即時回饋承重轉移訓練後的中風病人承重轉移能力的改善對於平衡功能及行走能力的影響

The effects of improvement of weight-shifting ability after immediate feedback weight-shifting training on balance function and walking ability in patients with stroke

洪嘉玲(Jia-Ling Hong)

指導教授 ： 廖麗君

高雄醫學大學/健康科學院/物理治療學系碩士班/碩士(2016年)

摘要

研究背景與目的：有鑑於過去文獻指出視覺回饋的提供可促進中風病人的動作學習，本研究以提供兩腳各自的即時承重比率的回饋方式來進行承重轉移的訓練，以期促進中風病人其平衡功能及行走能力的表現。因此本研究的主要目的為使用一具視覺回饋之平衡系統執行之承重轉移訓練對於中風病人在站姿下兩腳承重之對稱性及承重轉移能力的療效，並探討中風病人的兩腳承重對稱性及承重轉移能力與其平衡功能及行走能力的關聯性；另外，次要目的則是以健康人為受試對象，以建立兩腳承重對稱性與承重轉移能力的指標並探討兩次施測之再測信度，以作為中風病人同樣能力指標的參照標準，研究方法：本實驗分為兩部分：第一部分為蒐集20位健康年輕人之平衡功能、行走能力及承重轉移能力，以作為中風病人同樣能力的參照標準。第二部分則徵召7位中風病人，主要是探討中風病人接受8次承重轉移訓練的效果。中風病人需於訓練前進行兩次的評估，此兩次評估結果除了用以驗證各項指標之再測信度外，並以兩次結果的平均表現作為訓練前的基礎能力（Baseline）。並接受8次的訓練介入（每週2到5次，為期2到4週），並於訓練結束1週內再次進行能力評估。上述健康人或中風人所需接受的評估內容包含在坐到站、靜態站立和向前承重轉移三個任務下的兩腳承重對稱性以及承重轉移的能力，此外還有平衡功能及行走能力（十公尺走路測試）的測量。本實驗使用級內相關係數（intraclass correlation coefficient, ICC）來探討上述能力之再測信度、而魏克生符號等級檢定法則探討中風病人訓練前與後的差異、並使用曼恩-惠尼U檢定探討健康人與中風病人在上述能力的差異。最後，使用斯皮爾曼相關係數探討承重對稱性與轉移能力與平衡功能及行走能力的關聯性。研究結果：七位中風病人於一週內之所有承重轉移指標兩次測量的再測信度，其ICC值為0.56-0.99，顯示有中度以上的再測信度。中風病人的兩腳承重對稱性及承重轉移能力在重心轉移訓練後，其坐到站、靜態站立及向前承重轉移能力皆有顯著的進步，而且在平衡功能及行走能力也獲得改善。此外，承重轉移能力的進步與平衡功能及行走能力的改善有正相關。結論：中風病人在接受具視覺回饋之承重轉移訓練後對其平衡功能與走路能力均有正面的療效，而且中風病人兩腳承重對稱性及承重轉移能力的改善與其平衡功能及行走能力有一正相關。另外，本實驗所建立之平衡能力指標皆具有良好的再測信度。

關鍵字

具視覺回饋承重轉移訓練 ； 承重對稱性 ； 承重轉移 ； 平衡 ； 行走

並列摘要

Background and Purpose: Visual feedback has shown to be effective in motor relearning following stroke. This study were designed to explore the efficacy of weight-shift training, by providing a rear-time visual feedback of center-of-gravity position or weight distribution, on balance and walking following stroke. Therefore, the primary purposes of this study was to determine whether the weight-shift training with feedback of center-of- gravity position and weight distribution in stroke patients was effective in decreasing their balance function and walking ability, and we also to explore the relationship between weight-bearing symmetry/ weight- shifting ability and balance function/ walking ability in stroke patients. In addition, the secondary purposes were to establish the indexes of weight- bearing symmetry and weight-shifting ability and their test-retest reliability in healthy young adults. The inclusion of the healthy adults was just a reference for the stroke patients. Methods: Twenty young adults and 7 stroke patients were recruited. Healthy adults and stroke patients accepted two measurements within a week. Balance function, gait ability, weight- distribution and weight-shifting during sit-to-stand, quite standing, and weight-shifting toward the forward foot. In addition, the stroke patients received a weight-shifting training program , 30 minutes/time, 2-5 days a week for 2-3 weeks(8 sessions). After training, they accepted a post-test within a week. Intraclass correlation coefficient was used for confirming test-retest reliability. Mann-Whitney U test was used for comparing pre-test and post-test, and Wilcoxon signed rank test was used for comparing healthy and stroke patients. Spearman correlation was used for investigating relationship between weight-distribution, weight-shifting, balance function, and walking ability. Results: For the stroke group, the indexes of weight-bearing symmetry and weight-shifting ability in the tasks of sit-to-stand, quiet standing, and weight-shifting toward the forward foot has moderate to good test-retest reliability（ICC=0.58-0.99）. After training, the weight-bearing symmetry and weight-shifting ability of stroke patients have improved and the weight-shifting ability was significant correlated to the balance function and walking ability. Conclusions: The results of this study suggest that the weight-shift training with visual feedback have a positive effect on balance function and walking ability in stroke patients, and the weight-bearing symmetry and weight-shifting ability were positively correlated with their balance function and walking ability. In addition, the test-retest reliability of the indexes of weight-bearing symmetry and weight-shifting ability which established in this study are good.

並列關鍵字

Weight-shift training ； Visual feedback ； Weight distribution ； Weight shifting ； Balance ； Walking

參考文獻

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