節奏聽覺刺激對於慢性腦中風個案伸手及物表現與動作功能的影響

Effects of rhythmic auditory stimulation on arm reaching performance and motor functions in persons with chronic stroke

余沛珊(Pei-Shan Yu)

指導教授 ： 陳瓊玲

中山醫學大學/醫學科技學院/物理治療學系/碩士(2019年)

https://doi.org/10.6834/CSMU201900043

摘要

研究目的：本研究目的在探討1. 節奏聽覺刺激對慢性腦中風個案伸手及物表現的立即性影響，2. 使用低密集度的節奏聽覺刺激介入於慢性腦中風個案的伸手及物表現及動作功能的影響。
研究方法：20位慢性腦中風個案參與研究，使用電子節拍器做為節奏聽覺刺激來源。以Zebris動作分析系統蒐集運動學參數分析伸手及物表現，使用傅格－梅爾評估量表、動作活動日誌、沃夫動作功能量表評估動作功能。個案隨機分派為實驗組及控制組，兩組分別參與每週二次，每次三十分鐘的傳統職能治療與三十分鐘的節奏聽覺刺激或日常動作訓練，共計四週。以成對樣本T檢定檢驗有無節奏聽覺刺激立即性伸手及物表現的差異，以曼-惠特尼U檢定檢驗治療介入前後實驗組及控制組伸手及物表現與動作功能的差異，以魏克生符號等級檢定各別檢驗實驗組與控制組治療介入前後的組內差異。
研究結果：節奏聽覺刺激對於慢性中風個案伸手及物表現可立即性的提升動作速度(P<0.001)和動作流暢度(P=0.004)。使用低密集度的節奏聽覺刺激介入後實驗組與控制組在伸手及物表現與動作功能皆無顯著差異。實驗組與控制組於4週治療後在伸手及物動作時間(P=0.024與P=0.007)、傅格－梅爾分數(P=0.005與P=0.011)及沃夫動作功能(P=0.005與P=0.018)皆有進步，但表現日常生活功能的動作活動日誌沒有進步。
結論與建議：節奏聽覺刺激可以立即性提升慢性腦中風個案伸手及物表現，但低密集度的節奏聽覺刺激治療介入無法顯著增進伸手及物表現與動作功能，但有較進步的趨勢。建議臨床治療師可以使用節奏聽覺刺激加入慢性腦中風個案的動作訓練。

關鍵字

腦中風 ； 節奏聽覺刺激 ； 伸手及物 ； 動作表現

並列摘要

Objectives : The objectives of this study were to examine 1. the immediate effects of rhythmic auditory stimulation on arm reaching performance and 2. the effects of low-frequency stimulation intervention on arm reaching performance and motor functions in persons with chronic stroke
Methods: Twenty persons with chronic stroke participated in this study. An electrical metronome was used to provide rhythmic auditory stimulation. Kinematic parameters of arm reaching performance was measured by Zebris motion analysis system. Motor function was measured by the Fugl-Meyer assessment, motor activity log and the Wolf motor function test. Participants were randomized to either an experimental or control group. The experimental group received traditional occupational therapy for 30 minutes and rhythmic auditory stimulation during arm reaching for 30 minutes per time, twice a week for 4 weeks. The control group received traditional occupational therapy and daily activities training for the same period of time. The paired sample T test was used to examine the differences of arm reaching performance with and without rhythmic auditory stimulation. The Mann-Whitney U was used to examine the differences of arm reaching performance and motor function pre- and post-intervention between experimental and control group. The Wilcoxon sign rank test was used for within-group comparisons of the pre- and post-intervention in both experimental and control group.
Results: The results showed that the rhythmic auditory stimulation could immediately increase the movement velocity (p<0.001) and movement smoothness (p=0.004) during arm reaching in persons with chronic stroke. There were no significant differences in arm reaching performance and motor function pre- and post-intervention between experimental and control group. After 4 weeks intervention, both experimental and control groups improved arm reaching movement velocity (P=0.024 and P=0.007), Fugl-Meyer scores (P=0.005 and P=0.011), and Wolf motor function (P=0.005 and P=0.018). However, the daily living functions measured by motor activity log has not improved.
Conclusion and Suggestion: Rhythmic auditory stimuli could immediately improve the arm reaching performance in persons with chronic stroke but the low-frequency intervention could not significantly improve arm reaching performance and motor function. However, there was a trend for greater improvement after stimulation intervention. It is recommended that clinical therapists can use rhythmic auditory stimulation for movement training in persons with chronic stroke.

並列關鍵字

Stroke ； rhythmic auditory stimulation ； arm reaching ； motor function

參考文獻

邱弘毅. (2008). 腦中風之現況與流行病學特徵. 腦中風會訊, 15(3), 2-4.

Bakhti, K., Laffont, I., Muthalib, M., Froger, J., & Mottet, D. (2018). Kinect-based assessment of proximal arm non-use after a stroke. Journal of neuroengineering and rehabilitation, 15(1), 104.

Barker, R. N., Brauer, S., & Carson, R. (2009). Training-induced changes in the pattern of triceps to biceps activation during reaching tasks after chronic and severe stroke. Experimental Brain Research, 196(4), 483-496.

Bella, S. D., Benoit, C. E., Farrugia, N., Schwartze, M., & Kotz, S. A. (2015). Effects of musically cued gait training in Parkinson's disease: beyond a motor benefit. Annals of the New York Academy of Sciences, 1337(1), 77-85.

Bradt, J., Magee, W. L., Dileo, C., Wheeler, B. L., & McGilloway, E. (2010). Music therapy for acquired brain injury. Cochrane Database of Systematic Reviews, 7(2).