改良式制動療法與雙側動作訓練對中風後動作與日常生活功能成效之對照試驗

Effects of Stroke Rehabilitation on Motor and Daily Functions: A Comparative Trial of Modified Constraint-Induced Therapy and Bilateral Movement Training

張雅棻(Ya-Fen Chang) ； 吳菁宜(Ching-Yi Wu) ； 柯智裕(Jyh-Yuh Ke) ； 吳佩璇(Katie P. Wu) ； 鄭如芠(Ju-Wen Cheng) ； 陳玥岑(Yueh-Tsen Chen) ； 林克忠(Keh-Chung Lin)

《職能治療學會雜誌》 26卷1期 (2008/11) Pp. 37-52

https://doi.org/10.6594/JTOTA.2008.26(1).03

摘要

制動療法藉由侷限健側手並密集訓練患側手，來增進中風病患之動作與日常生活功能恢復。雙側動作訓練則藉由雙手同時執行對稱性活動，將健側手合併於功能訓練中。此兩種治療方法的相對成效尚乏對照性臨床試驗，本研究利用運動學分析與臨床評估，對照兩種療法對漫性中風病患上肢復原之相對療效。
本研究延攬23位發病超過半年之慢性中風病患，隨機分成兩組，其中12位為改良式制動療法組，每天接受2小時之患側手治療、及6小時之治療外健側手侷限；另外11位則為雙側動作訓練組，每天接受2小時雙手同時執行對稱性之動作訓練。兩組均接受每週5天，為期3週之治療介入。治療前後，以運動學分析評估單手與雙手對稱情境之動作表現，並配合臨床評估量測動作恢復與日常活動之改變。
運動學分析結果顯示治療後，雙側動作訓練組表現顯著優於改良式制動療法組：單手伸臂按水平鈴有較佳之動作策略(F(1, 20)=5.15, P=.034)，於雙手同時按水平鈴有較佳之雙手時問同步性(F(1, 20)=7.79, P=.011)。臨床評估顯示治療後，兩組都呈現進步，但組間差異未達顯著。本研究的臨床評估顯示兩組帶來近似功能成效，兩者皆為有效之密集性復健治療方案。運動學分析則顯示，雙側動作訓練可能經由神經動作系統將雙肢動作同步化，促進雙肢偶合，讓患側手更易呈現健側手之動作模式，而帶來動作策略的進步。此研究也顯示，運動學分析能敏感的反應出治療後動作行為的細微改變。

關鍵字

制動療法 ； 雙側訓練 ； 中風復健 ； 運動學分析

並列摘要

Background and purpose. Activity-dependent interventions such as modified constraint-induced therapy (mCIT) and bilateral movement training (BMT) may confer beneficial effects for improving upper-arm motor function and motor control in patients with chronic stroke. This study used kinematic analysis and clinical assessment to examine the relative effects of both interventions in patients with chronic stroke.
Methods. In a pre-post randomized, controlled trial, 23 stroke patients received either mCIT (restraint of the unaffected hand combined with intensive training of the affected hand) or BMT (intensive bilateral simultaneous and symmetrical training) for a period of 3 weeks, 5 days per week. Outcome measures included: (1) kinematic variables of reaching movement in unilateral and bilateral tasks, (2) the Fugl-Meyer Assessment (FMA), (3) the Functional Independence Measure (FIM), and (4) the Motor Activity Log (MAL).
Results. In comparison with the mCIT group, the BMT group showed significantly better performance in movement strategy (F(1, 20)=5.15, p=.034) in the unilateral condition and in bilateral synchronization in the bilateral condition (F(1, 20)=7.79, p=.011). While both groups improved in functional outcomes, there was no significant difference between the two groups. Discussion. Improvement of motor control after BMT was characterized by enhanced reaching strategy (preplanned control) and increased temporal synchronization at movement initiation. Bilateral movement practice may improve motor control of the affected hand by exploiting interlimb coupling and further promoting the affected hand to take on characteristics of the unaffected hand's movement pattern. The findings show that kinematic analysis is a sensitive tool to detect subtle changes in motor control after stroke rehabilitation.

並列關鍵字

constraint-induced therapy ； bilateral training ； stroke ； rehabilitation ； kinematics