不同頻率全身震動刺激對腦性麻痺孩童肌力、肌張力和柔軟度之反應

Effects of whole body vibration with different frequencies on muscle strength, muscle tone and flexibility in children with cerebral palsy

曾炫諭(Xuan-Yu Tseng)

指導教授 ： 唐詠雯

中山醫學大學/醫學院/醫學研究所/碩士(2009年)

https://doi.org/10.6834/CSMU.2009.00062

摘要

背景與目的：不同頻率之震動刺激由振動平台產生不同震動加速度傳導到身體，產生不同神經肌肉表現，本研究目的在探討六種震動頻率的全身震動刺激對腦性麻痺孩童肌力、肌張力和柔軟度的影響。研究方法：15位痙孿型腦性麻痺（平均9.14±3.30歲）隨機接受六種頻率（頻率12、16、20、25、30和35Hz × 振幅1.8mm）的震動刺激（震動機型號：Body Green AV001A），受試者於膝關節屈曲30度下站立接受振動刺激，分兩天進行，每次振動一分鐘，中間休息一小時，震動前後量測肌力、肌張力與柔軟度表現。以自製手握測力計（使用Load cell型號：MLP 200, Transducer Techniques )量測膝伸直肌肌力之最大自主收縮（Maximum voluntary contraction, MVC），用鐘擺運動之放鬆指數（Relaxation index, RI）量測肌張力，以坐姿體前彎（Sit to reach）量測柔軟度。用pair t test比較肌力、肌張力、柔軟度接受震動前後之差異，用Repeated measure ANOVA分析六種頻率震動前的MVC、RI與Sit to reach之差異，以及震動頻率對於MVC、RI和Sit to reach百分比變化的影響，用Person`s correlation分析MVC、RI和Sit to reach之百分比變化相關性。結果：在六種不同頻率震動前的變化中，MVC值、RI值與Sit to reach值皆無顯著差異(p＞0.05)；在震動前後比較中，MVC值在六種頻率皆有顯著增加（p＜0.05），30Hz 值最大，RI值在大部份頻率有顯著增加（p＜0.05）(除35Hz外，p＝0.11) ，20Hz值最大，Sit to reach於20Hz值最大且有顯著增加（p＝0.00）。在不同頻率變化中，不同頻率對於MVC、RI與Sit to reach皆有顯著影響（p＜0.05），MVC表現中，30Hz顯著大於12Hz（p＝0.002）與16Hz（p＝0.017），Sit to reach表現中，35Hz 顯著小於12Hz、16Hz、20Hz（p＜0.05）。相關性表現中RI與Sit to reach顯著負相關（r＝－0.45，p＜0.05）。結論：六種頻率震動前的MVC、RI與Sit to reach之表現無顯著差異，顯示不同頻率震動刺激的效果不會相互影響，每次震動效果於六十分鐘內消失。震動刺激均會增加肌力表現且不會引起肌張力負面效果；頻率變化對於肌力、肌張力與柔軟度均有影響。12Hz與16Hz表現中因此震動頻率範圍容易引發身體器官共震較大，而導致身體肢段之震盪減小，使得肌力表現比30Hz低，且柔軟度沒變化；身體軟組織變化對肌張力與柔軟度表現皆有影響，20Hz震動刺激可能改變肌肉與關節之黏滯性較多而顯著改善肌張力與柔軟度；30Hz震動刺激可能造成肌肉活動較多而顯著增加膝伸直肌肌力；30Hz以上的震動刺激較易產生肌肉疲勞之現象而造成35Hz震動刺激的肌張力無改善和柔軟度表現較差。臨床意義：本研究建議以30Hz為肌力訓練模式，以20Hz為改善張力與柔軟度之訓練模式。

關鍵字

全身振動 ； 肌力 ； 肌張力 ； 柔軟度

並列摘要

Background：Different neuromuscular responses on human body are produced by different frequencies of vibrations which cause different oscillatory accelerations by vibration platforms. The purpose of this study is to discuss that under the whole body vertical vibration with six different frequencies, the effect of muscular strength, muscular tone and flexibility for children with cerebral palsy. Method：15 children with cerebral palsy (average age: 9.14±3.30 years old) are stimulated by vibration machine (machine type: Body Green AV001A, amplitude: 1.8mm) with six kinds of frequencies (frequency: 12, 16, 20, 25, 30 and 35Hz) randomly in two days. Participants take a standing position and flex knees in 30 degrees and then are vibrated. Vibration takes one minute each time, and participants take a break for an hour between courses. This study uses self-design hand-held dynamometer (load cell type: MLP 200, transducer techniques) to measure the knee extensor maximum voluntary contraction (MVC). Pendulum test’s relaxation index (RI) measures muscle tone, and sit-to-reach measures flexibility. Also, the performances of muscular strength, muscular tone and flexibility are recorded before and after the vibrations. This study applies Pair t test to compare the results of muscle strength, muscle tone, and flexibility before and after accepting vibrations. In addition, Repeated measure ANOVA analyzes the difference between MVC, RI and Sit-to-reach before the vibrations, and analyzes the effects of vibration frequencies versus MVC, RI and Sit-to-reach. Moreover, to know the correlation between MVC, RI and Sit-to-reach after the vibrations, this study uses Person correlation coefficient analysis to analyze it. Result： The values of MVC, RI and Sit-to-reach before the vibrations do not have significant difference (p>0.05). After the vibrations, there are following results. The values of MVC are increased significantly (p<0.05). The value of MVC at 30Hz is the maximum. The values of RI at almost frequencies are increased significantly (p<0.05), except the frequency at 35Hz (P =0.11), and the value of RI at 20Hz is the maximum. The value of Sit-to-reach at 20Hz which is only increased significantly (p =0.00) is the maximum. In the different frequency has significant effects on MVC, RI and Sit-to-reach (p<0.05). The value of MVC at 30Hz is significant higher than 12Hz (P =0.002) and 16Hz（p =0.017）. The value of Sit-to-reach at 35Hz is significant lower than 12Hz, 16Hz and 20Hz (p<0.05). In the correlation part, there is negative correlation significantly between RI and Sit-to-reach (r =-0.45, p<0.05). Conclusion: The performances of MVC, RI and Sit-to-reach do not have significant differences before the six kinds of vibrations. It shows that the effects at different vibrations’ frequencies do not have interference, and each effect disappears in 60mins. However, the vibrations not only can encourage the response of muscular strength, but also can not cause the negative effect of muscular tone, and changing frequency has effects on muscular strength, muscular tone and flexibility. Furthermore, the responses of muscular strength at 12Hz and 16Hz are worse than it at 30Hz and the performances of flexibility do not have any change because these frequencies can easily cause resonances of the body's organs so that the accelerations of low extremity are decreased. Also, the change of soft tissue has effects on the responses of muscular tone and flexibility. The vibration at 20 Hz may enhance movements of muscles and joints and can improve muscle tone and flexibility. The vibration at 30Hz may increase more muscular activities so it can raise the muscle strength of knee extensor. The vibration at 35Hz results bad responses of flexibility and unimproved muscular tone from its vibration brings about the phenomenon of muscular tiredness. Clinical meaning: This study recommends the training model of muscle strength is the vibration at 30Hz, and the vibration at 20Hz is the training model to improve muscle
tone and flexibility.

並列關鍵字

Whole body vibration ； Muscular strength ； Muscular tone ； Flexibility

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