Knee Joint

Background and Purpose: Quadriceps weakness is one of the impairment causing disability in people with knee osteoarthritis (OA). In healthy knees, the quadriceps muscle is a primary contributor to the joint stability and provides shock absorption during locomotion. Studies showed a reduction in thigh muscle strength is association with knee pain while the increased vastus medialis (VM) size is related to reduced pain, cartilage loss, and joint replacement risk. Therefore, adequate therapy of the VM muscle strength is required in the management of knee OA. Cycling exercise allows people to work on muscle strength and lower extremity mobility while exert a smaller load on lower extremity joints compared to walking or jogging. However, it is still not clear if cycling with difference biofeedback cues will be effective for muscle re-education of the knee joint. This study aimed to evaluate the effect of providing visual feedback of the knee positions in frontal plane or realtime electromyography (EMG) biofeedback on VM activities in healthy subjects during cycling. Methods: Thirty healthy adults were included to conduct two experiences, one week apart. In the first experiment, the participants respectively performed 2-minute cycling in four conditions of hip frontal angles that were neutral, adducted, abducted hip positions, neutral hip combining adduction resistance from Thera band (Thera-band®, Hygenic Corp., Akron, OH, USA) and one condition of EMG biofeedback, 5 minutes apart. In the second one, they were randomized assigned to a 30-minute session of cycling combining with EMG biofeedback or without biofeedback (control group). The outcomes were VM activities and knee frontal-angles. Results: In the first experiment, there was no significant difference in the VM activities on the bike among different conditions of hip joint or EMG biofeedback during 2-minute bike (p ＞ 0.05). In the second one, the VM activities of the EMG biofeedback group was statistically higher than that of control group during the first twenty minutes of the cycling exercise (p ＜ 0.05). No significant differences were found in the VM activities during the last ten minutes (p ＞ 0.05) either in the knee frontal-angle (p ＞ 0.05). Conclusion: This result showed that combining EMG biofeedback is an effective method to increase the activity of VM during cycling exercise in healthy subjects when compared to cycling without any biofeedback. Clinical Relevance: The study helps to understand the roles of real-time biofeedback on the muscle activations and the kinematics of the knee joint during cycling. Additionally, a more efficient stationary cycling exercise program could be expected to reduce disability for the patient with knee pathologies.

• 期刊

【論文摘要】Step-Length-Associated Regulation of Anticipatory Postural Adjustments During Gait Initiation in Parkinson Disease

Background and Purpose: Short step length and gait initiation difficulty are common in people with Parkinson disease (PD). Abnormal anticipatory postural adjustment (APA) is suggested to be the mechanism for gait initiation difficulty. This research investigated the step-length-associated regulation of APA in people with and without PD. Methods: Ten healthy subjects (HC group) and ten individuals with PD (PD group) initiated gait at self-preferred speed. Three experimental conditions of step lengths (short, normal, and long) were used. A force plate was used to measure the center of pressure (COP) during gait initiation. The outcomes were the APA duration and amplitude, which includes the anteroposterior COP displacement (COPap) and mediolateral COP displacement (COPml). The p values set at 0.05. Results: There was no significant difference in COPap between the HC and the PD group (p ＞ 0.05) but a significant difference in step length (p ＜ 0.01). A significant group by step length interaction was observed in COPml (p ＜ 0.01) and APA duration (p ≤ 0.05). In COPml, the HC group showed significant differences in various step length conditions (p ＜ 0.01), but no difference in the PD group (p = 0.22). In APA duration, both the PD (p = 0.02) and the HC (p = 0.01) showed significant differences among step length conditions. Conclusion: This study suggests that APA is significantly regulated by the length of a step. The step-length-related APA regulation is abnormal in PD patients especially in duration and mediolateral weight shifting. Clinical Relevance: Our results provide important information to help the design of intervention program for improvement the difficulty in gait initiation among people with PD but further studies with larger sample size are suggested. Acknowledgement: This study was supported by the Ministry of Science and Technology (MOST-106-2218-E-182-003), Chang Gung Medical Foundation (CMRPD3E0113), Taiwan.

