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  • 學位論文

雙手與單手伸手及物對中風患者軀幹動作影響之運動學分析

Effects of Bilateral and Unilateral Reaching on Trunk Movement in Stroke Patients- A Kinematic Analysis

指導教授 : 張志仲
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摘要


中風病人早期軀幹控制能力是預測病人在日常生活功能恢復的重要因素,因此提升病人軀幹控制能力是早期的職能治療的主要治療目標之一,本研究運用三度空間動作分析儀記錄分析中風使用雙手與單手往健側及患側伸手及物的軀幹動作軌跡,並以運動學方式分析不同伸手及物情境是否會有不同的軀幹動作改變,以期能將研究結果應用在治療活動分級上。 研究對象為21位中風患者與19位健康人,執行四種運動情境:(1)單手觸碰患側的目標物(2)單手觸碰健側的目標物(3)雙手觸碰患側的目標物(4)雙手觸碰健側的目標物,結果顯示相較於健康個案,中風病患最大速度較小、運動時間較長、運動單位數目較多、標準化急動值較大。研究結果發現中風病患在四種情境間最大速度、運動時間、軀幹移動距離、軀幹旋轉角度、運動單位數目、標準化急動值變項平均值差異達統計上的顯著性(p<0.05),經事後比較分析的結果,雙手較單手伸手及物的情境可得到較大的最大速度與較長的軀幹移動路徑,而單手向患側碰觸目標物的情境較雙手操作的兩情境得到軀幹旋轉角度較大,單手往健側碰觸目標物較雙手操作的情境得到的平順度較佳,在雙手伸手及物的兩個情境中,各項動作參數並未達統計上的顯著性。 本研究結果支持雙手的操作情境,會比單手及物產生較大的軀幹移動,並可能為活動需求較高的操作情境,本研究結果可提供給職能治療師活動分級的臨床實證參考依據,以做為擬訂適當治療性活動的參考。

並列摘要


The ability of trunk control, in sub-acute stage, is a significant predictor on discharged activities of daily living function in stroke patients. One of the early treatment goals in occupational therapy for stroke patients is to improve sitting balance and trunk control for the preparation of independence in occupational performance. This study investigated the changes of trunk movement trajectories during four experimental reaching tasks by a kinematics analysis for patients with unilateral stroke. Twenty-one unilateral stroke patients and nineteen healthy participants were recruited in this study. Subjects were asked to perform four experimental reaching tasks in sitting position: (1) unaffected upper limb reaching to the cone located in the ipsilateral workspace;(2) unaffected upper limb reaching to the cone located in the contralateral workspace;(3) bilateral upper limbs reaching to the cone located in the ipsilateral workspace;(4) using bilateral upper limbs reaching to the cone located in the contralateral workspace. The trajectories of the trunk movement were recorded with a three-dimensional motion analysis system (VisualeyezTM Hardware, Canada). Data were analyzed with repeated measures ANOVAs. Stroke patients had a prolonged movement time, smaller maximal velocity, more motor units and larger normalized jerk score than healthy subjects. The results showed kinematical variables with significant differences among the four experimental tasks were maximal velocity, movement time, curve trunk trace value, trunk rotational angle, movement units and normalized jerk score of the trunk movements. Post hoc analysis with 95% confidence interval revealed that stroke patients showed significantly greater maximal velocity, curve trunk trace value and normalized jerk score of movement in bilateral reaching tasks. Stroke patients showed the greatest trunk rotational angle during using unaffected upper limb to reach the cone located in the contralateral workspace. There were no significant differences in trunk movement between contralateral and ipsilateral bilateral reaching tasks. Our study suggested that bilateral reaching tasks can induce more trunk movements, who adding higher task-demands to stroke patients when comparing to unilateral reaching. Findings from this study provide guideline on activity gradation for occupational therapists to set a therapeutic activity with challenge for stroke patients.

並列關鍵字

trunk movement kinematic analysis reaching stroke

參考文獻


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