- 學位論文
穴位電刺激對於中風病患下肢張力的影響
The Influence of Electrical Stimulation over Acupuncture Points on Lower Extremity Muscle Tone for Patient with Stroke
摘要
研究背景：中風是許多國家造成死亡及失能的主要原因之一，大約百分三十到百分六十六的中風患者會合併有肢體動作行動相關的問題及感覺喪失。中風病患缺乏活動，容易造成神經肌肉的改變，常見的有肌痙攣、關節攣縮。目前針對中風所造成的肌痙攣的處理方式包括有傳統中醫、西醫物理治療或利用神經阻斷劑或肉毒桿菌注射及一些抗張力藥物的服用…等方法。西醫的處理方法有其極限，而目前有關中醫處理中風的研究大多數還是在看治療後日常生活功能、行走能力、生活品質及功能性動作(包括吃飯、洗澡、走路…等)等是否有改善。但是目前這方面的研究仍然有許多的爭議。這些所牽涉的因素太廣泛，可能包括感覺、肌力、協調性、平衡…等，要去探討某一種治療是否對這些有影響，我想這個範圍太大了，所牽涉的變數太多。這樣要去看針灸的效果，也許會有一些困難度存在。因此我們把範圍縮小，只去看肌肉張力的影響。而且針灸並不是每個人都可以接受，因此本研究的目的，想要了解電刺激在穴位上對中風病人的張力或痙攣所造成的影響。材料與方法：參與實驗的受試者有34位中風患者，男性30位，女性4位，受試者的條件為中風後超過6個月(含6個月)。所有受試者分成2組：實驗組17位，使用向量干擾波(IFC)來刺激穴位，包括委中(UB54)、承山(UB57)、三陰交(SP6)及照海(K6)，並使用H反射恢復曲線及修改版艾許沃斯量表的評估觀察肌肉張力的變化。對照組17位，實驗流程與實驗組一樣，只是無穴位電刺激的介入。本實驗用SPSS 11.0 的統計軟體，用多因子變異數分析中的重複量表(repeated measures)來分析是否有變化。研究結果：電刺激間隔100ms(p=0.00)、150ms(p=0.001)、200ms(p=0.031)、250ms(p=0.05)有統計上的差異，其他50ms、300ms、400ms則無統計上的差異 ，而在對照組在所有電刺激間隔皆無統計上的差異，在修改版艾許沃斯量表中實驗組有的有改變，但並無統計上的差異，而在對照組則無統計上的差異。討論與結論：本實驗結果顯示穴位電刺激可以產生脊髓上的影響，進而影響反射的部分，至於非反射的部分則須要進一步研究。而這個效果可以持續多久則須要進一步研究。這個實驗可以提供大家處理中風病患時另一種選擇。
並列摘要
Background: Stroke is the cause of death and disability in many countries, about 30-66% patients have both sensory lose and movement problems. Due to long-term immobility, the stroke patients have neuromuscular system impairment. The most common situation is spasticity and joint contracture. The treatments of spasticily include physical therapy and traditional china medicine or use medical injection (never block ) and taken some anti-spasticity drug. There is the limit of cure stroke in the west medicine, as for the stroke research from china medicine focused on impairment of ambulation ability, the quality of life, the activity of daily life and functional ability. But there are still many arguments with the research. However, the variables (include sensory, muscle, coordination and balance…etc. ) involved in those studies are too broad to be controlled. It’s difficult to discuss the acupuncture’s effect. Therefore, in this study we minimize the size of variables and focus on the treatment effect of the muscle tone only. The purpose of this study is to investigate the effect from electrical stimulation on acupuncture point for reducing muscle tone and spasticity for stroke patients. Material and method: There are 34 stroke patients recruited, 30 male and 4 female, the criteria are (1).stroked after 6 months(include 6 months). (2).L/E have spaticity. (3).conscious clear. All the subjects were separated into 2 groups. Study group use IFC to stimulate the point (UB54, UB57, SP6 and K6) and use H-reflex recovery curve and Modify athworth scale (MAS) to assess the muscle tone. The control group’s received the same study protocal except the electrical stimulation treatment. In this study, we used the repeated measures and independent t-test to assess the changes between those groups. Result: The interval of stimulation (100ms, 150ms, 200ms, 250ms) has the significant different between those groups, others not. The result of study group showed that there are difference after electrical stimulation treatment in MAS but not statistically significant. No difference as noted in control group. Discussion and conclusion: The test shows the electrical stimulation can have supraspinal effect. Therefore it has affect on reflex component. There are more studies to be done in order to understand (1) the non-reflex component. (2) duration of the effect. This study can provide another way for the stroke patient and those patients who are afraid of acupuncture treatment. .