改良式侷限誘發動作治療於輕中度腦中風患者之成效：運動學分析之研究

Effects of Modified Constraint-Induced Movement Therapy on Patients with Mild-to-moderate Stroke: A Kinematic Study

李佳宜(Chia-Yi Lee) ； 林克忠(Keh-Chung Lin) ； 吳菁宜(Ching-Yi Wu) ； 連倚南(I-Nan Lien) ； 許美慧(Mei-Hue Hsu)

《職能治療學會雜誌》 24卷 (2006/12) Pp. 25-35

https://doi.org/10.6594/JTOTA.2006.24.03

摘要

背景與目的中風後常併生肢體動作功能的顯著減損，侷限誘發動作治療是針對中風後上肢動作缺失的一種復健療法，此療法是否改善動作的時間空間特質仍待釐清。本研究採用運動學分析來探討改良式侷限誘發動作治療對動作行為之運動學特質的成效。方法採用隨機控制臨床試驗的實驗設計，將20名單側腦中風患者分派至改良式侷限誘發動作治療組與傳統治療組。於三週期間，改良式侷限誘發動作治療組患者的腦傷同側上肢每日須侷限六小時，患側上肢則接受每週五天、每天二小時的密集性訓練；傳統治療組則維持既有之訓練。成效評量採用運動學分析來量測上肢伸取動作的運動學特質。運動學參數採用共變數分析比對兩組於後測表現之差異。結果對照兩組於後測之伸取動作表現，改良式侷限誘發動作治療組於反應時間、動作時間、標準化路徑和動作單位等參數的表現皆顯著優於傳統治療組，最大瞬時速率及達最大瞬時速率所佔時間比則未呈現顯著差異。結論改良式侷限誘發動作治療可以有效改善患者的動作能力及伸取動作的執行效率和流暢性。未來研究可調控傳統治療組的治療時數與強度，或採行特定治療的對照組（如雙側上肢訓練治療），進而合併使用腦部顯像儀器（如功能性磁振造影）探究接受侷限誘發動作治療後的腦部可塑性，以驗證侷限誘發動作治療的神經科學機制。

關鍵字

腦中風 ； 侷限誘發動作治療 ； 運動學分析 ； 復健

並列摘要

Background and Purpose Stroke is frequently accompanied by substantial loss of motor function. It remains unclear whether motor rehabilitation improves spatiotemporal characteristics of motor behavior post stroke. This study used kinematic analysis to investigate whether modified constraint-induced movement therapy (mCIMT) is more effective than traditional therapy in improving movement strategies of patients with stroke. Methods Twenty patients with stroke were assigned to either the mCIMT group (6-hour immobilization of the less-affected arm per day combined with 2-hour intensive training of the affected arm per weekday) or the control group of traditional rehabilitation for a period of 3 weeks. The primary outcome measures involved the kinematic system to capture the spatio-temporal characteristics of reaching performances. Results Patients in the mCIMT group exhibited better reaching performances than control group reflected by shorter reaction time (F(1,17)=5.12, p=0.019) and movement time (F(1,17)=5.11, p=0.019), less normalized total displacement (F(1,17)=7.01, p=0.009) and fewer movement units(F(1,17)=7.16, p=0.009). Conclusion The findings of this study supported the therapeutic benefits of mCIMT on improving motor function of the more-affected upper extremity and overcoming learned nonuse. Kinematic findings indicated that patients had better motor efficiency and smoothness in reaching performances after mCIMT. Future research may investigate the effect of mCIMT relative to more specific motor rehabilitation (e.g., bilateral arm training). In addition, use of neuroimaging modalities may help to elucidate neural mechanisms underlying plastic change after mCIMT.

並列關鍵字

stroke ； constraint-induced movement therapy ； kinematic analysis ； rehabilitation