雙側上肢運動訓練結合功能性電刺激應用於中風患者之臨床療效

Clinical Effects of Combined Bilateral Arm Training with Functional Electrical Stimulation in Patients after Stroke

吳芳宸(Fang-Chen Wu)

指導教授 ： 郭德盛

共同指導教授 ： 陸哲駒 ； 賴金鑫(Jin-Shin Lai)

國立臺灣大學/電機資訊學院/生醫電子與資訊學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.01465

摘要

腦血管意外，又稱為「中風」，是導致成人活動功能不便之主因。文獻指出，中風後可能出現上肢功能損傷並持續存在，患者日常生活會產生嚴重的負面影響，也伴隨一些因長期不活動而引發的併發症以及心理層面上的問題，對於醫療資源與人力照護的消耗都是很大的負擔。因此，臨床上許多復健治療嘗試更有效的介入，以提高中風患者上肢恢復之情形。在本研究中，我們嘗試結合雙側上肢運動訓練與功能性電刺激治療，發展雙滑軌系統平台同時合併功能性電刺激控制，應用於中風患者的手臂前伸練習， 共三十五中風受試者參與本研究，分為控制組(單純接受雙側上肢訓練)與實驗組(雙側上肢訓練結合功能性電刺激之合併訓練)，為期三周之介入，二十三人完成實驗。根據實驗結果，中風患者接受合併訓練出現正面的臨床療效，實驗組在介入後患側上肢的動作學參數分析有顯著進步，臨床量表似乎存在進步的趨勢。未來，針對不同訓練劑量與介入時間會多加考慮，且設計更具功能性之運動訓練，以期增進臨床中風上肢復健效果。

關鍵字

中風復健 ； 雙側上肢運動訓練 ； 功能性電刺激控制

並列摘要

Cerebral vascular disease (or stroke) is the main cause of disabilities in adults worldwide. Upper-limb dysfunction after stroke usually exists, leading to severe limits of motor capabilities as well as daily activities. Therefore, effective treatment interventions for upper-limb rehabilitation after stroke are needed. In this study, we attempt to combine BAT with FES applying to the post-stroke paretic arm. A linear guide platform with FES feedback control was developed to execute the training of bilateral reaching movements. 35 stroke subjects were recruited and divided into two groups (BAT with FES and BAT alone). 23 participants completed this experiment with 3-week intervention. According to the clinical results, a favorable trend toward improvement in experimental group (BAT with FES) existed after treatment and at follow-up. Comparing to the pre-test data, kinematic analyses confirmed significant improvement in the experimental group. In the future, various treatment doses as well as more functional approaches would also be considered for better effects of upper limb rehabilitation after stroke.

並列關鍵字

stroke rehabilitation ； bilateral arm training (BAT) ； functional electrical stimulation (FES) control system

參考文獻

[1] N. Stroebele, et al., "Knowledge of risk factors, and warning signs of stroke: a systematic review from a gender perspective," International Journal of Stroke, vol. 6, pp. 60-66, Feb 2011.

[2] "World Health Organization.," http://www.who.int/en/, 2011.

[3] J. W. Burke, et al., "Serious games for upper limb rehabilitation following stroke," 2009, pp. 103-110.

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[5] S. Kumar, et al., "Medical complications after stroke," The Lancet Neurology, vol. 9, pp. 105-118, 2010.