使用柺杖對中風偏癱病患自主性向前跨步動作表現與相關注意力需求之影響

Influences of Cane Use on Voluntary Forward Stepping Movement and Associated Attentional Demands in Hemiplegic Patients

呂麗華(Li-Hua Lu)

指導教授 ： 湯佩芳

國立臺灣大學/醫學院/物理治療學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01909

摘要

目的：探討使用單柺對中風病患與健康成人自主性向前跨步動作表現、力學變化及其相關注意力需求之影響。方法：共徵召11位健康成人(平均年齡：55.5歲)與11位中風病患(平均年齡：54.1歲)。採雙項任務研究方法，以自主性快速向前跨步動作為主要任務，口語選擇性反應任務為次要任務。受試者於單項跨步任務情境下，分別在持與不持柺時以左或右腳跨步各3次，共跨12次；於單項口語選擇性反應任務情境，受試者分別在持與不持柺靜態站姿下回答所聽音調為高或低頻各6次，共回答12次；於雙項任務情境下，受試者則分別在持與不持柺時以左或右腳向前跨步且同時執行口語選擇性反應任務，共測試12次。跨步動作表現以標準化跨步步長、跨步反應時間、單腳承重時間、動作時間、足底壓力中心移動軌跡模式與移動速率等變數反應之。注意力需求則以口語選擇性反應時間、回答正確率兩變數反應之。結果：中風病患持柺跨步時柺杖的垂直方向施力會預期性的增加，其雙下肢施力的穩定性則較不持柺時為佳。此外，持柺亦增加中風病患患肢跨步時之跨步步長、健肢跨步時之跨步動作時間與跨步反應時期之足底壓力中心移動速率(p＜0.05)。兩組受試者於雙項任務情境下之口語選擇性反應時間顯著較單項任務情境時長(p＜0.001)，且中風患肢跨步時單、雙項任務間之口語選擇性反應時間差距較健康受試者為大(p＜0.001)。持柺與否對兩組受試者跨步所需之注意力需求則無顯著影響。討論：持柺增加中風病患跨步時之動態平衡且不增加其跨步時之注意力需求。兩組受試者跨步時所需之注意力皆較靜態站姿時高，尤其是中風病患以患肢跨步時。故臨牀上訓練中風病患動態平衡能力時應考慮病患之注意力需求及持柺之正面效益。

關鍵字

半側偏癱 ； 單柺 ； 自主性跨步 ； 動態平衡 ； 注意力 ； 雙項任務

並列摘要

Purpose: The purpose of this study was to examine the influence of cane use on the movement, kinetics, and associated attentional demands of performing a voluntary forward stepping movement in patients with stroke and age-matched healthy adults. Methods: Eleven healthy adults (mean age= 55.5 years) and 11 patients with stroke (mean age= 54.1 years) participated in this study. The dual-task paradigm was used, with the volitional forward stepping movement serving as the primary task and the verbal reaction time (VRT) task as the secondary task. In the single, primary task condition, subject performed 3 trials of stepping in the cane-free and cane-use conditions, respectively, with each leg. In the single, secondary task condition, subject performed 6 trials of the verbal task in both cane conditions, respectively, during quiet standing. In the dual-task condition, subjects simultaneously performed 3 trials of verbal and stepping tasks in both cane conditions, respectively, with each leg. Stepping performance was reflected by normalized step length (SL), step reaction time (SRT), step single limb support time (SST), step movement time (SMT) and speed of COP (COPspeed). The attentional demands were reflected by VRT and accuracy rate. Results: With the use of a cane, anticipatory adjustments of the vertical forces applied on the cane prior to step initiation and more steady force generation patterns exerted by both lower extremities were found in the stroke group, especially when they stepped with the unaffected leg. Using a cane also significantly increased the SL of stroke patients when they stepped with the affected leg, and the SMT and COPspeed of the SRT phase when they stepped with the unaffected leg (p＜.005). Furthermore, it was found that the VRTs in dual task condition were significantly longer than those in the single, secondary task condition for both groups (p＜0.001), especially when stroke patients stepped with the affected leg (p＜0.001). The use of a cane did not significantly change the attentional demands of performing the stepping task for both groups. Discussion: The results indicate that using a cane significantly improve the dynamic balance, but not increase the attentional demands, associated with performing a forward stepping task for stroke patients. Patients’ attentional capability and the positive effects of cane use should be taken into consideration in the clinic practice of balance training of these patients.

並列關鍵字

dual task ； attention ； regular cane ； hemiplegia ； volitional stepping ； dynamic equilibrium

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