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身體垂直定向能力與視覺回饋訓練策略對推者症候群是否有幫助:系統性文獻回顧

Is Vertical Orientation Ability and Visual Feedback Training Strategy Useful for Pusher Syndrome after Stroke: A System Review

摘要


背景:有推者症候群(pusher syndrome)症狀的中風患者治療方式與病因目前仍未明朗,也困擾著臨床的治療師很久。國內學者王宏哲等人於2005年發表一篇相關文獻回顧,該文獻最後結論指出,推者症候群患者缺乏垂直定向的能力,並且必須依賴視覺回饋策略來調整身體平衡,但目前臨床缺乏有架構的訓練方式,亦缺乏臨床醫學實驗的論證。目的:本篇文獻回顧延續王宏哲等人的研究,探討針對身體垂直定向能力與視覺回饋訓練策略上是否有可靠的實證基礎可以改善推者症候群患者的症狀,以及是否能有效縮短中風後恢復的時間。另外在訓練上,是否能找到有效的訓練方式可提供參考。結果:三篇文獻納入本文獻討論。治療方式比較了使用任天堂(wii)平衡板結合電腦控制的視覺回饋訓練、全身鏡視覺回饋治療方式、用機械行走輔具外骨骼在懸吊式跑步機上行走輔以治療師回饋訓練方式,以及直流電前庭電刺激治療方式等對推者症候群患者帶來的效益。結論:針對推者症候群患者使用身體垂直定向能力與視覺回饋訓練策略上能有效減緩症狀、增進平衡能力,以及下肢動作控制能力。而電腦控制的即時回饋訓練又比使用鏡子及環境周遭垂直物體來提供患者回饋的方式來的有效。如果經費有限,治療師仍可嘗試使用視覺與體感覺回饋引導的方式。

並列摘要


Stroke patients with pusher syndrome (PS) have a longer recovery time than those without this disorder. This special syndrome causes difficulty in maintaining balance when sitting or standing, with sufferers "pushing and leaning" automatically to hemi-side. PS patients may also have cognition impairment, hemi-neglect, or aphasia. Alleviating all these factors requires extensive training for therapists, however, few undergo such training. Wang et. al. published a review article in Taiwan Journal of Physical Medicine and Rehabilitation in 2005, and the conclusions drawn were: 1) PS patients have abnormal subjective posture and vertical orientation ability; 2) training strategies that use visual feedback could help patients correct their posture. However, after a decade, the effect of this training strategy is still unclear, with a lack of evidence. This paper further explores the issue by reviewing randomized controlled trials and offers advice for training strategies.

參考文獻


王宏哲、孟令夫。中風病患伴隨推倒症候群之相關現象。台灣復健醫學雜誌,33(1),2005,P39~46。
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