• 期刊

【論文摘要】家長與專業人員合作以作息本位訪談設定目標－個案報告

背景與目的：作息本位訪談(Routines-Based Interview, RBI)實踐以家庭為中心的早療理念，強調專業人員與家庭建立合作之夥伴關係，使家庭「增能」，利用孩童日常生活作息來提供足夠的練習機會；並讓家庭「充權」，享有參與療育及決策的權利。本篇報告個案的家庭，對於個案的發展感到焦慮及壓力。因此，希望透過作息本位訪談，瞭解家庭成員真正關切的問題，促進家庭成員與專業的相互信任與共同合作，讓家庭看見自己具有的親職能力，並藉此提升家庭成員的照顧及教養自信。方法：個案為一歲四月（矯正年齡一歲）腦性麻痺合併全面性發展遲緩的男孩。在訪談前治療師先對個案進行評估，瞭解個案之個人能力及功能預後，使訪談內容與提問能符合個案情況。接著進行作息本位訪談瞭解個案與家庭需求及設定目標：先請母親說出主要關切的問題。接著逐一訪談家庭作息內容，強調投入、獨立性與社會關係，並將訪談內容之重要資訊標註星號，與母親一起回顧並請母親選定10 ~ 12個未來半年內想要達成的目標，且排出優先順序。訪談完成後治療師將家庭自訂目標轉化成功能性量化目標，並與母親討論出每個目標達成量尺分數(0 ~ 4)之標準，藉此客觀且明確地觀察到個案在家中參與表現的進步，之後的介入則是針對目標發展出介入策略，並定期與母親討論進展。結果：母親主要關切的問題為(1)走路、獨立坐著玩、趴和爬、語言與表達能力。(2)擔心不爬會影響腦部發育。(3)擔心個案為腦性麻痺。經由作息本位訪談，母親共選出12個目標，包括9個參與性目標與3個家庭目標。以第一優先之參與性目標為例，家庭自訂目標為「自己會爬、在地墊上爬且拿到玩具」；轉化之功能性量化目標為「在家中的遊戲時間裡，個案能在大人輕度協助下，在地墊上爬行1 m並拿到喜歡的玩具，一個禮拜有3天，連續3個禮拜，我們就知道這個目標達成了」。家長藉由固定的日常作息中，充分提供個案機會，並以向治療師習得之協助技巧，讓個案在遊戲過程中增進爬行能力與成功經驗。治療師在每次療育中可由家長提供訊息與觀察瞭解個案的進展，並藉由示範與討論解決在家執行目標時的問題。結論：藉由半結構化的作息本位訪談，讓家長能建立自己關切的且合理的優先目標成效，並利用家庭原本的作息執行功能性目標，藉此過程讓家庭對於親職能力具有勝任感，增進專業─家庭合作，也更能使個案的進展顯現於日常生活中有意義的改變。

