「踩車運動訓練」對於中風病人下肢功能恢復與行走能力的療效

Effect of Cycling Motion Training on Functional Recovery and Walking Ability of Lower Extremity in Patients with Stroke

楊慧菁(Huei-Ching Yang)

指導教授 ： 林昭宏

共同指導教授 ： 李佳玲(Chia-Ling Lee)

高雄醫學大學/醫學院/神經學科研究所/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00051

摘要

目的：探討踩車運動訓練對慢性期腦中風患者的下肢動作功能恢復及行走耐力和行走速度改善之療效。方法：本研究徵召三十位慢性期中風患者接受踩車運動訓練計畫。以隨機交叉分組實驗設計方法分為兩組，A-B組15位 (平均年齡53.9±10.5歲)首先執行四週傳統復健治療及額外踩車運動訓練 (一週五次，每次30分)，接下來四週只執行傳統復健治療。B-A組15位 (54.5±8.0歲)執行相反順序的訓練。研究選用德國製踩車訓練儀器 (MOTO med viva2 Movement Trainer, Germany)踩車運動訓練時受試者被告知盡可能維持踩踏轉速為每分鐘60±10 rpm並藉由踩車面板的視覺回饋維持雙側下肢對稱用力踩踏。主要療效評估與測試工具包含福格邁爾量表-下肢次量表 (Lower Extremity subscale of Fugl-Meyer Assessment, LE-FMA)、六分鐘行走距離測試 (Six-Minute Walk Test, 6MWT)、十公尺行走速度測試(Ten-Meter Walk Test, 10MWT)，次要療效包括巴氏量表 (Barthel Index, BI)評量日常生活功能和修正式艾許瓦氏量表 (Modified Ashworth Scale, MAS)評量患側膝伸直肌張力。所有受試者於訓練前，訓練第四週，訓練第八週接受上述療效評估與測試。每次踩車運動訓練後擷取踩車系統晶片卡運動參數代表踩車表現進步狀況，主要包含下肢踩踏過程承受的平均阻力 (average resistance)及平均輸出功率 (average power)和健側與患側踩踏力量對稱性 (symmetry)。比較所有受試者第一週與第四週上述主要運動參數值的進步量。以皮爾森相關係數 (Pearson correlation coefficient)檢定療效進步量與踩車表現進步量之間相關性。結果：兩組踩車期間主要療效評估包含福格邁爾量表-下肢次量表 (p<.05)、六分鐘行走距離測試 (p<.001)、行走速度 (p<.001)進步量，皆明顯大於沒有踩車期間。踩車運動訓練介入後所有評量之治療效應 (treatment effect)達顯著差異 (p<.001)，踩車期間與沒有踩車期間殘留效應 (carryover effect)未達顯著差異 (p>.05)。經由多變量變異數分析調整相關變項，所有評量進步量呈現踩車期間顯著大於沒有踩車訓練期間 (p<.001)。第四週踩車表現進步量包括平均阻力 (p<.001)及平均輸出功率(p<.001)和踩踏力量對稱性 (p<.05)皆明顯大於第一週。以皮爾森相關係數檢定療效進步量與踩車表現進步量之間相關性，其中行走耐力與平均踩車阻力 (r=.59, p<.001)，行走耐力與平均踩車輸出功率 (r=.52, p<.05), 行走速度與平均踩車阻力 (r=.65, p<.001)及行走速度與踩車輸出功率 (r=.53, p<.05)之間呈現中度相關性。結論：本研究證實四週踩車運動訓練可以改善慢性期中風患者的下肢動作恢復及行走耐力和行走速度，同時也可以增進踩車的平均阻力，平均輸出功率及對稱性表現。

關鍵字

中風 ； 下肢 ； 功能恢復 ； 踩車運動訓練 ； 視覺回饋

並列摘要

Purpose: This study was to investigate the effectiveness of cycling training on lower limb functional recovery, walking endurance, and walking speed for patients with chronic stroke. Methods: Thirty chronic stoke patients were recruited and randomly placed into two groups using crossover design. The A-B group (N=15) (mean 53.9±10.5yr) underwent conventional rehabilitation and cycling training (30 minutes/session, 5 times per week for 4 weeks), followed by only conventional rehabilitation for another 4 weeks. The B-A group (N=15) (mean 54.5±8.0yr) underwent the same training in reverse order. The bike used in this cycling training was the MOTO med viva2 Movement Trainer (Germany). During cycling training, participants were required to maintain pedaling speed of 60±10 revolutions per minute (rpm) and symmetry in their lower extremities via the visual feedback on the cycling faceplate. Primary outcome measures included the lower extremity subscale of Fugl-Meyer Assessment (LE-FMA), the Six-Minute Walk Test (6MWT) and, the Ten-Meter Walk Test (10MWT). Secondary measures including Barthel Index (BI) for the activity of daily living function and Modified Ashworth Scale (MAS) of knee extensor were recorded. All participants were assessed with both outcome measures at the beginning of the study, at the end of the fourth week, and at the end of the eighth week. Finally, the mean values from the cycling performance parameters measured on the software chip card of the cycling system including the average resistance, average power and symmetry (sound side and affected side of force) of the first and fourth weeks in the cycling training were compared respectively. Pearson correlation coefficients between the changed values of the primary outcome during the cycling motion training and the changed values of bike parameters from the first to the fourth week in the cycling motion training were calculated. Results: The results showed the period with cycling motion training improved more significantly than the no cycling period in LE-FMA (p<.05), 6MWT (p<.001), 10MWT (p<.001). All measurement demonstrated positive treatment effect (p<.001) and no carryover effect (p>.05). After the adjustment in Multivariate analysis of variance (MANOVA), the improvement of primary and secondary measurements showed significant difference in the cycling period than in the no cycling period (p<.001). The cycling performance change values at the fourth week were significantly more improved than the first week in average resistance (p<.001), average power (p<.001) and symmetry (p<.05). Pearson correlation coefficients were moderate between the walking endurance and average resistance (r=.59, p<.001), between walking endurance and average power (r=.52, p<.05), between walking speed and average resistance (r=.65, p<.001) and between walking speed and average power (r=.53, p<.05). Conclusions: The study indicated the four-week cycling motion training improved functional recovery of the lower extremities, walking endurance and speed in the lower extremities of chronic stroke patients. In addition, this cycling training enhanced the cycling performance in average resistance, average power and symmetry.

並列關鍵字

stroke ； lower extremity ； functional recovery ； cycling motion training ； visual feedback

參考文獻

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