改良式制動療法與雙側動作訓練對慢性中風病患之相對效應：運動學分析

近來針對上肢復健已發展出多項具實證研究支持之密集性治療方案，如改良式制動療法及雙側動作訓練。改良式制動療法指侷限健側手並密集訓練患側手；雙側動作訓練乃藉由雙手同時密集性練習對稱功能性動作。本研究利用運動學分析與臨床評估，進一步探討兩者對高功能慢性中風病患之相對效應。本研究採前後測之隨機控制型研究設計，共延攬23位慢性中風病患，隨機分成兩組：改良式制動療法組（12位）與雙側動作訓練組（11位），前一組每天接受2小時之患側手訓練、6小時之健側手侷限；後一組每天接受2小時雙手對稱性之動作訓練。兩組均接受每週5天，爲期三週之治療介入。治療前後，以運動學分析評估單手與雙手情境之伸手取物表現，並以臨床評估量測動作恢復。運動學分析結果顯示，雙側動作訓練組表現顯著優於改良式制動療法組：於單手情境中拿起水杯有較佳之動作效率；雙手情境之拉抽屜取物，可誘發患側手較大的肌肉衝量、較快的運動速度、且動作較流暢，具較佳之雙手時間同步性(p=.005~.014)。臨床評估則顯示治療後，兩組皆有進步，但組間差異未達顯著。兩種治療手法在治療量與治療頻率相同下，運動學分析結果顯示雙側動作訓練相較於改良式制動療法，可改善輕度至中度動作受損之慢性中風病患，其患側手之動作控制與協調，可能的原因是藉由肢體間之耦合效應，讓患側手更易呈現健側手之動作模式，進而改善患側手在單手與雙手非對稱情境之動作表現。

關鍵字

制動療法；雙側動作訓練；中風復健；運動學分析

並列摘要

Background and Objective: Several evidence-based treatment programs for improving upper extremity functions such as constraint-induced therapy (CIT)/modified CIT (mCIT) and bilateral movement training (BMT) have been developed recently. The mCIT program combines restraint of the unaffected hand with intensive training of the affected hand, and BMT involves intensive bilateral training with symmetrical functional training. In this study, the relative efficacy of mCIT vs. BMT was compared by a kinematic analysis that quantitatively assessed motor control in high functioning stroke patients when performing unilateral and bilateral functional tasks. Methods: In a pretest-posttest, randomized controlled trial, twenty-three stroke patients were randomly allocated to either the mCIT group (6 hours restraint of the unaffected hand and 2 hours intensive training of the affected hand daily) or the BMT group (2 hours intensive bilateral training daily) for 5 days weekly over 3 weeks. Outcome measures included (1) kinematic analysis of reaching movement in unilateral and bilateral asymmetrical tasks and (2) the Fugl-Meyer Assessment (FMA) of motor impairment severity. Results: In comparison with the mCIT group, the BMT group revealed the following: better movement efficiency in the unilateral reach-to-grasp task; faster and smoother movement with greater force in the bilateral box-opening task; better temporal synchronization in the bilateral condition (p=.005~.014). The two groups did not significantly differ in FMA. Discussion: When controlling for duration and intensity, BMT was more effective than mCIT for improving motor control during both the unilateral and the bilateral asymmetrical tasks in chronic stroke patients with mild-to-moderate motor impairment. The BMT may facilitate coupling between the upper extremities and may cause the affected upper limb to assume the same movement characteristics of the unaffected upper limb, which would improve motor control of the affected upper limb during unilateral and bilateral asymmetric functional activities.

並列關鍵字

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

國際替代計量

改良式制動療法與雙側動作訓練對慢性中風病患之相對效應：運動學分析

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