侷限-誘發動作療法應用於 亞急性與慢性中風病患之一個月追蹤性臨床試驗

The Effects of Constraint-induced Movement Therapy in Subacute and Chronic Stroke Patients: A Controlled Clinical Trial with One-month Follow-up

黃綺虹(Chi-Hung Huang)

指導教授 ： 林克忠

國立臺灣大學/醫學院/職能治療研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.02445

摘要

目的 探討侷限-誘發動作療法（constraint-induced movement therapy, CIMT）是否優於傳統治療手法是否可以較有效改善中風病患患肢動作功能。在亞急性期與慢性期提供CIMT介入，是否有不同的療效差異。利用運動學動量分析來評估接受CIMT後,是否能有效改善動作控制的策略形成與執行能力，並維持治療效應至一個月後的追蹤期。

方法 分別取樣亞急性與慢性中風病患共28名，含7位亞急性、8位慢性患者，共15名接受CIMT治療。CIMT組個案患肢接受每日兩小時、每週五天，持續三個星期的大量密集性功能性活動訓練，且健側肢體以布質手套每日侷限至少六小時。傳統治療組則接受一般職能治療。於治療前後及一個月後的追蹤期，利用運動學動量分析評估個案在
伸手及物及取物動作上相關動量參數的改變量並配合使用相關臨床行為量表以了解個案在動作損傷、活動失能層級以及個體自我安適感的進步狀況。

結果 CIMT組在動量分析或臨床評量上皆比控制組進步較多，在執行伸手按鈴的活動情境中，反應時間、移動路徑偏移明顯減少較多、達到瞬時速度所佔運動時間比也明顯增加較多而與控制組有顯著差異。臨床評量中的富格麥爾上肢動作評量與上肢動作活動紀錄量表的「患肢使用量」、「動作品質」以及功能獨立測驗皆比控制組進步明顯。而在主觀評定自我安適感的中風量表中，CIMT組明顯呈現較正向的整體復原感受。這些改變量的差異並維持到一個月後的追蹤期。接受CIMT的亞急性患者普遍比慢性病患進步較多，但達到統計上明顯有差異的項目不多，分析結果發現不同發病期對CIMT的療效反應不盡相同。

結論 提供CIMT較一般傳統治療可以有效改善患肢動作功能，不僅改善動作控制策略形成的能力，改善動作執行的品質，更能實際提升個案在日常生活情境中使用患肢的頻率並促進個體安適感。亞急性病患接受CIMT的療效有較佳的趨勢，顯示及早提供足夠強度的治療策略可以有效啟動神經塑性，促進動作恢復。慢性病患藉由CIMT可以有效改善患肢「學習廢用現象」，有效增進患肢使用量。

關鍵字

運動學動量分析 ； 動作功能 ； 慢性中風病患 ； 侷限-誘發動作療法 ； 臨床評量 ； 亞急性中風病患

並列摘要

Objective The purpose of this study was to investigate the effectiveness of constraint-induced movement therapy (CIMT). This study also compared the effects of CIMT applied to subacute and chronic stroke patients. By using more sensitive and objective evaluation tool, 3-D motion analysis, we could get information about how patients improved their motor function by improving motor control strategy after they received CIMT. After one-month follow-up, the long-term effects of CIMT could be evaluated.

Methods Twenty-eight stoke patients were recruited in this study. Fifteen were assigned to receive CIMT (seven were subacute patients, eight were chronic patients), involving 2-hour intensive training for the affected arm and 6-hour constraint of the unaffected arm per day for 3 weeks. The control group received conventional occupation therapy. This study used kinematic motion analysis to assess the changes of the movement performance of reaching and reaching-to-grasping tasks and used other clinical outcome measures to evaluate the improvement of functional performance and well-being perception.

Results The CIMT group improved more in kinematic or clinical assessments than the control group. In pressing desk bell condition in motion analysis, the CIMT group showed significantly more improvement in reaction time, norzTD, and PPV that implicating faster to initiate movement, more direct movement to the target, and more advanced motor planning. CIMT group also showed more significant improvements in FMA, MAL-AOU & QOM, FIM and also perceived more positive well-being of life, especially in physical domains. The subacute patients who received CIMT generally improved more than chronic patients, although the differences were not significant in many dependent variables. Subacute patients and chronic patients might have different responses to CIMT.
Conclusion CIMT was a more effective and efficient method to improve motor function of affected arm in subacute and chronic patients. CIMT applied in subacute patients might have more benefits to help patients to induce brain plasticity and could keep improvements to one-month follow-up.

並列關鍵字

constraint-induced movement therapy ； kinematics ； chronic stroke patients ； motor function ； clinical measures ； subacute stroke patients

參考文獻

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