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  • 學位論文

虛擬實境踩車訓練系統於中風患者之臨床療效

Effects of Leg-Cycling with Virtual Reality Training System for Patients with Stroke

指導教授 : 葉純妤

摘要


研究背景:中風患者常見肢體間不對稱及站立與行走時的重心改變,平衡功能缺失及步行功能異常亦增加跌倒的機率及降低功能獨立性,重建平衡及行走的能力為中風後復健之主要目標。研究目的:比較加入虛擬實境踩車運動訓練對中風患者兩側下肢之用力對稱性、平衡能力及行走能力之影響,並探討是否優於控制組。研究方法:實驗組(21人)與控制組(10人)皆接受10次傳統治療,實驗組額外接受1週3次,共10次的虛擬實境治療。虛擬實境藉由兩側踏板偵測之力量控制汽車左右動向。評估分別為治療前與治療後,項目包含下肢踩車踏板偵測之力量對稱性、兩腳足壓變化量對稱性、站立平衡重心位移量、步態參數及對稱性、下肢痙攣埃許-沃斯(MAS)量表。統計分析:使用two-way ANOVA with one repeated measure分析,分析實驗組與控制組之間是否有交互效應,若無交互效應,則以pair t test進行實驗組與控制組之組內前、後比較,參數包含下肢踩車踏板力量不對稱比指數、足底壓力分布不對稱比指數、站立平衡重心位移量、步態參數不對稱比指數;以independent t test分析兩組組內前後改變量之組間比較。而肌肉痙攣程度以Nonparametric Wilcoxon signed-ranks test分析兩組之組內肌肉痙攣程度是否達顯著差異,並以Mann-Whitney test進行兩組間比較。研究結果:本研究所建立之虛擬實境踩車訓練系統,可顯著改善踩車踏板偵測之雙側踏板力量及踏步長對稱性且優於控制組(p<0.05)。可顯著改善雙側足底壓力分布對稱性、步態參數中站立期、單腳承重期、擺盪期之對稱性(p<0.05),但組間比較未優於控制組(p>0.05)。而重心位移量及下肢痙攣程度則無顯著改善(p>0.05)。結論與建議:經虛擬實境踩車訓練後,可有效提升靜態站立平衡及步態之對稱性,雖只有雙側踏板力量及踏步長優於控制組,但仍提供未來臨床復健治療之新選項。

關鍵字

中風 踩車 虛擬實境 復健 平衡 步態

並列摘要


Background: The asymmetric limb movements between affected and unaffected limbs are commonly observed in post-stroke patients. The insufficient balance ability and abnormal gait pattern increase the falling risk. Restoring patients’ symmetric standing balance and ambulation was the main goal of post-stroke rehabilitation. Purpose: The purpose of this study was to examine the effects of combining cycling exercise with virtual reality on balance and gait in stroke patients compared to control group. Methods and Materials: Both the experimental group (N=21) and control group (N=10) received 10 times of the traditional treatment. The experimental group was instructed to perform an additional Leg-Cycling with Virtual Reality Training System training for 3 times/week, total 10 times. Bilateral pedal forces were measured to control the VR. The assessment was performed before and after training, included bilateral pedal forces, bilateral foot pressure and COP displacement in static standing, gait parameter, and modified ashworth scale. Statistical analysis: The interaction effects between the two groups were compared by two way ANOVA with repeated measure. The results of asymmetry ratio index of pedal force, asymmetry ratio index of foot pressure, COP displacement, and asymmetry ratio index of gait parameter between pre and post-training in two groups were compared by pair t test. The change ratio of pre and post-training between two groups were compared by independent t test. The results of modified ashworth scale between pre and post-training was compared by wilcoxon signed-rank test. The difference of modified ashworth scale of pretest between two groups and the difference of post-training between two groups were compared by Mann-Whitney test. Results: The asymmetry ratio index of bilateral pedal force and step length showed significant improvement after the Leg-Cycling with Virtual Reality Training, and the experimental group was better than control group (p<0.05). The asymmetry ratio index of bilateral foot pressure, stance phase, single support and swing phase showed significant improvement in experimental group (p<0.05) but no significant difference between groups (p>0.05). The COP displacement and modified ashworth scale without significant difference in both groups (p>0.05). Conclusions and Suggestion: The Leg-Cycling with Virtual Reality Training improves the symmetry of static standing balance and gait parameter although only the bilateral pedal force and step length was better than control group. The Leg-Cycling with Virtual Reality Training System provides the new selection of clinical rehablitation.

並列關鍵字

stroke cycling virtual reality rehabilitation balance gait

參考文獻


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被引用紀錄


劉淑靜(2014)。結合虛擬實境之踩車運動復健對中風病人下肢肌肉活動之影響〔碩士論文,中山醫學大學〕。華藝線上圖書館。https://doi.org/10.6834%2fCSMU.2014.00211

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