冷熱刺激法對於中風病人上肢動作與功能恢復的療效

背景與目的：先前研究證實，冷熱刺激療法有助於加速發病初期中風患者的上肢感覺及動作功能之恢復；然而，冷熱刺激療法對於發病後不同時期的中風患者之療效及後續追蹤，尚未得到進一步驗證。本研究目的探討冷熱刺激療法對於中風至少三個月以上患者上肢動作與功能恢復的療效。方法：本研究採用單盲隨機分組控制實驗設計，共徵召二十一名中風至少三個月以上患者，經由隨機分組方式分配至實驗組或控制組。實驗組個案除了接受一般傳統復健治療之外，加入為期八週，每週三天，每天一次，每次三十分鐘的上肢冷熱刺激療法；控制組個案除了接受一般傳統復健治療之外，加入相同治療期間與治療頻率的下肢冷熱刺激療法。所有個案於實驗前、實驗中(第四週時)、實驗後(第八週時)及實驗後一個月共接受四次療效評量。使用布朗斯壯動作恢復分期(Brunnstrom’s recovery stage)、中風復健動作評估量表(Stroke Rehabilitation Assessment of Movement, STREAM)、修正版艾許沃斯氏量表(Modified Ashworth Scale, MAS)、上肢動作研究量表(Action Research Arm Test, ARAT)及巴氏量表(Barthel Index, BI)評估個案肢體動作與功能恢復。結果：共計二十位受試者完成實驗和四次療效評量，實驗組及控制組分別是十一位及九位。兩組受試者在實驗前的個別人口學資料及臨床基本特性，都無統計上的顯著差異。八週治療結束後，實驗組在上肢動作與功能的恢復速率高於控制組；其中，實驗組在布朗斯壯的手部動作恢復分期(Brunnstrom’s recovery stage for the hand)、腕部屈肌的肌肉張力(MAS scores for the wrist flexors)及上肢動作研究量表的進步量，與控制組比較有統計上的顯著差異(P < .05)，並且療效可維持到治療結束一個月後的追蹤期。控制組則在中風復健動作評估量表下肢次量表(lower-extremity subscale of the STREAM, LE-STREAM)的進步量，與實驗組有統計上的顯著差異(P < .05)。結論：本研究結果顯示中風至少三個月以上患者接受為期八週之冷熱刺激療法有助於降低患側上肢的肌肉張力，並改善患側上肢的動作與功能恢復。

關鍵字

中風；上肢；動作；功能恢復；冷熱刺激

並列摘要

Background and Purpose: Thermal stimulation (TS) has been found as an effective strategy to facilitate upper extremity (UE) motor recovery after acute stroke. However, the efficacy of TS in patients who are at least 3 months post stroke and the retention of effect at follow-up period remains unknown. This study aimed to examine the effect of additional TS on the UE movement and functional recovery in patients who were at least 3 months post-stroke. Methods: The study was an assessor-blinded randomized controlled clinical trial. Twenty-one patients (more than 3 months posts-stroke) following a first-ever stroke were enrolled. All participants received and continued the same dose and length of regular conventional rehabilitation programs from the existing rehabilitation team. They were randomly assigned to experimental (EXP) and control groups. The EXP group received additional UE-TS protocol for 30 minutes a day (3 days/week for 8 weeks); the control group received the same TS protocol over the lower extremity (LE). Brunnstrom’s recovery stage, Modified Ashworth Scale (MAS), Stroke Rehabilitation Assessment of Movement (STREAM), Action Research Arm Test (ARAT) and the Barthel Index (BI) were outcome measures and were administered at baseline, 4 weeks and 8 weeks post inception, and at one month follow-up period. Results: Twenty participants completed the 8-week TS protocol and all assessments. No pre-existing group differences between the experimental group (n=11) and the control group (n=9) was found on demographic variables and basic characteristics. The scores of the Brunnstrom’s recovery stage for UE, the MAS of elbow flexors and wrist flexors, the UE-STREAM and the ARAT improved more in the EXP group than in the control group after 8 weeks of treatment and at the one month follow-up period. The mean score change between baseline and post-treatment of the Brunnstrom’s recovery stage for hand, the MAS scores for wrist flexors, and the ARAT showed significant improvement in the EXP group compared to the control group (P < .05). The change between baseline and post-treatment of the LE-STREAM showed significant improvement in the control group compared to the EXP group (P < .05). Conclusion: These results suggest that 8-week TS protocol enhances UE movement and functional recovery for stroke patients in this study.

並列關鍵字

stroke ； upper extremity ； movement ； functional recovery ； thermal stimulation

參考文獻

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冷熱刺激法對於中風病人上肢動作與功能恢復的療效

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