以系統性回顧探討中風患者之轉身動作困難

A Systematic Review of Turning Difficulties in Individuals with Stroke

周佩儀(Pei-Yi Chou) ； 李淑君(Shu-Chun Lee)

《台灣復健醫學雜誌》 46卷1期 (2018/06) Pp. 1-8

https://doi.org/10.6315/TJPMR.201806-46(1).01

摘要

前言：轉身對於中風患者是一個充滿挑戰性的動作，由於他們不對稱的肢體以及較差的平衡控制，造成對於轉身的動作感到困難。因此本篇研究主要希望透過系統性的文獻回顧，統整中風患者在轉身時的動作特徵，並加以討論分析轉身困難可能的神經肌肉機制。方法：本研究透過CINAHL、Medline、PsycINFO等三種資料庫，利用關鍵字turn和stroke搜尋，並限制文獻為原始論著及英文文章之方式檢索。結果：根據選取條件共有11篇納入本文的討論，共計有277位偏癱中風受測者。統整資料顯示中風患者比健康成年人需要較多的時間、踏較多的步伐，以及較差的品質來完成轉身，例如平衡不穩、需要較大的轉身空間、較差的兩腳重心轉移、身體各部位延遲轉身且同步啟動。除此之外，轉身策略會因為朝向不同方向轉身而有不同的表現，但轉身時間和步伐數則沒有方向之間的差異。結論：這些轉身特徵顯示中風患者有明顯的轉身困難，但也可能是他們為了讓轉身的動作更加穩定而做出的代償策略和適應。建議臨床醫護人員在評估中風患者的一般性功能活動時，不可忽略轉身能力的評估，透過簡單的時間、步數和品質的觀察可篩檢出轉身困難的患者，以利進一步的復健活動介入和改善，來降低可能跌倒的風險。

關鍵字

中風(stroke) ； 系統性回顧(systematic review) ； 轉身(turning)

並列摘要

Introduction: Making turn is a challenging task that is reported as one of the activities that most frequently leads to fall in stroke patients. Among community-dwelling older adults, hip fractures are eight times more likely to result from falls while making turns than from falls while walking straight. The stroke patients have asymmetric posture and movements due to hemiparesis, thus their turning performance may varied depending on the direction of the turn. Therefore, the purpose of this systematic review was to summarize the characteristics of turning after stroke and discuss the possible neuromuscular mechanisms of turning difficulties. Methods: Searches of electronic databases including CINAHL, Medline, and PsycINFO were undertaken using the search terms: ＂turn＂ and ＂stroke.＂ The selection criteria for the literature were that the article was original, written in English and that the full text of the article was available. Results: We included 11 papers and 277 stroke patients in this systematic review. The literature indicated that individuals with stroke required greater number of steps, longer time, and worse quality to complete a turn. The sequential initiation of body segments showed significant delay compared to healthy individuals. Also, their center of gravity displacements in medial-lateral directions were smaller and slower within their base of support. They had longer total trajectories of turning and significant deviations from the reference trajectories of healthy subjects. Turning strategies were different between turning directions with reduced stability of the affected leg when the turn was made toward the affected side. By contrast, there was a dragging foot, insufficient hip and knee flexion and rigid intersegment body rotation when the turn was towards the unaffected side. However, similar turn times and number of steps were found in both turning directions. The possible neuromuscular mechanisms of turning difficulties could be related to axial or leg impairments. Axial impairments include increased postural muscle tone, rigid axial trunk, and decreased intersegmental flexibility. Leg impairments include muscle weakness, instability, and an increased extensor synergy pattern of the affected lower limb. Conclusions: The use of a greater number of steps, taking longer time to complete the turn, and the poor quality of the turn indicate turning difficulty in stroke individuals. However, this could be a compensatory or adaptative strategy to maintain balance during the turn. This systematic review provides clinicians a better understanding of turn difficulty after stroke, and the criteria to identify potential stroke patients with high risks of dysfunctional turning. In addition, healthcare professionals could evaluate turning ability by investigating turn time, the number of steps taken, and turn quality during routine assessment in order to identify turning difficulty in stroke patients. This assessment may offer the opprtunity to provide patients with tailored rehabilitation or exercise intervention to improve turning performance and decrease the risk of falling.

並列關鍵字

stroke ； systematic review ； turning

參考文獻

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