單側大腦中風病患站姿傾倒趨勢之信度研究與特質分析

Reliability Study and Features of Falling Tendency When Standing in Unilateral Hemispheric Stroke Patients

孟令夫(Ling-Fu Meng) ； 祝旭東(Shi-Dong Jush) ； 陳美香(Mei-Hsiang Chen)

《中華民國復健醫學會雜誌》 27卷3期 (1999/09) Pp. 91-102

摘要

無法站立是病患於中風後常見的立即性表現，傳統上對於無法站立的病患多給予一個「差」的代號，而關於無法站立的傾倒特質卻少有探討。由於無法站立的結果就是傾倒至不同方向，因此本研究試圖藉由病患的傾倒方向來探討無法站立中風病患的站姿特性。研究中首先建立判定傾倒方向的施測者間信度，並了解個案傾倒特質表現的前後穩定性，最後再比較左右腦傷患者的傾倒表現是否呈現差異。結果顯示(1)判定傾倒方向的評量方式具有好的施測者間信度，兩兩施測者間的kappa係數值分別為 .89, .88, .87(p值均小於 .001); (2)病患連續五次站立的傾倒方向呈現出前後一致的穩定性；(3)若用對側與非對側區分，左腦傷與右腦傷病患均傾向倒至對側，若用前方與後方區域區分，左腦傷與右腦傷病患則均傾向倒至後方，因此左右腦傷的個案於傾倒趨勢大體呈現類似特質。文中將從大腦理論或臨床的觀點針對研究結果做相關的討論。

關鍵字

大腦側化 ； 姿勢缺陷 ； 推倒症候群 ； 姿勢不對稱

並列摘要

”Astasia(inability to stand)” is a popular and immediate result after onset from stroke. Health professionals usually label astasia as ”poor” standing performance. However, few studies substantiate the falling tendency of astasia. The result of inability to stand is to fall toward one specific direction; therefore, this study used ”falling direction” as a medium to analyze the falling tendency of astasia. Three major results were found in this study. Firstly, the measurement used in this study to judge falling direction demonstrated good inter-rater reliability. Two raters' kappa value was .89, .88, .87 respectively(each p value ＜ .001). Secondly, while comparing 5 standing, most patients showed stable falling tendency. Thirdly, most left and right brain damage patients fell toward contra-lateral area and posterior area. Both groups demonstrated similar falling tendency. The implications of related brain theories and clinical views will be discussed.

並列關鍵字

cerebral lateralization ； postural deficit ； pusher syndrome ； postural asymmetry