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

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

林婷瑩(Ting-Ying Lin) ； 董玟伶(Wen-Lin Tung) ； 郭藍遠(Lan-Yuen Guo) ； 張增瑩(Tseng-Ying Chang) ； 張志仲(Jyh-Jong Chang)

《職能治療學會雜誌》 23卷 (2005/10) Pp. 38-48

https://doi.org/10.6594/JTOTA.2005.23.04

摘要

Trunk control ability, in sub-acute stage, is a significant predictor of discharged activities of daily living function in stroke patients. One of the early treatment goals in occupational therapy for stroke patients is to improve the ability of trunk control for the preparation of independence in occupational performance. This study, by using kinematic analysis method, investigated the changes of trunk movement trajectories during four experimental reaching tasks in order to analyze the gradation level of trunk movement during unilateral and bilateral reaching for patients with unilateral stroke.
Fifteen unilateral stroke patients (mean age=57.00±11.83 y/o; 7 males, 8 females) were recruited in this study. Subjects were asked to perform the following four experimental reaching tasks in sitting position with random order:
(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) both hands clasped and bilateral upper limbs reaching to the cone located in the ipsilateral workspace; (4) both hands clasped and bilateral upper limbs reaching to the cone located in the contralateral workspace. The trajectories of the subject's trunk movement were recorded with a three-dimensional motion analysis system (Visualeyez(superscript TM) Hardware, Canada) during reaching. The trunk trajectories were computed and final data were analyzed with repeated measures ANOVAs.
The results showed that significant differences in trunk movement kinematics, among the four experimental reaching tasks, were maximal reaching velocity, trunk curve line value, trunk rotational angle, and normalized jerk score of the trunk movements (p＜0.05). Post hoc analysis revealed that subjects showed significantly greater maximal velocity, trunk curve line value and normalized jerk score of the trunk movement in bilateral reaching tasks than in unilateral reaching tasks. Subjects showed the greatest trunk rotational angle while using unaffected upper limb reaching to the cone located in the contralateral workspace. There were no significant differences in kinematics of trunk movement between contralateral and ipsilateral bilateral reaching tasks.
Our study suggested that bilateral reaching tasks would add higher task-demands to stroke patients and might induce more trunk forward movements when comparing to unilateral reaching tasks. Findings from this study provide guideline on activity gradation for occupational therapists to set a challengeable therapeutic activity for stroke patients.

關鍵字

中風 ； 運動學分析 ； 伸手及物 ； 軀幹動作

並列摘要

Trunk control ability, in sub-acute stage, is a significant predictor of discharged activities of daily living function in stroke patients. One of the early treatment goals in occupational therapy for stroke patients is to improve the ability of trunk control for the preparation of independence in occupational performance. This study, by using kinematic analysis method, investigated the changes of trunk movement trajectories during four experimental reaching tasks in order to analyze the gradation level of trunk movement during unilateral and bilateral reaching for patients with unilateral stroke.
Fifteen unilateral stroke patients (mean age=57.00±11.83 y/o; 7 males, 8 females) were recruited in this study. Subjects were asked to perform the following four experimental reaching tasks in sitting position with random order:
(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) both hands clasped and bilateral upper limbs reaching to the cone located in the ipsilateral workspace; (4) both hands clasped and bilateral upper limbs reaching to the cone located in the contralateral workspace. The trajectories of the subject's trunk movement were recorded with a three-dimensional motion analysis system (Visualeyez(superscript TM) Hardware, Canada) during reaching. The trunk trajectories were computed and final data were analyzed with repeated measures ANOVAs.
The results showed that significant differences in trunk movement kinematics, among the four experimental reaching tasks, were maximal reaching velocity, trunk curve line value, trunk rotational angle, and normalized jerk score of the trunk movements (p＜0.05). Post hoc analysis revealed that subjects showed significantly greater maximal velocity, trunk curve line value and normalized jerk score of the trunk movement in bilateral reaching tasks than in unilateral reaching tasks. Subjects showed the greatest trunk rotational angle while using unaffected upper limb reaching to the cone located in the contralateral workspace. There were no significant differences in kinematics of trunk movement between contralateral and ipsilateral bilateral reaching tasks.
Our study suggested that bilateral reaching tasks would add higher task-demands to stroke patients and might induce more trunk forward movements when comparing to unilateral reaching tasks. Findings from this study provide guideline on activity gradation for occupational therapists to set a challengeable therapeutic activity for stroke patients.

並列關鍵字

stroke ； kinematic analysis ； reaching ； trunk movement