Training Effect of Pedaling Exercise in Stroke Patients: A Single Subject Study Design

腳踏車運動對中風病人之訓練效果：單一受試者實驗設計

顔妙如(Miao-Ju Yen) ； 林桑伊(Sang-I Lin)

《物理治療》 29卷6期 (2004/12) Pp. 365-373

摘要

腳踏車運動已被證實在騎乘過程中以及訓練後三十分鍾，對於中風患者的患側下肢有改善運動表現的潛潛在效果。然而，過去的文獻對於在腳踏車訓練停止後，中風患者運動表現改善的情形是否還能維持，卻甚少提及。因此本實驗的目的是要使用單一受試者實驗設計，來檢測是滯中風患者在接受一個朋腳踏車訓練後，以及停止訓練後一個月，其在肌力、肌肉張力、和整體運動功能的表現情形是否會有改變。方法：有六位慢中風患者參與本實驗。受試者皆接受四次重複的測量：腳踏車運動訓練前一個月、訓練前、訓練後一個月以及停止訓練後一個月。測量項目包括患側下肢肌力、肌肉張力、以及整體運動功能表現。受試者皆接受每週三次，爲期一個月的腳踏車訓練。繪制成圖的結果會先被分析其運動訓練前的狀態穩定與否，唯有狀態穩定者才會被進一步分析其在訓練期及停止訓練期的結果表現。爲有同樣的結果趨勢出現四郊以上才能被定義爲顯著的結果。結果：大量的受試者間變異性可以被觀察到。而有顯著意義的結果如下：患側下肢的髖屈肌及踝屈肌在腳踏車訓練後並無肌力改善的現象；而患側之踝屈肌的肌肉張力在腳踏車運動後也無産生變化。結論：一個月的腳踏車運動並無法改善中風病人患側下肢的運動功能表現，進一步的研究來確認肢踏車的功效是必須的。

關鍵字

中風 ； 腳踏車 ； 肌力 ； 肌肉張力 ； 整體運動功能表現

並列摘要

Background and purposes: Pedaling exercise has been shown to be potentially effective for reversing muscular weakness and improving motor performance in stroke patients during the pedaling process and 30 mins after pedaling. However, few studies have examined if the effect would be maintained after discontinuing training. The aim of this study was to investigate the changes of strength, global motor function, and muscle tone in stroke patients immediately and after one month follow-up following pedaling training.
Methods: Six subjects with chronic (＞6months) post-stroke hemiparesis participated in this study. The assessments, which took place one month prior to (PRE-1), immediately before (PRE-2), immediately after (POST), and one month after (follow-up, FU) training, included muscle strength (tested with a hand held dynamometer), muscle tone (graded by the Modified Ashworth Scale), and global motor function (scored by the Fugl-Meyer motor assessment) of the lower limb. All patients received 3 times a week bicycling training for one month. Visual inspections of the data were used first to determine the stability of the baseline phase (between PRE-1&-2), and only the data from patients with stable baselines would be further inspected for changes in the intervention (between PRE-2 and POST), and withdrawal (between POST and FU) phases. Based on the principle of visual inspection for data obtained from single subject design research, between-phase changes that occur for at least 4 times would be considered significant. Results: Large between-subject variabilities were observed, and only findings showing significant trend of changes are reported. The strength of the affected hip flexors and ankle dorsiflexors maintained stable in the intervention and withdrawal phase. The muscle tone of the ankle dorsiflexors maintained stable in the intervention and withdrawal phase. Conclusions: The findings indicated that the one- month pedaling training did not improve the motor performance of the affected leg. Further research is needed to verify the training effect.

並列關鍵字

Stroke ； Ergometer ； Strength ； Muscle tone ； Global motor function