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Effects of EMG Biofeedback Training on Ankle Control and Gait in Hemiparetic Patients

肌電圖生物回饋治療對中風患者踝關節控制與步態之效果

摘要


腦中風後患者常見關節控制與步態問題,爲能提供物理治療師在面對此問題時的參考,本研究探討一種合幷傳統運動治療與肌電圖生物回饋訓練對中風患者踝關節控制與步態之效果,幷分析不同身體位置對肌肉徵召的影響。共有十位26~67歲(平均年齡=53)能夠步行、且發病超過四個月的中風患者參與本研究。所有的受試者都接受一個月的運動治療與在坐姿時的肌電圖生物回饋訓練,幷在訓練前及結束後接受關節活動度、步行時間、步數、與坐及站時前脛肌肌肉徵召程度之測試。研究結果發現經過一個月的訓練後患者徵召前脛肌之能力顯著增強,關節活動度、步行時間、及步數則無顯著的改善;至於前脛肌肌肉徵召能力雖不因測試位置不同而有顯著的差异,但在坐姿下測得之肌肉徵召能力傾向比站姿下測得之值大。此外關節活動度與步行時間、步數、及坐姿下徵召前脛肌之能力呈顯著的相關性,而且步數也與坐姿下徵召前脛肌之能力呈顯著的相關。這些研究結果顯示運動治療與肌電圖生物回饋訓練對前脛肌肌肉徵召能力有顯著的效果,而且動作學習有轉移之現象。然而患者之功能性動作能力幷不因此訓練而跟著改善,因此臨床上使用肌電圖生物回饋訓練時應同時合幷功能性動作的訓練,以期使患者之動作功能得充分恢復。

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並列摘要


Background and Purpose. The objectives of this study were to investigate the effect of a combined treatment program of therapeutic exercises and EMG biofeedback (EMGBF) on gait, ankle dorsiflexion range of motion (ROM), and motor unit recruitment of the tibialis anterior (TA) muscles, and to reveal the influence of body position on the level of motor unit recruitment. Subjects. Ten ambulatory hemiparetic patients (onset duration>4 months), aged 29 to 67 years (mean=53, SD=12), participated in the study. Methods. Subjects received an EMGEF training in sitting position targeted on the tibialis anterior muscles, in addition to their regular therapeutic exercise program during the experimental period. The ROM of the affected ankle dorsiflexion, the time and the number of steps (STEP) taken to ambulate a walkway, and the EMG (integrated and peak) activity of the TA in sitting and standing were evaluated before and after one month's treatment. Results. Significant improvement was found in the TA EMG after the training. The difference in the level of EMG between sitting and standing, and changes in the gait variables and ankle range of motion were nonsignificant. The ankle range of motion was significantly correlated with the gait variables and the TA EMG in sitting. The EMG in the sitting position is also correlated with STEP. Discussion and Conclusion. The combined treatment of therapeutic exercise and EMGBF is effective in enhancing the level of motor unit recruitment in the TA and the subjects learned to control this muscle in both sitting and standing. Thus, transfer in motor learning is possible after EMGBF training. However, the subjects failed to gain significant improvement in the gait variables and the ankle ROM, indicating that the ability to control individual muscle does not necessarily accompanied by better functional performance. Functional training following EMGBF training is recommended in order to maximize functional gain.

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