動靜態平衡訓練對腦中風患者身體功能之探討

腦中風患者因感覺及動作功能缺損，往往造成不同程度的平衡能力障礙，進而影響其行走能力與日常生活獨立性，因而降低其生活品質。研究指出動靜態平衡訓練可增加肌肉力量並增進身體功能表現，例如：平衡能力、行走速度及增加行走距離，故本研究目的為探討動靜態平衡訓練對腦中風患者在平衡功能、姿勢控制穩定性、行走功能及跌倒改善之成效。研究方法為隨機對照研究設計，以簡單隨機抽樣執行，收案對象為實驗組與對照組各27人，對照組維持復健醫學科醫師所開立的常規物理治療（約30~40分鐘），而實驗組除了常規物理治療，額外接受本研究所設計的動靜態平衡訓練動作（約20分鐘）。評估工具為伯格氏平衡量表、中風病患姿勢控制評估量表、緹氏步態評估量表，於動靜態平衡訓練前進行前測，而後分別於介入措施執行後一個月和三個月進行測量，以瞭解動靜態平衡訓練的成效。研究結果顯示，動靜態平衡訓練能有效提升平衡能力、姿勢控制穩定性、行走功能及改善跌倒，實驗組及對照組在各個依變項上都呈現顯著性差異，而且實驗組的分數都明顯高於對照組（ p <0.05），尤其是在介入後一個月成效最佳（ p <0.001）。針對平衡能力的細項，坐到站（ p <0.05）、維持站姿（ p <0.05）、站到坐（ p <0.05）在介入後三個月實驗組明顯優於對照組；在姿勢控制穩定性細項上，實驗組在維持姿勢-無扶持下坐立（ p <0.01）、維持姿勢-健側腳站立（ p <0.05）、變換姿勢-從平躺翻身到患側（ p <0.05）、由坐到站（ p <0.05）於介入後一個月呈顯著差異，而介入後三個月的維持姿勢-扶持下站立（ p <0.001）、維持姿勢-無扶持下站立（ p <0.01）、變換姿勢-從平躺翻身到患側（ p <0.001）、從坐到平躺（ p <0.001）也達顯著差異，這說明本研究的腦中風患者是先由姿勢控制穩定能力開始改善，進而再增進其平衡能力；在行走功能細項上的抬腳高度-左腳跨步（ p <0.001）及步長-左腳跨步（ p <0.05）於介入後一個月實驗組有顯著差異，而於介入後三個月，在抬腳高度-左腳跨步（ p <0.001）、抬腳高度-右腳跨步（ p <0.01）、步伐連續性（ p <0.01）上也具顯著差異。整體而言，透過動靜態平衡訓練可以增強腦中風患者的姿勢控制穩定性且提升站姿靜態及坐姿動態平衡，進而改善行走功能及跌倒情形，而且介入時間愈早，效果愈好，建議在臨床實務面可將動靜態平衡訓練納入復健病房護理指導的一部分，教導病人及家屬於住院期間或返家後自行練習，不受時間、地點的限制，增加復健的密集度，不但能有效改善身體功能，也能有效降低醫療人力成本。

關鍵字

腦中風；動靜態平衡訓練；身體功能

並列摘要

The purpose of this research is to examine the effectiveness of the dynamic and static balance training for patients with stroke. Patients with stroke may suffer from different levels of balance dysfunction and walking disability due to sensory and movement defect, which will decrease their quality of life. Researches indicate that dynamic and static balance training can improve muscle strength and body functions, such as, balance ability, walking speed and distance. Therefore, this research aims to understand the benefit of dynamic and static balance training in the balance stability, posture control, walking ability and fall prevention for patients with stroke. A randomized control trial design was used. The research subjects were separated into experimental group and control group. Each group had 27 subjects. The control group maintained the conventional physical therapy (about 30-40 minutes) that was prescribed by the doctor. However, the experimental group received extra dynamic and static balance training (about 20 minutes) which was designed by the researcher and physical therapist. The results of the study showed that the dynamic and static balance training can effectively improve the balance stability, posture control, walking ability and fall prevention. The experimental group and the control group showed significant differences in each variable, and the scores of the experimental group were significantly higher than the control group (p < 0.05), especially at one month after intervention (p < 0.001). This period is the fastest progress for patients. For the items of balance stability, there was a significant difference in sitting to standing (p <0.05), standing unsupported (p <0.05) and standing to sitting (p <0.05) for the experimental group after three months. For the items of posture control, the experimental group was significantly different compared with control group in sitting without support (p <0.01), standing on nonparetic leg (p <0.05), supine to affected side lateral (p <0.05), and sitting down to standing up (p <0.05) after one month, while there was a significant difference in the standing with support (p <0.001), standing without support (p <0.01), supine to affected side lateral (p <0.001) and sitting on edge of table to supine (p <0.001) for the experimental group after three months. This indicates that the improvement for the patients in this study started from posture control and then balance stability. For the items of walking ability, the experimental group was significantly different in step height through left (p <0.001) and step length through left (p <0.05) after one month. There was also a significant difference in step height through left (p <0.001), step height through right (p <0.001) and step continuity (p <0.01) at three months after intervention。 Overall, dynamic and static balance training can enhance the posture stability which includes the static posture and posture dynamic balance, and further improve walking ability and prevent fall. The earlier the interventions start, the better the effect will be. It is recommended that the dynamic and static balance training can be utilized as part of rehabilitation programs, which could be conducted by nursing staff in the department. Through teaching, patients and caregivers can practice by their own to intense rehabilitation programs in the hospital or at home without time or place limitations. This not only improve patient’s body functions, but also effectively reduce the cost of medical labor.