比較前後踩車運動對於中風病患下肢神經肌肉特性之立即效應

Comparison of the immediate effects between forward and backward cycling exercise on neuromuscular properties of lower extremity in patients with stroke

陳麒方(Qi-Fang Chen)

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(2019年)

摘要

背景與目的：踩車運動對於中風病患是一項簡便的復健訓練方式。過去研究顯示中風患者在跑步機上向後行走訓練能改善下肢脊髓興奮性，但少有研究探討向後踩車運動對於中風病患下肢的神經肌肉特性之影響。本研究目的比較向前和向後踩車運動對於中風病患下肢神經肌肉特性之立即效應。
方法：徵召12位健康人及12位中風患者，每位參與研究個案隨機順序接受向前和向後踩車運動20分鐘。兩種踩車模式介入前和介入後各別進行比目魚肌神經肌肉特性評估，神經脊髓興奮性使用周圍神經電刺激器紀錄最大比目魚肌H反射與M波之比值、比目魚肌H 反射與M波動作閾值之比值、比目魚肌H反射與M波徵召曲線斜率之比值；並同時使用Myoton-PRO儀器量測比目魚肌肌肉張力、彈性和僵硬度。
結果：中風患者和健康人踩車前後，脊髓興奮性改變量兩組組內與兩組之間比較皆未達顯著差異。中風個案執行向前與向後踩車運動與前測相比，比目魚肌彈性與僵硬度皆有顯著下降的立即效應(前踩: p=.01; p=.03)(後踩: p=.04; p=.001)；向前踩車比目魚肌彈性及僵硬度改變量比較健康人均有顯著下降 (p=.02; p=.04)；向後踩車比目魚肌僵硬度改變量比較健康人也有顯著下降(p=.02)。
結論：中風病患進行單次20分鐘向前與向後踩車運動皆能促使比目魚肌僵硬度減少之立即效應，但皆未能影響神經脊髓興奮性。
臨床意義：初步結果可以提供臨床中風患者執行不同踩車運動模式用於評估改善比目魚肌神經肌肉特性之參考。

關鍵字

中風 ； 踩車 ； H反射 ； 比目魚肌

並列摘要

Background and purpose: Cycling exercise is a simple rehabilitation training program for stroke patients. Previous studies have shown that backward treadmill walking could improve spinal excitability of lower extremity in stroke patients. However, the effect of backward cycling on neuromuscular properties of lower extremity in stroke patients has not been investigated. The purpose of this study was to compare the immediate effects between forward and backward cycling exercise on neuromuscular properties of lower extremity in patients with stroke. Methods: Twelve healthy subjects and 12 individuals with stroke were recruited. Each subject was instructed to perform 20-minute forward or backward cycling in a random order. Before and after the forward or backward cycling exercise, the neuromuscular property of the soleus was evaluated. The spinal circuit excitability was assessed by peripheral electrical stimulation to measure Hoffmann reflex/M wave ratio, H reflex threshold/motor threshold ratio, and H reflex slope/M wave slop ratio of the soleus muscle. At the same time, the MyotonPRO device was used to measure soleus muscle tone, elasticity, and stiffness. Results: No significant differences on the change scores for the spinal circuit excitability were found within and between groups after cycling exercise. Compared with the baseline, there were significant decreases on soleus elasticity and stiffness after forward and backward cycling exercise for stroke subjects (forward cycling: p=.01 and p=.03; backward cycling: p=.04 and p=.001). Compared with healthy subjects, stroke patients showed decreased the amount of change on soleus elasticity and stiffness after forward cycling exercise and on the soleus stiffness after backward cycling exercise (p=.02). Conclusions: After a single 20-minute session of forward or backward cycling exercise, the immediate decrease on soleus muscle stiffness was demonstrated in patients with stroke. However, there was no obvious effect on the spinal circuit excitability. Clinical implications: The preliminary findings may provide a reference for using different modes of cycling exercise to improve neuromuscular properties of soleus muscle for stroke patients.

並列關鍵字

stroke ； cycling ； H reflex ； soleus muscle

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