- 學位論文
拐杖及其擺位點對腦中風病患由坐姿到站立起身之影響
Influence of cane and it’s positioning on sit-to-stand performance of stroke patients
摘要
對部份腦中風病患而言，可以獨立步行卻不一定能獨立從椅子上站起來活動，所以能否順利的由坐到站常作為復健進展的重要指標。此外，腦中風病患的跌倒常發生在姿勢轉位的時候，因此無法安全地完成坐到站的起身動作會限制其日常活動能力與降低獨立性。腦中風病患常使用拐杖協助站立與步行的穩定度，但拐杖對坐到站的影響並不清楚。本研究針對需要持拐杖步行的腦中風病患，利用測力板探討拐杖有無與不同拐杖擺放位置對於由坐姿到站立動作的影響。 本研究為實驗性設計。由國泰醫院復健科徵求30位持拐杖可以獨立步行且能夠不需協助由坐到站的腦中風病患參與本研究。實驗步驟採7種坐到站方式執行，第一種是無扶持拐杖，其他六種方式是健側手扶在單拐或四腳拐上且二種拐杖分別放在腳踝旁、第五腳趾旁與第五腳趾前10公分處。7種起身方式執行隨機，同時控制座椅高度、腳踝角度與扶手等主要影響坐站表現的外在因子。實驗過程收集雙腳在測力板上壓力中心的資料，並利用計重器計錄拐杖上施力變化。 研究結果顯示腦中風病患在有無拐杖兩種情況下，由坐到站動作完成時間、足底壓力中心前後及左右的最大位移量等並無顯著差異。然而使用拐杖時，可顯著減少最大地面反作用力(p<0.001)與減少起身後站立時足底壓力中心的移動速度(p<0.01)。相較於其他2個擺位點，當拐杖放在腳踝旁會顯著增加坐到站動作完成時間(p<0.001)、起身時足底壓力中心的最大位移量(p<0.01)與起身後站立時足底壓力中心的移動速度(p<0.05)，但最大地面反作用力則顯著降低(p<0.001)。 本研究結論是使用拐杖雖不能縮短中風患者坐到站起身的完成時間與過程中的足底壓力中心移動程度，但可以顯著減少最大地面反作用力與提昇起身後站立時的穩定度。當拐杖擺放越靠近身體時除了坐到站起身地面最大反作用力較小外，會讓起身過程更不穩、更費時而且起身後也站的比較不穩。
並列摘要
Some of the stroke patients may walk independently but not stand up from seat for ambulation by themselves. Independent sit-to-stand (STS) has become one of the important indicators for the progress of rehabilitation. Many falls happened when stroke patients are trying to transfer. Unsafe STS consequently will limit their daily activities and prevent them from independence. Additionally, stroke patients often use a cane to facilitate their stability of standing and walking, but the role of a cane in STS movement remained unclear. In this study, we use a forceplate to measure and elucidate the supporting effect from varied positions of a cane on the moving pattern of STS for hemiparetic stroke patients. This is a study of quasi-experimental design. We recruited 30 stroke patients who could stand up independently but need a cane for level walking. Participants performed the sit-to-stand test in seven situations: one baseline as without cane and the others from 3 different cane positions (ankle level, beside the 5th toes and 10cm in front of the 5th toe, respectively) as assisted by either regular cane or quad cane. Seven tests were performed in a random order for each individual under a fixed height of a no-armrest seat and ankle dorsiflexion. Both vertical reaction force of the cane and the time-force data of center of pressure (COP) from the forceplate were collected for every participants. The results showed that both the maximum sway range of COP and the STS duration were not significantly different whether or not assisted by a cane. However, using crutches could significantly reduce the peak ground reaction force (p <0.001) and standing COP sway velocity after standing up (p <0.01). Compared with the other two cane positions, when the cane was positioned at the ankle level would increase STS movement time (p <0.001), COP maximum sway range (p <0.01) and mean standing COP sway velocity (p <0.05), while the ground reaction force is significantly lower (p<0.001). This study concluded that the STS duration and the COP sway during STS were similar for stroke patients either assisted by a cane or not, although a cane could significantly reduce the maximum ground reaction force and standing stability after STS. The closer a cane to the body, the smaller the maximum ground reaction force, while the more the COP sway range, the more time-consuming during the STS process and the much more unstable after standing up.
參考文獻
延伸閱讀
- 呂麗華（2004）。使用柺杖對中風偏癱病患自主性向前跨步動作表現與相關注意力需求之影響〔碩士論文，國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342/NTU.2004.01909
- 呂茜芸、施嫈嫈（2020）。【論文摘要】跪姿行走訓練對亞急性中風病人於步態站立期之髖關節伸直角度影響：病例報告。物理治療，45(4)，325-326。https://doi.org/10.6215/FJPT.202012.P16
- 洪嘉玲、廖麗君、張祐誠、嚴成文（2017）。發展中風病患從坐到站其雙腳承重對稱性與轉移能力之力學指標。物理治療，42(4)，323-323。https://doi.org/10.6215/FJPT.2017.74.O01
- 劉秀之、陳瓊玲、楊國德、王珩生、郭雪娥、游志煌（2000）。站立姿勢與伸手及物對中風患者患側載重之影響。職能治療學會雜誌，18()，10-18。https://doi.org/10.6594/JTOTA.2000.18.02
- 吳淑娟（2011）。Investigation of the Correlated Factors Influencing the Home-based Rehabilitation for Stroke Patients〔碩士論文，中臺科技大學〕。華藝線上圖書館。https://doi.org/10.6822/CTUST.2011.00060