評估中風病人下顎關節之活動與神經肌肉電刺激介入之療效

Assessment of the Changes in the Range of Motion of Mandibular Joints and the Effectiveness of Neuromuscular Electrical Stimulation in Patients with Stroke

蔡承昕(Cheng-Hsin Tsai)

指導教授 ： 林志峰

中山醫學大學/醫學科技學院/醫學檢驗暨生物技術學系碩士班/碩士(2012年)

https://doi.org/10.6834/CSMU.2012.00118

摘要

背景：下顎關節與很多生理功能有關，也是口頷系統中重要的結構，關節障礙、損傷、神經麻痺或中風皆可能導致下顎關節動作之改變。目的：(1)比較中風患者與健康成年人下顎關節活動範圍之差異。(2)比較神經肌肉電刺激前後對中風患者下顎關節之影響。方法：22位中風患者及18位健康成年人參與本研究，其中7位中風患者接受神經肌肉電刺激。使用下顎關節動作分析系統量測下顎與髁突關節的活動、壓阻式壓力感測元件量測唇壓與咬合力、肌電訊號分析系統記錄唇肌與嚼肌的肌電訊號、以及神經肌肉電刺激7位中風患者的唇肌與嚼肌。採獨立 t檢定來測試中風患者及健康成年人下顎關節之活動，包括張口前突、側移、及兩側髁突之活動範圍、兩側位移指數、唇壓、咬合力、以及兩側唇肌與爵肌之肌訊號差異百分比。以配對樣本t檢定來測試中風患者健側與患側下顎關節之活動。採Wilcoxon signed rank test來測試中風患者接受神經肌肉電刺激前後下顎關節活動之差異。結果：兩組受試者在下顎張口(p=0.001)、左右側移(p=0.001,p=0.03)、左右髁突位移指數(p=0.03, p=0.021)、兩側唇肌與嚼肌肌電訊號差異百分比(p=0.000, p=0.000)方面達顯著差異，在對稱性方面健側與患側的顆突位移指數方面達顯著差異(p=0.023)。在電刺激介入後，在下顎張口(p=0.04)、左側移(p=0.03)、左右髁突活動範圍(p=0.02, p=0.02)及唇閉合力(p=0.02)方面達顯著差異，對稱性方面下顎側移向患側(p=0.04)、健側與患側的髁突活動範圍(p=0.02, p=0.02)達顯著差異。結論：中風患者下顎關節活動範圍相較於一般健康人小，經過4週神經肌肉電刺激介入後下顎關節活動範圍及對稱性皆有改善。

關鍵字

中風 ； 下顎關節活動範圍 ； 神經肌肉電刺激

並列摘要

Background:Mandibular joints are correlated with many physiological functions and are important structures of the stomatognathic system. Changes in the range of motion(ROM) of mandibular joints may be caused by disorder, lesion, nerve palsy or sequelae of stroke. Purpose: To assess(1) the differences in the range of motion of mandibular joints between patients with stroke and healthy adults,(2) and to assess the effectivenessof neuromuscular electrical stimulationin patients with stroke.Methods: A total of 22 patients with stroke and 18 healthy adultsparticipated in this study and only 7 patients with stroke receivedneuromuscular electrical stimulation. The range of motion of the mandibular and condylar joints were measured by the Zebris Jaw Motion Analyzer; the lip closing and biting forcewere measured by theForce Sensing Resistor; electromyography(EMG) of the lip and masseter muscleswere recorded by the Zebris Bluetooth EMG analysis system; and neuromuscularelectrical stimulationwas applied on lip and masseter musclesin7 patients with stroke.Results: The ROM of opening, lateralization, and right condylarjoints, displacement index(DI), the EMGdifference ratio in bilateral lip and masseter muscles, as well as the DI ofaffected and unaffected mandibular joints had statistically significant differences between the patients with stroke and healthy adults.After intervention byneuromuscular electrical stimulation, the ROM of opening, lateralization to left, and condylar joints, lip closing force, andlateralization to theaffected side showed statistically significant differencesbetween affected and unaffected mandibular jointsin patients with stroke. Conclusion: Patients with stroke presentedless ROM in the mandibular joints than those of healthy adults. However, increased ROM in mandibular joints and symmetrywas observed after neuromuscularelectrical stimulationintervention.

並列關鍵字

Stroke ； mandibular range of motion ； neuromuscular electrical stimulation

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