比較「痛覺冷熱溫度刺激」、「神經肌肉電刺激」和「痛覺冷熱溫度刺激混合神經肌肉電刺激」於慢性期中風病患上肢動作恢復之療效

Comparisons of effects among noxious thermal stimulation only, neuromuscular electrical stimulation only, and hybrid of noxious thermal stimulation and neuromuscular electrical stimulation on motor recovery of upper extremity in patients with chronic stroke

唐鈺晶(Yu-Ching Tang)

指導教授 ： 林昭宏

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

背景與目的：先前研究證實冷熱溫度刺激及神經肌肉電刺激皆有助於中風病患上肢動作與功能之恢復。然而，比較冷熱溫度刺激和神經肌肉電刺激療效或搭配兩種治療模式對於慢性期中風病患療效是否顯著，皆未可知。本研究目的比較「冷熱溫度刺激」、「神經肌肉電刺激」和「冷熱溫度刺激混合神經肌肉電刺激」對於慢性期中風病患上肢動作恢復之療效驗證。方法：於三家教學醫院復健科徵招首次中風且發病超過六個月以上病患。採單盲隨機控制實驗設計，受試者依電腦亂數方式隨機分派至「冷熱溫度刺激組」、「神經肌肉電刺激組」和「冷熱溫度刺激混合神經肌肉電刺激組」三組。受試者除接受傳統復健治療外，再接受為期8週，每週3次，每次30分鐘「冷熱溫度刺激」或30分鐘「神經肌肉電刺激」或15分鐘「冷熱溫度刺激」將加上15分鐘「神經肌肉電刺激」之介入治療。療效評估工具包含福格梅爾動作上肢次量表、上肢動作研究量表、動作指標，修正式艾許沃氏量表和巴氏量表。所有個案於治療前、治療後及治療後一個月進行評估。結果：共計38位病患完成所有治療評估追蹤。使用雙因子重複測量變異數分析比較接受冷熱溫度刺激(n=10)、神經肌肉電刺激(n=12)或冷熱溫度刺激混合神經肌肉電刺激(n=16)三組之間於治療前、後及治療後一個月之療效，結果顯示三組之間療效皆未達統計上顯著差異(p>.05)。結論 本研究結果發現給予為期8週，每週3次，共24次之治療，比較痛覺冷熱溫度刺激或神經肌肉電刺激治療，對於中風發病六個月以上慢性患者上肢動作和功能恢復並無達到顯著療效差異。臨床意義：這個研究結果有助於釐清「痛覺冷熱溫度刺激」或和「神經肌肉電刺激」於中風慢性期患者上肢動作恢復之療效差異及提供臨床選擇使用的參考。

關鍵字

溫度刺激 ； 神經肌肉電刺激 ； 動作恢復 ； 中風

並列摘要

Background and Purpose: Recent studies verified that both the thermal stimulation (TS) and neuromuscular electrical stimulation (NMES) were beneficial to motor recovery of upper extremity in patients with stroke. However, the comparison between TS and NMES or combination TS and NMES to the patients with stroke was unknown. The purpose of this study was to compare the effects of TS, NMES, TS+NMES on motor recovery of upper extremity in patients with chronic stroke. Methods: Subjects with first-stroke onset more than 6 months were recruited from the rehabilitation departments of three hospitals. A single-blind randomized design was used. The subjects were assigned into 3 groups (TS, NMES, TS+NMES) with computer-generated random numbers. In additional conventional rehabilitation therapy, all participants received 30 minutes TS or 30 minutes NMES or 15-minute TS first and then 15-minute NMES. Treatment period was 8 weeks, 3 days/week, 30 minutes/time. Outcome measures included upper extremity-Fugl Meyer assessment (UE-FMA), Arm Research Arm Test (ARAT), Motricity index (MI), modified Ashworth scale (MAS), and Barthel index (BI). All participants were evaluated at pre-, post-treatment and follow-up 1 month. Results: A total of 38 participants completed this study. The two- way repeated measures ANOVA was used to compare the changes of treatment effects at pre-, post-treatment and follow-up 1 month for TS group (n=10), NMES group (n=12), and the combination of TS and NMES group (n=16). The results showed no significant differences in all outcome measures among 3 groups. Conclusion: The finding of this study revealed no significant differences in motor recovery of upper extremity in patients with chronic stroke after receiving TS or NMES treatment program a total of 24 times in 8-weeks. Clinical implication: This study contributes to clarify whether there are the treatment effects of TS and NMES and provide the reference of clinical use for upper motor recovery in patients with chronic stroke.

並列關鍵字

thermal stimulation ； neuromuscular electrical stimulation ； motor recovery ； stroke

參考文獻

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