肌電回饋誘發電刺激器對腦性麻痺兒童之效果：單一個案研究

Effect of Electromyography-Triggered Electrical Muscle Stimulation for Children with Cerebral Palsy: Single Subject Design

甘蜀美(Shu-Mei Gan) ； 廖華芳(Hua-Fang Liao)

《物理治療》 25卷3期 (2000/05) Pp. 146-156

摘要

研究目的：探討肌電回饋誘發電刺激器(Electromyographic-triggered Electrical Muscle Stimulation)合併功能訓練對腦性麻痺兒童肌力及動作功能之影響。方法：採用多基準線單一個案設計，個案為一7歲雙邊痙攣女童。實驗流程分為基準期1 (下肢2週)、治療期(下肢8 週、上肢4週)、基準期2( 4週)。個案接受5次評估，包括最大等長肌力、步行功能、粗動作功能評量( Gross Motor Function Measure，簡稱GMFM)與布魯因斯克-歐西瑞司基動作評量之精細動作組合量表( Bruininks-Oseretsky Test of Motor Proficiency，簡稱BOTMP)測試。第2次( E2)與第3次( E3)評估間為下肢治療期，上肢之基準期。依據基準期1測試結果，上下肢分別選擇腕伸直肌及臀大肌為訓練肌肉，並於功能性姿勢下訓練。治療期中個案接受持續8週、每週2次、每次45-60分之訓練。結果：基準期1之肌力及動作功能未有明顯變化。E2-E3間下肢肌力與功能有改善，上肢則無。治療期中髖伸直肌肌力增加且明顯大於下肢其他肌肉；E3-E4間腕仲直肌之肌力增加與上肢其他肌肉類似。個案行走之步行速度及步距增加；GMFM 中跪／爬、站立、走／跑／跳向量皆有改善，尤以站立增加8%最為明顯。BOTMP中上肢速度及靈巧度明顯進步。結論：在功能性姿勢下以肌電回饋誘發電刺激器訓練腦性麻痺兒童，能增加肌力及動作功能，值得臨床上使用；然本研究僅單一個案，確實之療效有待進一步探討。

關鍵字

肌電回饋誘發電刺激器 ； 肌力訓練 ； 粗動作功能 ； 腦性麻痺 ； 多基準線單一個案設計

並列摘要

Purpose: To investigate the effect of electromyographic-triggered electrical muscle stimulation (EMG-EMS) with functional resistance training on the muscle strength and gross motor function of children with cerebral palsy. Methods: Multiple baseline single-subject design for a 7-year old child. with spastic diplegic. Duration of baseline 1 st was 2 weeks. Of the treatment was 4 weeks and of 2nd baseline was 4 weeks. The case received 5 times evaluation. Between the 2nd (E2) and 3rd (E3) evaluation, the lower extremity was treated and the upper extremity was as control. Both of the upper extremity( UE )and lower extremity ( LE ) received treatment between E3 and E4. The evaluation included maximal isometric contraction, walking function, Gross motor Function Measure (GMFM) and Fine Motor Composite of Bruininks-Oseretsky Test for Motor Proficiency (BOTMP ).The gluteus maximum (GM) and wrist extensor (WE) were chosen as training target muscles according to the evaluation results at the 1st baseline. The functional training with EMG-EMS were applied to the GM for 8 weeks and the WE for 4 weeks. The child received treatment twice per week, 45 min. to 60 min. per time. Results: the muscle strength and the motor function did not change during the 1st baseline. During E2-E3, the strength and motor function of LE showed improving, and they were not in UE. During treatment period, the strength of GM increased more than the other LE muscles, the increasing of strength of WE was similar with the other UE muscles. The walking speed, stride length, GMFM, the upper extremity speed and dexterity of BOTMP in the treatment period were better than those in the baseline. Conclusion: The EMG-EMS with functional training can improve the muscle strength and the motor function in child with cerebral palsy.

並列關鍵字

Electromyographic-triggered electrical muscle stimulation ； Strengthening ； Gross motor function ； Cerebral palsy ； Multiple baseline single-subject design