中風病患任務導向治療模式臨床效果之系統性文獻回顧

Effects of Task-oriented Approach in Stroke Rehabilitation a Systematic Review

陳綉儀(Hsiu-I Chen) ； 湯佩芳(Pei-Fang Tang) ； 胡名霞(Ming-Hsia Hu)

《物理治療》 32卷6期 (2007/12) Pp. 308-315

摘要

背景與目的：近代神經物理治療強調任務導向治療模式(task-oriented approach)的應用可有助於中風偏癱病患之患側動作控制與功能恢復。本文目的在探討任務導向治療在中風復健的臨床運用與治療成效。方法：以系統性文獻回顧(systematic literature review)搜尋自1970年至2007年－月間的PubMed、Medlin、PEDro、CINALH、CEPS等國際資料庫中針對中風病患作任務導向治療之原始論著，並經由引用文獻擴大搜尋範圍。結果：總共納入8篇相關文獻，3篇探討手臂前伸取物之任務訓練，5篇則探討與功能活動及行走訓練相關之任務訓練。其中有6篇為隨機分組控制實驗(randomized controlled trials), 2篇為非隨機分組控制案例報告(case reports)。隨機分組控制實驗結果顯示任務導向的訓練效果優於非任務導向之訓練效果。結論：任務導向訓練對於中風病患，尤其是慢性期病患，能提供比傳統或以非任務導向為主的訓練較佳的訓練效果。但臨床應用此治療方法時，除應注意動作訓練設計需符合任務導向原則外，任務的變異性多寡、口令的內容、回績時機及內容以及漸進性的練習模式皆須同時考量。

關鍵字

任務導向 ； 任務相關活動訓練 ； 中風 ； 腦血管疾病 ； 偏癱

並列摘要

Background and purpose: The task-oriented approach is based on the assumption that the goal of motor control is to control movement in order to accomplish a particular task. This approach focuses on retraining of functional tasks by taking into account the integration of multiple systems. Clinical research in stroke rehabilitation has suggested that the approach has beneficial effects on functional recovery in patients with stroke. The purpose of this systematic review was to examine the effects and clinical implications of task-oriented approach in stroke rehabilitation. The core components of such therapeutic approach and the therapeutic intensity used were also discussed. Method: A systematic search of literature published between 1970 and 2007 Jan in the PubMed, Medline, PEDro, CINALH and CEPS electronic databases was performed. Original articles including both task-oriented approach and stroke patients were selected. All included articles were rated using the PEDro scale. Results: A total of 8 articles, 6 RCT and 2 non-experimental studies were included in this review. Three examined the effects of seated reaching task, one investigated the effect of progressive resistance training and 5 were related to ambulation training. The results suggested that patients with stroke had better motor recovery and functional gain after training with task-oriented approach, compared to those receiving conventional training programs. Conclusion: This review shows that task-oriented approach is more efficacious than conventional or non-task-oriented approach for improving the functions of upper extremity, muscle strength of lower extremity, walking ability and functional performance in patients with stroke. When applying the task-oriented training regimens in the clinics, task variability, contents of the instructions, augmented feedback and repetitive practice are important components that therapists should take into consideration.

並列關鍵字

Task-oriented ； Task-related training ； Stroke ； CVA ； Hemiplegia