踝關節虛擬實境訓練對於中風患者下肢肢體功能的改善

中文摘要研究背景與目的：許多研究認為中風後失能造成的平衡與行走能力缺損會影響功能的獨立及日常生活品質，也會成為中風後患者能否回到社區的重要因素，因此許多復健訓練和中風患者本身都會將改善平衡與行走能力當作治療的目標，但訓練的焦點大多在整體的能力與大塊肌肉力量的訓練，忽略踝關節對於平衡與步態的影響。在目前中風的治療觀點普遍認為可以藉由促進神經塑性來改善肢體功能，近幾年也來越來越多人研究虛擬實境應用在中風患者訓練上的效果。因此本篇研究就是希望能開發出簡單操作並結合虛擬實境概念應用在踝關節的訓練，希望能改善中風患者下肢平衡與行走能力。方法：利用台中某區域教學醫院復健科，收取符合收案條件之參與者共20人，分為實驗組與控制組，最後共有15人完成研究進行資料分析，其中實驗組7人，控制組8人。兩組皆接受傳統常規復健治療，實驗組額外增加30分鐘踝關節虛擬實境訓練，一週執行三次共執行四週，評估測量實施於四週前與四週後，評估的內容包含1.行走能力：10公尺行走測試；2.平衡能力:博格式平衡量表、起立行走測試；3.姿勢穩定度測試。結果：研究中利用獨立樣本t檢定分析兩組特徵，發現並沒有差異；無母數魏克遜符號等級檢定(Nonparametric Wilcoxon signed-ranks test)各個測量值，測試前後兩組各別的差異，發現實驗組在博格式平衡量表的分數、起立行走測試、舒適與快速行走以及兩腳承重的差異，都有達到顯著的差異，但控制組沒有；利用Mann-Whitney U test來分析介入組與控制組在介入前後差異值是否有達到兩組之間的顯著差異分析兩組在測試前後改變的差異，發現在博格氏量表分數與雙腳承重的差異的變化在兩組之間是有達到顯著差異的。結論：在進行為期四週，一週三次，一次三十分鐘的踝關節虛擬實境訓練可以增加平衡能力、行走速度以及改善兩腳承重的差異。

關鍵字

中風；虛擬實境；踝關節；平衡；行走

並列摘要

Objective: To evaluate gait biomechanics after training with a ankle joint virtual reality (VR) system and to elucidate underlying mechanisms that contributed to the observed functional improvement in gait speed, balance, and postural stability. Design:Ｑuasi-Experimental Designs, didn’t use randomized control, and have two group: VR group and NVR group. Setting: Department of rehabilitation in a Taichung hospital in Taiwan. Participants: Eleven men and women with hemiparesis caused by stroke. Interventions: Subjects trained on a ankle dorsiflexion and plantarflexion interfaced with a VR. Subjects were assigned to either a VR group (n=7) or non-VR group (NVR, n=4). Training was performed three times a week for 4 weeks for approximately 30minutes each visit. Main outcome measures: Berg balance scale, Timed up and go test, Biodex balance system, 10 m walking test. Result: Overall 15 subjects complete the training, 7 in the intervention group, and 8 in the control group. Their demographical characteristics between two group have no different. In each group effect, the intervention group significant improvement in balance, gait speed, and weight bearing ability, but not find in control group. Between groups the intervention have move improvement in Berg balance scale and the weight bearing ability than control group. Conclusion: Ankle joint virtual reality training can improve lower extremity function about balance, gait speed, and improve imbalance weight bearing while standing.

並列關鍵字

Stroke ； Virtual reality ； Ankle joint ； gait ； Balance

參考文獻

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• 3.Saposnik, G., Levin, M., & Stroke Outcome Research Canada (SORCan) Working Group. (2011). Virtual reality in stroke rehabilitation a meta-analysis and implications for clinicians. Stroke, 42(5), 1380-1386.

• 4 .Walker, M. L., Ringleb, S. I., Maihafer, G. C., Walker, R., Crouch, J. R., Van Lunen, B., & Morrison, S. (2010). Virtual reality–enhanced partial body weight–supported treadmill training poststroke: feasibility and effectiveness in 6 subjects. Archives of physical medicine and rehabilitation, 91(1), 115-122.

• 5.Sakuma, K., Ohata, K., Izumi, K., Shiotsuka, Y., Yasui, T., Ibuki, S., & Ichihashi, N. (2014). Relation between abnormal synergy and gait in patients after stroke. Journal of neuroengineering and rehabilitation, 11(1), 1.

• 6. Wutzke, C. J., Mercer, V. S., & Lewek, M. D. (2013). Influence of lower extremity sensory function on locomotor adaptation following stroke: a review. Topics in stroke rehabilitation, 20(3), 233-240.

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踝關節虛擬實境訓練對於中風患者下肢肢體功能的改善

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