• 期刊

【論文摘要】區別老人有無衰弱之身體功能測試及其最適切點

背景與目的：衰弱被認為是身體多系統失調造成身體儲備量下降，應變能力變差，最終產生不良的健康結果。這會嚴重影響老人的生活狀態和生活品質。若能瞭解與衰弱相關的身體功能及區分衰弱與否的最適切點，將有助於運動介入計畫之擬定、施測結果判讀及臨床決策。方法：本研究使用衛生福利部國民健康署委託計畫中針對臺灣北中南各地之不同行動功能的老人進行調查的部分資料進行分析。受試者為來自全臺各地社區、日照中心、護理之家之年滿65歲、無失能者（巴氏量表 = 100分）、且身體功能測試沒有遺漏值者，共188人，再依其衰弱評估分為無衰弱及衰弱組（包括衰弱前期及衰弱期）二組。並使用人口學及健康相關變數、衰弱評估、7項身體功能測試（手握力、膝伸直肌力、步行速度、計時起走、30秒曲臂、30秒坐站、2分鐘踏步）以及日常生活功能(activity of daily living, ADL)評估等資料。無衰弱及衰弱組間在上述變數的差異用獨立t檢定來檢驗。用receiver operating characteristic (ROC)曲線分析，檢定身體功能測試在鑑別不同衰弱組別的鑑別力(area under the curve, AUC)，並報告鑑別力(AUC)達0.7者的最適切點，男女分別進行分析。結果：衰弱組比無衰弱組：較年老、認知退化較嚴重、各項身體活動表現都較差。男性只有「膝伸直肌力」這項測試區辨衰弱組別的鑑別力(AUC) ＜ 0.7，而女性只有「手握力」及「步行速度」兩項的鑑別力 ＞ 0.7。結論：區別衰弱組別鑑別力最好的測試，在男性是計時起走(AUC = 0.852)，女性為手握力(AUC = 0.782)。特異性高的測試，可用來「rule in」有問題者，敏感度高的測試可用來「rule out」沒問題者。臨床意義：具區別不同衰弱層級的體能測試可幫助針對不同衰弱狀況長輩的運動介入設計與規劃，所報告的切點有助於臨床人員解讀測試結果及臨床決策使用

• 期刊

【論文摘要】以較執行早期下床活動與ABCDE組合照護對內科加護病房病人呼吸器使用天數之影響

背景與目的：加護病房病人因使用呼吸器需臥床不活動，導致肌肉骨骼失能及心肺功能退步。本研究是針對內科加護病房生命徵象穩定的病人，分別執行早期下床活動與ABCDE組合照護模式，比較兩種模式對病人呼吸器使用天數的影響。方法：本研究針對內科加護病房病人，插管72小時內、意識清楚、生命徵象穩定（血氧大於88%，血液動力學穩定，無使用升壓劑），呼吸器設定合乎條件（吸入氧濃度(fraction of inspiration O2, FiO2) ≤ 60%，呼氣末正壓(positive end expiratory pressure, PEEP) ≤ 10），即符合收案條件。自2016年1至3月共32位呼吸器使用病人且符合收案條件為早期下床活動組。接受Morris (2008)早期下床活動四個階段（第一階段：物理治療師床邊給予被動關節運動；第二階段：床頭搖高超過60度，坐30分鐘；第三階段：協助病人坐於床邊30分鐘；第四階段：協助病人移至床邊椅子，坐30分鐘）。早期下床活動組於加護病房呼吸器使用期間，由物理治療師每日執行一次早期活動。自2016年6至11月共32位呼吸器使用病人且符合收案條件為ABCDE組合照護模式組，接受Balas (2014) ABCDE組合照護（每天讓病人清醒、接受自主呼吸訓練和鎮靜藥物的調整，評估病人是否譫妄與進行環境改善控制病人瞻望情形，進行早期下床活動）。使用獨立t檢定及卡方檢定比較兩組病人的年齡、性別及疾病嚴重度是否有差異，並使用獨立t檢定比較兩組呼吸器使用天數的差異，p ＜ 0.05為統計上顯著差異。結果：早期下床活動組與ABCDE組合照護模式組的年齡分別為72.9 ± 15.4歲與71.6 ± 12.5 歲 (p = 0.92)，急性生理和慢性健康評分別為21.9 ± 5.9與20.7 ± 6.4 (p = 0.61)，年齡、性別及疾病嚴重度無顯著差異。經過早期下床介入或ABCDE組合照護模式的呼吸器使用天數分別為7.0 ± 4.0天與4.1 ± 1.6天(p ＜ 0.001)，統計上達顯著差異。結論：針對內科加護病房呼吸器使用病人，執行ABCDE組合照護模式，除了可以減輕病人鎮定劑的使用，減少譫妄產生，加入早期活動與心肺物理治療的介入，可以減少病人呼吸器使用的天數。臨床意義：在內科加護病房使用組合式照護模式對使用呼吸器病人有較好的治療成效。