- 學位論文
振動訓練對於慢性單側偏癱中風患者之上肢功能表現的影響
Effects of Vibration Training on Upper Limb Functional Performance in Chronic Hemiplegic Stroke Patients
摘要
研究目的：比較八週傳統復健治療與傳統復健治療合併上肢振動訓練，對於慢性單側偏癱腦中風患者之上肢功能表現的影響。 研究方法：本次研究是採隨機控制實驗。 60 位初次腦中風、單側偏癱且腦中風至少六個月以上的受試者，被隨機地分配到上肢振動訓練組與僅接受傳統復健治療的控制組。上肢振動訓練組的受試者，除接受傳統的復健治療外，另使用 AV-001A 垂直振動訓練儀訓練上肢。訓練時，受試者採修正式蹠行姿勢（modified plantigrade posture），將兩側上肢垂直支撐於振動平台上。 AV-001A 垂直振動的頻率是 20Hz，振幅是 1.2 mm。以每次五分鐘，每週三次，持續八週的方式訓練受試者。傳統復健治療控制組的受試者，於研究期間則維持僅接受傳統復健治療的治療模式。兩組受試者於治療前與治療八週後，完成療效評估。療效評估包含—使用修正式艾許瓦氏等級量表（Modified Ashworth Scale）評估患側上肢肌痙攣（spasticity）程度、使用JAMAR握力計評估雙手握力、使用功能研究手臂測試（Action Research Arm Test）評估患側上肢功能性表現、使用動作活動日誌（Motor Activity Log-28）評估受試者患側上肢的日常使用量及動作品質、使用布郎斯壯上肢恢復分期（Brunnstrom Upper Limb Recovery Stage）評估患側上肢的動作功能。 研究結果：在兩手間握力比率（P=0.9236）、功能研究手臂測試（P=0.8319）、動作活動日誌的動作品質（QOM）（P=0.3411）、使用量（AOU）（P=0.6379）、布郎斯壯上肢恢復分期近端側（P=0.6285）與遠端側（P=0.4907）的結果上，兩組間的受試者並無統計上顯著的差異。在修正式艾許瓦氏等級量表（P=0.0394）的結果上，兩組間的受試者具有統計上顯著的差異。 結論：八週的傳統復健治療與傳統復健治療合併上肢振動訓練，對於慢性單側偏癱腦中風患者之握力（grasp strength）、功能性表現（functional performance）、真實環境（real-world）中的使用與動作功能（motor function）的影響並無統計上顯著的差異。對於上肢肌痙攣（spasticity）程度的影響具有統計上顯著的差異。
並列摘要
Objective: The aim of this study was to compare the effects on upper limb functional performance after 8 weeks of upper limb vibration training plus traditional rehabilitation training with traditional rehabilitation training only in chronic hemiplegic stroke patients. Methods: This study was a randomized controlled trial. Sixty subjects with first-ever stroke and above six-month post-stroke were randomly assigned to either upper limb vibration group ( ULV group ) or traditional rehabilitation control group. The subjects of ULV group, besides accepting traditional rehabilitation training, used the vertical vibration of AV-001A to train the upper limbs. At the time of training, the subjects adapted modified plantigrade posture supporting the both upper limbs vertically on the vibration platform. The frequency of vertical vibration of AV-001A was 20 Hz and the amplitude was 1.2 mm. The subjects of ULV group received five minutes vibration training each time for three days per week during eight weeks. The subjects of control group received traditional rehabilitation training only in studying. The subjects of two groups were assessed outcome measures before and after eight-week treatment. The outcome measures included muscle spasticity of paretic upper limb by Modified Ashworth Scale, grasp strength of both hands by JAMAR dynamometer, functional performance of paretic upper limb by Action Research Arm Test, daily use and movement quality of paretic upper limb by Motor Activity Log-28, and motor function by Brunnstrom upper limb recovery stage. Results: Except Modified Ashworth Scale score (P=0.0394), there were no statistical significant differences in grasp strength ratio (P=0.9236), Action Research Arm Test score (P=0.8319), Motor Activity Log-28 QOM scale score (P=0.3411), AOU scale score (P=0.6379), Brunnstrom upper limb recovery stage of proximal part (P=0.6285) and distal part (P=0.4907) between the groups. Conclusion: The influences on grasp strength, functional performance, real-world use and motor function of chronic hemiplegic stroke patients after eight-week traditional rehabilitation and traditional rehabilitation combined with upper limb vibration training were no statistical significant difference. There was relevant influence on spasticity of paretic upper limb.