- 學位論文
認知動作策略與即時體感覺提示對巴金森患者轉身動作的立即效應
Immediate effect of cognitive movement strategy and real-time somatosensory cue on turning in people with Parkinson's disease
摘要
目的：本論文使用動作分析，以三個研究探討巴金森患者的轉身困難。研究一比較巴金森患者與同齡健康成人在轉身時軀幹肢段間協調與姿勢穩定上的差異。研究二探討一種認知動作策略，即「時鐘轉」技巧，對巴金森患者轉身過程步態穩定度、凝凍步態與轉身表現的影響；研究三探討即時體感覺提示對轉身過程的體重轉移與凝凍步態的影響。方法：三個研究皆採橫斷式設計，並以三維動作捕捉系統紀錄受試者行走與轉身中的肢段動作。研究招募原發性巴金森且有凝凍步態的患者，並於藥物停電期執行試驗。結果：研究ㄧ，巴金森患者的軀幹肢段在轉身時呈同時轉動，而同齡健康成人則呈由頭至尾依序轉動。同時巴金森患者較同齡健康成人具有較大的側向不穩與較小的前向推進。研究二，使用時鐘轉策略的巴金森患者較不使用策略的患者在轉身時有較低的跨步時間變異度與不對稱度。同時使用時鐘轉策略的患者較不使用策略的患者以較短的時間完成轉身，並在轉身中發生較少的凝凍步態。研究三，巴金森患者在給予即時體感覺提示下，於重啟跨步時有較大的體重轉移與跨步長。同時，巴金森患者在給予即時體感覺提示下，以較少的跨步完成轉身，且轉身過程凝凍步態的持續時間較短。結論：本論文驗證不同介入方式對改善巴金森患者轉身困難的效益，建議未來研究可從中樞控制的面向進一步探究這些效益的原理。
並列摘要
Purpose: This dissertation included three studies using motion analysis to address turning difficulty in people with Parkinson’s disease (PD). Study 1 compared the truncal coordination and postural stability during turning between PD and healthy adults. Study 2 investigated the effect of a cognitive movement strategy, the clock-turn strategy, on gait stability, freezing of gait and turning performance. Study 3 investigated the effect of a real-time somatosensory cue on weight shift and freezing of gait during turning. Methods: All three studies were cross-sectional, and employed a 3D motion capture system to record participants’ movements. Idiopathic PD with freezing of gait were enrolled and took the studies during medication OFF period. Results: In study 1, PD showed a simultaneous rotation of truncal segments during turning rather than a craniocaudal sequence seen in healthy adults. Moreover, PD had greater frontal instability and less sagittal progression than healthy adults. In study 2, PD using the clock-turn strategy had lower gait variability and asymmetry than PD not using the strategy. Moreover, PD with the strategy had fewer freezing episodes and turned faster than PD without the strategy. In study 3, PD showed greater weight shift and step length at the reinitiation step in trials with the real-time somatosensory cue than trials without cue. Moreover, PD had fewer turning steps and shorter freezing duration in trials with cue than trials without cue. Conclusion: This dissertation verified the effects of different intervention approaches for resolving turning difficulty in people with PD. Future studies are suggested to investigate the mechanisms contributing to these effects from the central control perspective.
參考文獻
延伸閱讀
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