綜論中風患者的感覺再教育

Sensory Reeducation after Stroke: A Review of the Literature

葉蘭蓀(Lan-Suen Yeh) ； 簡福佑(Allen Gean) ； 江心瑜(Hsin-Yu Chiang) ； 紀昕妤(Hsin-Yu Chi)

《臺灣職能治療研究與實務雜誌》 4卷1期 (2008/06) Pp. 17-26

https://doi.org/10.6534/jtotrp.2008.4(1).17

摘要

目的：針對上肢感覺缺損的中風患者，植基於腦塑性的概念及避免習得廢用，感覺再教育是臨床上常用介入方式。本文希以文獻回顧的方式整合療效證據，探究其治療技巧、流程及可能治療機轉，以提出對臨床工作及未來研究方向之建議。方法：檢索電子資料庫中1950年至2008年發表之相關文獻，找出以感覺訓練為自變項，依變項至少含一項感覺功能評估，且為針對中風感覺缺損的患側上肢給予感覺刺激之隨機控制試驗或單一對象實驗設計。結果：共收錄八篇文獻報告，其中七篇顯示感覺能力明顯提升，另一篇無顯著差異；動作控制能力則均大幅進步。在治療技巧上，多建議提供大量的感覺刺激及學習時程。結論：中風患者的感覺再教育可有效改善中風患者的上肢感覺能力及動作功能。未來可進一步針對可能影響治療效益之因子進行探究，如不同發病時程的腦塑性及適用治療內容或日常生活功能的品質等。也可透過更嚴謹的實驗設計，增加樣本數，並結合腦影像學技術，以發展具實證基礎及學理基礎的中風復健治療。

關鍵字

感覺訓練 ； 職能治療 ； 腦中風 ； 文獻回顧

並列摘要

Objective: Sensory reeducation, based on the concept of neuroplasticity and on the prevention of learned nonuse, is frequently used for improving stroke-induced sensory impairment of the upper limb. The purposes of this study were to integrate the evidence of therapeutic effects of sensory reeducation for stroke and to analyze the treatment techniques, protocols, and possible rationale by literature review. Methods: To retrieve relevant studies for this review, articles published during 1950 to 2008, including randomized controlled trials (RCTs) and single-subject experimental designs (SSEDs), were searched from electronic databases. The independent variables of the target studies were sensory reeducation or sensory reeducation and other treatment. The dependent variables were sensory function or assessment containing at lest one sensory function and other abilities. Results: Five RCTs and three SSEDs articles were included. Our findings demonstrated that patients receiving sensory reeducation generally performed better in motor function and sensory function. The treatment protocols emphasize providing a lot of sensory stimuli and intensive trainings. Conclusion: With limited studies, sensory reeducation for stroke patients deserves more research. It is necessary to develop more valid and sensitive evaluation tools and refine treatment techniques and protocols to enhance adequate practice. Moreover, further research may underscore the factors that might mediate effects of sensory reeducation. Lastly, with large sample size, more precise experimental designs, and the use of neuroimage laboratory modalities, future research may facilitate development of theory-and evidence-based rehabilitation after stroke.

並列關鍵字

Somatosensory retraining ； Occupational therapy ； Cerebral vascular accidents ； Literature review