利用冷熱刺激法誘發中風病患上肢在慢性期的動作及感覺功能恢復的探討

動機與目的：中風病患的肢體功能性活動通常是下肢優於上肢，而上肢的功能性受損影響病患本身的自主獨立，造成家庭及社會極大的負擔，並會造成待院時間的延長及醫療資源的浪費。傳統的復健治療（如Bobath, Brunnstrom, proprioception neuromusclar facilitation, and motor relearning等），雖已實行了數年，但較難以量化，而一些新的實驗治療方式（如電刺激，肌電圖生理回饋，自動裝置輔助系統等），近來亦常被用於附加治療，並有良好療效。最近利用溫覺刺激法對急性中風病患的上肢功能恢復，顯示出有顯著效果，但其給予溫覺刺激法是用熱敷包及冰敷包，溫度易隨時間改變而不易受到控制。本篇研究利用水療桶定溫設備來探討在慢性期（>6個月）後，以冷熱覺刺激法是否可以持續改善上肢的功能恢復。方法：實驗共收集了29位自願受試者，為行政院衛生署苗栗醫院復健科之病患，將病患隨機分為兩組：實驗組13位及對照組16位。兩組均接受門診時例行的物理及職能治療，在實驗組部份則再加上交替的冷熱水浴（熱水為42±2℃冷水為18±2℃），交替刺激30秒並重複十次，每天進行一次，每週5天並持續8週。實驗前後評估患側上肢主動動作測試（Action Research Arm Test）、肌張力測試（Modified Ashworth Scale）、肌力測試（手握力及指側捏力）及手部感覺測試（Semmes-Weinstein monofilaments），藉由這些評估方式來衡量上肢動作及感覺功能恢復的程度。結果：結果顯示實驗組在各項臨床測試數據上皆比對照組有所改善，但只有在感覺功能項目有顯著的恢復（P<0.05）。結論：由本實驗可以了解，在慢性期的中風病患患側上肢在傳統復健合併冷熱交替刺激法可更加改善病患的動作功能等各項能力，尤其是感覺功能恢復。

關鍵字

中風；溫覺刺激；動作恢復

並列摘要

Purposes: Poor recovery of arm function after stroke can often have a negative impact on the patients and their families. These patients often need assistance from the society and may need to rely on government resources. Numerous therapeutic treatments are currently available for stroke rehabilitation. Traditional rehabilitation strategies（Bobath, Brunnstrom, proprioception neuromuscular facilitation, and motor relearning）have been used for many years. However, few of these interventions have been tested in clinical trials and are thus practiced on an empirical basis. Various evidence-based therapies（electric stimulation, electromyographic biofeedback, constraint-induced movement therapy, robotic aided system, and virtual reality）have been added to classic rehabilitation approaches and seem to improve function. Recently, Chen et al. investigated used the thermal stimulation facilitated upper-limb functional recovery after acute stroke have significational benefit. They used hot pack and cold pack for thermal stimulation, however, their temperatures were changed with time and not easy control. We used whirlpools control the temperature to investigate whether the CVA patients using the thermal stimulation intervention still continue improved the upper extremity motor and sensory function recovery after onset 6 months. Method: Patients（n=29）were randomly assigned into 2 groups and received regular traditional rehabilitation program. Thermal stimulation on the upper limb of affected side was added to experimental group 5 times per week for 8 weeks. Motor（Action Research Arm Test, Modified Ashworth Scale, muscle strengthen）and sensory（Semmes-Weinstein monofilaments）assessments were evaluated before and after experiment. Results: The performance of sensation was improved significantly（P<0.05） after thermal stimulation intervention 8 weeks. But the others（motor functional ability, muscle strength, muscle tone）were similar in both group. Conclusion: Thermal stimulation on the paretic hand significantly improved sensory function in chronic stroke patients.

並列關鍵字

stroke ； thermal stimulation ； motor recovery

參考文獻

1. Wolf, P.A., et al., Secular trends in stroke incidence and mortality. The Framingham Study. Stroke, 1992. 23(11): p. 1551-5.

2. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO Task Force on Stroke and other Cerebrovascular Disorders. Stroke, 1989. 20(10): p. 1407-31.

3. Feys, H.M., et al., Effect of a therapeutic intervention for the hemiplegic upper limb in the acute phase after stroke: a single-blind, randomized, controlled multicenter trial. Stroke, 1998. 29(4): p. 785-92.

4. Mayo, N.E., et al., Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil, 2002. 83(8): p. 1035-42.

5. Chen, J.C. and F.Z. Shaw, Recent progress in physical therapy of the upper-limb rehabilitation after stroke: emphasis on thermal intervention. J Cardiovasc Nurs, 2006. 21(6): p. 469-73.

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利用冷熱刺激法誘發中風病患上肢在慢性期的動作及感覺功能恢復的探討

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