步行訓練結合垂足神經輔具應用於慢性中風患者之臨床療效

背景與目的：垂足是導致慢性中風患者行動不便的原因之一，為了防止垂足，傳統治療會在步行時給予踝足裝具。但是穿戴踝足裝具的缺點會使踝關節背屈肌群喪失主動收縮機會，造成肌肉無法再學習和訓練。本研究擬使用沃克艾德垂足神經輔具(WalkAide System)進行步行訓練，加強於步行擺盪期踝關節背屈肌群主動收縮的訓練，探討是否能改善慢性中風患者的行走速度、距離、生理耗能指數、腳踝背屈肌力、腳踝的關節角度、腳踝伸直肌的肌痙攣、下肢的動作恢復程度和功能性平衡能力。方法：收取8位慢性中風患者，6位男性，2位女性。平均年齡為50.38(±14.31) 歲，中風時間為38.25(±23.99) 個月，功能性行走分類等級(Functional Ambulation Category) 5-6分。患者接受訓練前，先進行沃克艾德垂足神經輔具的設定和實驗前測。前測的項目中主要療效指標有穿戴和沒有穿戴垂足神經輔具10公尺行走速度、6分鐘行走測試及生理耗能指數(Physiological Cost Index, PCI)。次要療效指標有腳踝背屈肌力、腳踝的背屈被動關節角度、腳踝伸直肌的肌痙攣、下肢的動作恢復程度和功能性平衡能力。受試者共接受為期8週，每週3天，每次20分鐘的步行訓練加沃克艾德垂足神經輔具電刺激在腓總神經，使產生踝關節背屈肌群主動收縮的訓練，8週後進行實驗後測。使用SPSS 14.0 軟體分析，以配對樣本t 檢定(Pair-Sample t test)檢定實驗前後測平均數的差異，統計分析之α 值訂為0.05。結果：沒有穿戴垂足神經輔具時的主要療效指標，10公尺的行走速度從0.74±0.29公尺/秒進步到0.83±0.37公尺/秒(p>0.05)；6分鐘行走測試的行走速度從0.63±0.23進步到0.70±0.30 (p<0.05)，6分鐘行走測試的距離從226.48±85.23公尺進步到250.11±107.17公尺 (p<0.05)；及生理耗能指數從0.58±0.42心跳/公尺減少至0.53±0.45心跳/公尺(p<0.05)。有穿戴垂足神經輔具主要療效指標的10公尺的行走速度從0.75±0.31公尺/秒進步到0.88±0.37公尺/秒 (p<0.05)；6分鐘行走測試的行走速度從0.60±0.24公尺/秒進步到0.72±0.30公尺/秒 (p<0.05)，6分鐘行走測試的距離從217.00±86.53公尺進步到 258.53±107.50公尺 (p<0.05)；及生理耗能指數從0.63±0.58心跳/公尺減少至0.44±0.37心跳/公尺(p<0.05)。次要療效指標除了腳踝伸直肌的肌痙攣沒有改善之外(P>0.05)，腳踝背屈肌力、腳踝的背屈被動關節角度、下肢的動作恢復程度和功能性平衡能力都有進步，且訓練前後有統計上顯著的差異(P<0.05)。結論：慢性中風患者穿戴沃克艾德垂足神經輔具的步行訓練，對患者的行走速度、距離、生理耗能指數、腳踝背屈肌力、腳踝的關節角度、下肢的動作恢復程度和功能性平衡能力都有正向的臨床效益。

關鍵字

慢性中風；垂足神經輔具；功能性電刺激；行走訓練

並列摘要

Background: Drop foot is the main cause of abnormal gait pattern in patients with chronic stroke. Patients wearing an ankle-foot orthosis (AFO) to prevent foot drop is a common approach in clinical practice. However, wearing an AFO doesn’t allow active dorsi-flexion or muscle relearning of the ankle. An alternative approach is to apply a drop-foot neuroprosthesis (WalkAide) to stimulate the common peroneal nerve for ankle dorsi-flexion during the swing phase of a gait cycle. Purpose: The purpose of this study was to investigate the effects on walking ability of the combination of gait training and the use of a WalkAide in patients with chronic stroke. Methods: A total of eight patients with chronic stroke were recruited in the study. They were 6 males and 2 females with a mean age 50.38 (±14.31) years, a mean time after stroke is 38.25 (±23.99) months, and a functional ambulation category 5 or 6. The primary outcome measures were the 10 meters walking test (10MWT), the 6 minute walking test (6mWT), and the physiological cost index (PCI). The secondary outcome measures were muscle strength of ankle dorsi-flexion, passive range of motion (PROM) of the ankle, spasticity of calf muscles, motor recovery of the lower extremity, and balance. All patients received physical therapy for 40 minutes and walked on a treadmill with or without wearing a WalkAide for 20 minutes, three days a week for eight weeks. Paired-t tests were conducted to examine the mean differences of outcomes between the pre- and post-training, at an alpha level of 0.05. Results: There were significant improvements in walking speed for the 10MWT (from 0.75 to 0.88 m/s, p=0.05), in walking speed for the 6mWT (from 0.60 to 0.72 m/s, p=0.01), in walking distance for the 6mWT (from 217.00 to 258.53 m, p=0.01), and in the PCI (from 0.58 to 0.44 b/m, p=0.04) in patients wearing a WalkAide. The results also showed improvements in walking speed for the 10MWT (from 0.74 to 0.83 m/s, p=0.14), in walking speed for the 6mWT (from 0.63 to 0.70 m/s, p=0.04), in walking distance for the 6mWT (from 226.48 to 250.11 m, p=0.04), and in the PCI (from 0.58 to 0.54 b/m, p=0.03) in patients not wearing a WalkAide. Additionally, improvements occurred in all the secondary outcomes except in the spasticity of calf muscles in patients wearing and not wearing a WalkAide. Conclusions: Patients with chronic stroke improved walking speed, walking distance, PCI, muscle strength of the ankle dorsi-flexors, PROM of the ankle, motor recovery of the lower extremity, and balance after 8 weeks of ambulation training with the use of a WalkAide.

並列關鍵字

Chronic stroke ； neuroprothesis ； functional electrical stimulation ； ambulation training

參考文獻

45.行政院衛生署. (2010年). 中華民國99 年死因統計.

47.黃麗麗, 胡名霞, 蔡美文, & 連倚南. (1985). 中風病人物理治療後之步態探討－五年的回顧. 物理治療學會雜誌, 10, 12.

1.Belda-Lois, J.-M., Horno, S. M.-d., Bermejo-Bosch, I., Moreno, J. C., Pons, J. L., Farina, D., . . . Rea, M. (2011). Rehabilitation of gait after stroke: a review towards a top-down approach. J Neuroeng Rehabil, 8, 66. doi: 10.1186/1743-0003-8-66

2.Bogey, R., & Hornby, T. G. (2007). Gait training strategies utilized in poststroke rehabilitation: are we really making a difference? Top Stroke Rehabil, 14(6), 1-8. doi: 10.1310/tsr1406-1

3.Bohannon, R. W. (1997). Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age Ageing, 26(1), 15-19.

國際替代計量

步行訓練結合垂足神經輔具應用於慢性中風患者之臨床療效

全文下載

主題瀏覽