- 學位論文
兩種上肢阻力訓練模式對慢性中風病人 上肢動作功能療效之比較
Comparison of Two Resistive Arm Movement Trainings on Upper Extremity Functional Recovery in Patients with Chronic Stroke
摘要
背景：影響中風病人日常生活功能的上肢機能缺損包括肌肉無力、易疲勞、痙攣以及缺乏自主動作控制的能力，其中以肌肉無力最為常見，不管是患側上肢近端或遠端肌群的肌力不足，都將使個案在日常生活功能上產生依賴性。因此，如何改善中風病人上肢的動作缺損，尤其是加強病人的上肢肌力進而提升上肢功能恢復是中風病人上肢復健很重要的課題。 本研究之目的為探討兩種上肢阻力訓練對於改善中風病人上肢肌力與功能之療效，並做此兩種訓練效果之比較。 方法：本研究計畫採單盲隨機分配試驗、前-後測評估設計。共選取30位慢性中風病人，並以隨機方式分派至兩組。一組施以機械協助式單側上肢阻力訓練，另一組則接受單側推拉箱上肢阻力訓練。兩組受試者之治療頻率皆為每週三次，每次治療時間為20分鐘，共計8週。主要療效評量則針對上肢肌肉張力（修正版艾許沃斯氏量表）、上肢動作（上肢布朗斯壯動作恢復分期，中風復健動作評估上肢次量表）、上肢功能性動作（上肢功能研究量表，箱子和木塊測驗）與上肢肌力（手部握力，上肢推拉力，肩關節及肘關節肌力）等方面加以評估，二次之評估時間點分別為：治療前、治療8週後。 結果：兩組組間在所有臨床評量項目中並無統計學上之顯著差異(P＞.05)。機械協助式上肢阻力訓練組在上肢動作、功能及肌力方面臨床評量之組內進步達統計學上之顯著差異(P＜.05)，其治療效應，主要發生在上肢布朗斯壯動作恢復分期(F=17.5, P=.001, effect size: partial η2=.56)、箱子和木塊測驗(F=28.76, P=.000, effect size: partial η2=.69)、手部握力(F=13.9, P=.002, effect size: partial η2=.50)，皆達中度效應以上。而推拉箱阻力訓練組在上肢動作、功能及肌力方面臨床評量之組內進步達統計學上之顯著差異(P＜.05)，其治療效應，主要發生在箱子和木塊測驗(F=14.74, P=.004, effect size: partial η2=.62)、肘關節肌力(F=14.6, P=.002, effect size: partial η2=.52)，皆達中度效應以上。 結論：雖然兩組治療模式不同，但兩種訓練方式之治療前後變化皆呈現正向效果，且不會增加上肢不正常肌肉張力，顯示傳統復健加入此兩種阻力訓練方式皆為有效提升慢性中風病人上肢功能之臨床治療方式。
並列摘要
Patients with stroke will suffer from significant motor impairments, on upper limb that drastically impacts the performance of functional abilities in activities of daily living. Significant impairments are observed in persons post-stroke including weakness, generalized fatigue, spasticity, loss of voluntary motor control. Upper limb weakness is the common motor deficit. Thus, this study was to examine the effects of two resistance trainings, robot-assisted device and sanding box activity, on upper limb functional recovery in patients with chronic stroke. A single-blind randomized controlled trial, pre-and post-test research design was applied in this study. Thirty participants, who had unilateral strokes for at least 6 months, were enrolled in this study. Subjects were randomly assigned to one of the two training groups: the robotic-assisted group and the sanding box group. Both groups will be exposed to the training for 20 minutes in a session, three sessions per week for 8 weeks. Main outcome measures include paretic upper-limb muscle tone (Modified Ashworth Scale), arm motor (Brunnstrom’s recovery stage, Stroke Rehabilitation Assessment of Movement), upper-limb motor function(Action Research Arm Test, Box and Block Test ) and paretic upper-limb strength(grip strength, arm push and pull strength, shoulder and elbow strength). The measurements will be administrated during baseline test and post-test. Both groups will be assessed before and after the intervention. After comparing all of the sets of scores, there were no significant differences between two groups. However, the post-test scores were higher than the pretest scores both in robotic-assisted group and sanding box group. The statistically significant improvement in robotic-assisted group were on Brunnstrom’s recovery stage of U/E (F=17.5, P=.001, effect size: partial η2=.56), Box and Block Test (F=28.76, P=.000, effect size: partial η2=.69), and arm grip strength (F=13.9, P=.002, effect size: partial η2=.50); the statistically significant improvement in sanding box group were on Box and Block Test (F=14.74, P=.004, effect size: partial η2=.62), and elbow strength (F=14.6, P=.002, effect size: partial η2=.52). Both robotic-assisted and the sanding box resistive arm trainings can positively increase strength, promote functional improvement, and without increasing spasticity in stroke upper limb rehabilitation. These findings suggest that robotic-assisted and the sanding box training programs should be integrated as parts of rehabilitation programs.
參考文獻
延伸閱讀
- 邱宜君（2009）。任務取向雙側上肢運動訓練對中風患者動作功能之療效〔碩士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2009.00572
- 陳世銘、李佳容、林芳瑾、唐鈺晶、李佳玲、林昭宏（2016）。冷熱溫度刺激治療強度對於慢性期中風患者上肢動作恢復的療效。物理治療，41(1)，48-55。https://doi.org/10.6215/FJPT.PTS1439878295
- Chen, P. T., Lin, K. C., Wu, C. Y., & Hsieh, Y. W. (2019). 近、遠端機器輔助療法結合高強度功能性任務訓練於慢性中風患者上肢功能之療效. 臺灣職能治療研究與實務雜誌, 15(1), 1-14. https://doi.org/10.6534/jtotrp.201906_15(1).0001
- 楊文英、李岩恆、吳淑娟、蘇希洵、陳美伶、孫天龍、黃建華（2017）。急性後期中風病患上肢動作缺損與日常生活功能之關聯分析。醫學與健康期刊，6(2)，45-55。https://www.airitilibrary.com/Article/Detail?DocID=23046856-201709-201709210009-201709210009-45-55
- Wu, C. L., Huang, M. H., Lee, C. L., Liu, C. W., Lin, L. J., & Chen, C. H. (2006). Effect on Spasticity after Performance of Dynamic-Repeated-Passive Ankle Joint Motion Exercise in Chronic Stroke Patients. The Kaohsiung Journal of Medical Sciences, 22(12), 610-617. https://www.airitilibrary.com/Article/Detail?DocID=02575655-200612-22-12-610-617-a