踩車運動訓練對於中風患者大腦皮質活化與下肢動作恢復之影響

Effects of cycling training on cortical activation and motor recovery of lower extremity in patients with stroke

周詣倫(Yi-Lun Chou)

指導教授 ： 林昭宏

高雄醫學大學/醫學院/神經學科研究所/碩士(2014年)

摘要

背景與目的：踩車運動是一種常見用於促進中風患者下肢動作功能恢復的訓練模式。然而，少有研究探討下肢動作功能恢復與大腦皮質活化的關聯性。本研究目的探討慢性期中風患者接受踩車運動訓練後，大腦皮質活化型態改變與下肢動作功能恢復之關聯。
方法: 本研究徵招慢性期中風患者接受為期四週，每週五次的踩車運動訓練。每位受試者在接受踩車運動訓練前和結束後分別以傅格-梅爾下肢動作評估次量表及六分鐘走路測試和十公尺走路測試評估下肢動作功能恢復情況。同時以功能性核磁共振造影分析受試者患側及健側主動足踝背屈動作時的大腦皮質活化型態，計算大腦兩側感覺動作皮質區和輔助動作皮質區加權側化指標以評估患側及健側大腦間的活化程度。
結果: 五位中風受試者接受完成四週踩車運動訓練後，傅格-梅爾評估次量表下肢動作功能的平均分數由25.20±2.86分進步至29.00±2.55分；六分鐘走路測試的總距離由254.47±50.01公尺進步至276.65±52.27公尺；十公尺走路測試由13.48±3.11秒進步至11.50±2.17秒。患側主動足踝背屈動作的主要感覺動作皮質區的活化型態在踩車運動訓練後，3位呈現雙側活化型態，而另外兩位呈現對側活化型態。而輔助動作皮質區的活化型態的改變並沒有特定的活化型態。
討論與結論: 本研究的初步結果顯示慢性期中風患者接受四週踩車運動訓練後，下肢功能恢復與主要感覺動作皮質區的活化型態為雙側活化或對側活化型態有關，而與輔助運動皮質區活化型態的呈現並無一致關聯。未來研究需要徵招更多中風病人探討其動作相關皮質的活化型態及其接受踩車運動訓練後的活化改變和下肢功能恢復的關聯，並且追蹤其活化型態。

關鍵字

中風 ； 踩車訓練 ； 功能恢復 ； 功能性核磁共振造影 ； 皮質活化

並列摘要

Background and purposes: Leg cycling motion training is commonly used to facilitate the functional recovery of the lower extremity in patients with stroke. However, studies investigating the relationships between the functional recovery of the lower extremity in patients with stroke and cortical activations are limited. This study aimed to explore the relationships between the functional recovery of the lower extremity in patients with stroke and cortical activation patterns after a cycling training.
Methods: This study recruited patients with chronic stroke to undergo a leg cycling motion training five times a week for 4 weeks. Functional recovery was evaluated with the Lower Extremity subscale of the Fugl-Meyer Assessment (LE-FMA), the 6-Minute Walk Test (6MWT), and the 10-Meter Walk Test (10MWT) at baseline (pre-training) and after the four-week training (post-training). In addition, the affected and non-affected ankle dorsi-flexion paradigm based on the functional MRI (fMRI) were done in order to analyze the cortical activation patterns and the activation balance between the two hemispheres using the weighted Lateralization Index (wLI) in the primary sensorimotor cortex (SMC) and the supplemental motor area (SMA) before and after the cycling training.
Results: After the cycling training, the LE-FMA score of five subjects improved from 25.20±2.86 to 29±2.55, and the 6MWT (walking endurance) improved from 254.47±50.01 meters to 276.65±52.27 meters, and the 10MWT improved from 13.48±3.11 seconds to 11.50±2.17 seconds. After the cycling training, three subjects demonstrated bilateral activation patterns and the other two showed contralateral activation patterns in the SMC during the affected ankle dorsi-flexion paradigm. In addition, there were no specific patters in the SMA.
Discussion and Conclusion: This study demonstrated the activation pattern in the SMC was bilateral or contralateral activations, while no specific pattern in the SMA, after the cycling training. Future studies with more subjects and follow-ups are suggested to fully explore the relationship between functional recovery of lower extremity and the cortical activation after cycling training.

並列關鍵字

stroke ； cycling training ； functional recovery ； fMRI ； cortical activation

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