冷熱溫度刺激治療強度對於慢性期中風患者上肢動作恢復的療效

Effects of Treatment Intensity of Noxious Thermal Stimulation on Motor Recovery of Upper Extremity in Patients with Chronic Stroke

陳世銘(Shih-Ming Chen) ； 李佳容(Chia-Jung Lee) ； 林芳瑾(Fang-Jing Lin) ； 唐鈺晶(Yu-Ching Tang) ； 李佳玲(Chia-Ling Lee) ； 林昭宏(Jau-Hong Lin)

《物理治療》 41卷1期 (2016/03) Pp. 48-55

https://doi.org/10.6215/FJPT.PTS1439878295

摘要

背景與目的：痛覺溫度刺激對於中風患者上肢動作功能恢復的療效已被證實，而最佳治療強度尚未探討。本研究目的探討不同治療強度痛覺溫度刺激對於慢性中風患者上肢動作恢復的療效。方法：本研究徵招慢性中風患者，受試者隨機分派到高或低強度組。除了接受復健治療外，高強度組每次接受冷熱刺激治療60分鐘，低強度組則治療30分鐘，兩組皆為期每週3天，持續6週介入。療效評估使用福格梅爾上肢次量表、Semmes-Weinstein單絲檢測工具、修正式艾許沃斯量表和巴氏量表。分別於治療前、6週治療結束和治療結束1個月後追蹤評估。結果：在介入治療後，兩組組內改變僅福格梅爾上肢次量表有顯著進步（高強度組p=0.006，低強度組p＜0.001），然而兩組之間進步量並無達到顯著性差異。結論：每週3天為期6週，每天60分鐘或30分鐘的痛覺溫度刺激合併復健治療對於慢性中風患者上肢動作恢復皆有相似的療效，且可維持到1個月。臨床意義：60分鐘痛覺溫度刺激合併傳統復健的成效並無優於30分鐘的介入。

關鍵字

溫度刺激 ； 治療強度 ； 中風 ； 動作恢復

並列摘要

Background and Purpose: The noxious thermal stimulation (NTS) has been suggested its effects on upper extremity (UE) of patients with stroke. However, optimal treatment intensity has not been investigated. This study aims to compare effects of different treatment intensity of NTS on UE of patients with chronic stroke. Methods: Subjects with chronic stroke were randomly assigned into the high-intensity or the low-intensity groups. In addition to regular rehabilitation, the high-intensity group received a 60-minute NTS and the low-intensity group did a 30-minute NTS. Both groups received NTS intervention once per day, 3 days/week, and a total of 18 times for 6 weeks. The UE subscale of Fugl-Meyer assessment (UE-FM), Semmes-Weinstein monofilaments test (SWMT), modified Ashworth scale (MAS), and Barthel Index (BI) were administered by blind raters at baseline, post-intervention, and 1 month follow-up. Results: No significant basic characteristics differences between groups were found. Significant improvements within each group for UE-FM (p=0.006 in high-intensity, p＜0.001 in low-intensity) were seen; however, no significant differences between two groups on UE-FM, SWMT, MAS and BI improvements. Conclusions: A 60-minute NTS with regular rehabilitation and a 30-minute NTS with regular rehabilitation, 3 days/week for 6 weeks, led to similar treatment and maintenance effects for patients with chronic stroke. Clinical Relevance: The 60-minute NTS with rehabilitation therapy did not show better treatment effects than those of the 30-minute intervention.

並列關鍵字

Thermal stimulation ； Treatment intensity ； Stroke ； Motor recovery