比較冷熱刺激療法與經皮神經電刺激療法於急性期
中風病人上肢感覺及動作功能恢復之效益

背景:大部分中風後患者會遭遇到感覺及動作功能的缺損，特別是上肢功能往往較下肢嚴重。過去已經有文獻支持利用冷熱刺激(Thermal Stimulation, TS)或經皮神經電刺激(Transcutenous Electrical Nerve Stimulation, TENS) 等感覺輸入刺激有助於改善中風後患側動作及感覺功能恢復，但目前仍然沒有研究探討冷熱溫度刺激與經皮神經電刺療效的差異。目的:比較冷熱溫度刺激與經皮神經電刺激於中風後急性期患者上肢感覺及動作功能之恢復。研究方法:本研究利用隨機分組設計， 30位受試者接受徵召，將受試者分為冷熱刺激組、經皮神經電刺激組及控制組。冷熱刺激組接受早上30分鐘、下午30分鐘的冷熱溫度刺激加上原有各1小時的傳統物理及職能治療；經皮神經電刺激組接受早上30分鐘、下午30分鐘的電刺激治療加上原有各1小時的物理及職能治療；控制組則接受各1小時的物理及職能治療，共計5天。使用福格邁爾上肢次量表(UE- Fugl-Meyer motor assessment scale )、布朗斯壯分級(Brunnstrom’s stage)、最低電流感知覺(Minimal Current Perception, MCP)及修正艾許沃斯量表(Modified Ashworth Scale, MAS)作為評估工具，並於治療前及5天治療後評估。研究結果:雙因子重複量數分析結果顯示三組在福格邁爾上肢次量表中治療後皆有統計上的進步(p<0.05)，且冷熱刺激組更優於控制組(p <0.05)； VI 最低電流感知覺則是三組皆較治療前有統計上的進步(p <0.05)；布朗斯壯分級(近端)同樣為三組皆較治療前有統計上的改善(p <0.05)；布朗斯壯分級(遠端)則只有冷熱刺激組及經皮神經電刺激組較介入前有改善(p <0.05)。結論:中風後急性期住院患者接受5天的冷熱刺激、經皮神經電刺激及傳統復健治療後動作功能皆有改善，且額外接受冷熱刺激或經皮神經電刺激則效果更佳；感覺功能則是三組皆較治療前有進步。

關鍵字

冷熱溫度刺激；經皮神經電刺激；中風後急性期；感覺功能恢復；動作功能恢復

並列摘要

Background: Most post-stroke patients have the experience of sensory and motor dysfunction. The upper extremity usually tends to be more severely affected than the lower extremity. Previous researches showed that the sensory stimulation such as Thermal Stimulation (TS) or the Transcutaneous Electrical Nerve Stimulation (TENS) is able to improve sensory and motor recovery in the post-stroke population. However, there is no research on the difference between TS and TENS treatment in this population. Purpose: To investigate the difference in upper extremity sensory and motor recovery between TS and TENS among the acute post-stroke population. Method: 30 subjects were randomized to 5 days of treatment in TS group, TENS group, and control group. TS group received 30 minutes TS treatment in both mornings and afternoons with regular physical therapy and occupational therapy each for an hour; the TENS group received 30 minutes TENS treatment as the same setting as TS group; the control group received only regular physical therapy and occupational therapy. UE-Fugl-Meyer motor assessment scale, Brunnstrom’s stage, Minimal Current Perception (MCP), and Modified Ashworth Scale (MAS) were used as the assessment tools before the treatment and after 5 days of treatment. Result: Two way repeated measure ANOVA showed that all groups had statistically significant improvement in UE-Fugl-Meyer motor assessment scale (p<0.05) after the treatment, and the TS group had significant difference compared to control group. The MCP showed significant improvement after the VIII treatment in all groups. The same result was founded in the Brunnstrom’s stage(proximal); but only TS group and TENS group showed significant improvement in Brunnstrom’s stage(distal) after the treatment. Conclusion: Acute post-stroke inpatient could improve their sensory and motor function from 5 days of treatment with TS, TENS, and traditional rehabilitation. The outcome of adding TS or TENS to the traditional rehabilitation showed better motion recovery than the outcome of the traditional rehabilitation alone.

並列關鍵字

Thermal stimulation(TS) ； Transcuteneous electrical nerve stimulation(TENS) ； acute phase stroke ； sensory recovery ； motor recovery

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