使用紅繩作核心穩定運動對偏癱患者軀幹功能、平衡能力、行走功能及日常生活功能之影響

The Effect of Core Stability Exercises Using Redcord on Trunk Function, Balance Ability, Walking Performance and Daily Living Activities in Hemiparesis Patients

曾士琦(Shih-Chi Tseng)

指導教授 ： 郭藍遠

高雄醫學大學/醫學院/運動醫學系碩士在職專班/碩士(2018年)

摘要

研究背景與目的:
腦中風是導致成年人後天身體失能的主要原因之一。大約有80 % 之腦中風患者軀幹控制受到影響，動作協調或平衡能力變差，增加跌倒風險，進而影響其行走能力和日常生活功能，所以復健的重要目標就是增進腦中風患者的軀幹穩定度。近年來的研究發現，比起在穩定平面的訓練，在不穩定平面上執行軀幹穩定運動有更好的效果。紅繩懸吊系統為常見之不穩定平面，藉由紅繩的彈力繩支撐體重，可幫助患者較輕易地進行訓練。本研究的目的是探討使用紅繩作核心穩定運動對偏癱患者軀幹功能、平衡能力、行走功能及日常生活功能之影響。
方法 :
徵召40位急性後中風患者，隨機分為對照組和紅繩組，受試者皆於8週內接受20次常規物理治療，紅繩組除了常規物理治療之外，每次額外使用紅繩，以躺姿之橋式為基礎，執行下肢交替動作之核心穩定運動。第一次訓練前實施前測，8週內完成訓練後施行後測。以軀幹功能損傷量表、骨盆後傾用力最大值評估軀幹功能，以伯格氏平衡量表、計時起走測試、中風病患姿勢控制評估量表評估平衡功能，以五公尺行走測試、六分鐘行走測試評估行走功能，以巴氏量表、特定活動平衡信心量表評估日常生活功能。以成對t檢定檢測兩組的個別組內差異，以二因子重複測量變異數分析檢測紅繩組及對照組之組間差異。
結果 :
在軀幹功能、平衡功能、行走功能及日常生活功能前後測(組內)比較，紅繩組和對照組兩組皆有統計學上的顯著進步( p < 0.05 )。但紅繩組與對照組相比(組間)，只有行走功能有顯著差異，紅繩組的表現比對照組好( p < 0.05 )。
結論 :
本研究認為使用紅繩作核心穩定運動對偏癱患者軀幹功能、平衡能力、行走功能及日常生活功能有正面療效。而使用紅繩作核心穩定運動加上常規神經物理治療，相較於常規神經物理治療，在行走功能有較佳效果。

關鍵字

紅繩 ； 核心穩定運動 ； 偏癱 ； 物理治療

並列摘要

Background and Purpose:
Strokes are one of the leading causes of disabilities in adults. About 80 % of stroke patients have problems with trunk control, which is correlated with restricted balance, increased risk of falls, poor walking performance, and dependence on people in daily activities. The goal of physical therapy is to improve the trunk stability of stroke patients. In addition, recent studies have found that the trunk exercises performed on an unstable surface are more effective than those performed on the plinth. The Redcord suspension system, which is a common type of unstable surface, can help patients perform the training program more effectively by supporting the patient’s body weight with the elastic cord. The purpose of this study was to determine the effects of core stability exercises, using Redcord, on hemiparesis patients’ trunk function, balance ability, walking performance, and daily living activities.
Methods:
The subjects consisted of 40 stroke patients, who were randomly divided into two groups: a Redcord group and a control group. In an 8-week span, subjects in both groups received physical therapy 20 times, and subjects in the Redcord group practiced additional core stability exercises using Redcord. The exercises consisted of patients lying on their backs to perform reciprocal movements in their lower limbs as well as bridge exercises. All subjects were evaluated on their trunk function, balance ability, walking performance, and activities of daily living before the experiment ( pre-test ) and after 8 weeks of intervention ( post-test ) . The methods included Trunk Impairment Scale ( TIS ) and maximum force of pelvic posterior tilt to assess trunk function; Berg Balance Scale ( BBS ) , Timed Up and Go test ( TUG ) and Postural Assessment Scale for Stroke ( PASS ) to assess balance ability; 5 Meter Walk Test ( 5 MWT ) and 6 Minute Walk Test ( 6 MWT ) to assess walking performance; and Barthel Index ( BI ) and Activities-specific Balance Confidence scale ( ABC ) to assess activites of daily living. The paired t test was used to analyze differences between the pre-test and post-test within a group, while the two way repeated measured ANOVA was used to compare the Redcord group with the control group.
Results:
Within all of the total scale scores for both the Redcord group and control group, there were statistically significant differences ( p < 0.05 ) between the pre-test and post-test. When comparing the Redcord group with the control group, the only significant difference ( p < 0.05 ) observed was that the Redcord group improved in walking performance more than the control group.
Conclusions:
The results of this study suggest that core stability exercise training using Redcord is effective in improving hemiparesis patients’ trunk function, balance ability, walking performance, and daily living activities. Core stability exercises using Redcord combined with conventional physical therapy are more effective in improving the walking performance of hemiparesis patients than conventional physical therapy.

並列關鍵字

Redcord ； core stability exercise ； hemiparesis ； physical therapy

參考文獻

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