比較向前和向後踩車運動對於中風病患下肢神經肌肉特性之立即效應：先導性研究

Comparison of the Immediate Effect Between Forward and Backward Cycling Exercise on Neuromuscular Properties of Lower Extremity in Patients With Stroke: A Preliminary Study

陳麒方(Qi-Fang Chen) ； 吳珮楨(Pei-Chen Wu) ； 蕭世芬(Shih-Fen Hsiao) ； 許妙如(Miao-Ju Hsu) ； 林昭宏(Jau-Hong Lin)

《物理治療》 46卷3期 (2021/09) Pp. 201-209

https://doi.org/10.6215/FJPT.202109_46(3).0003

摘要

背景與目的：踩車運動對於中風病患是一項簡便的復健訓練方式。過去研究顯示中風患者在跑步機上向後行走訓練能改善下肢神經脊髓興奮性，但少有研究探討向後踩車運動對於中風病患下肢的神經肌肉特性之影響。本研究目的比較向前和向後踩車運動對於中風病患下肢神經肌肉特性之立即影響效應。方法：採用便利取樣方式徵召12位有意願且符合條件中風患者，每位參與研究個案依隨機順序接受向前和向後踩車運動各20分鐘。2種踩車模式介入前和介入後，各別進行比目魚肌神經肌肉特性評估，使用Myoton® PRO儀器量測比目魚肌肌肉張力、彈性和僵硬度；並使用周圍神經電刺激器紀錄最大比目魚肌H反射與M波之比值。結果：向前與向後踩車運動後測與前測相比，比目魚肌僵硬度（F_((2,22)) = 10.2, p = 0.001）有顯著下降的正面立即效應；然而，彈性（F_((2,22)) = 5.1, p = 0.001）則是顯著下降的負面立即效應。比較中風患者向前和向後踩車運動介入前後比目魚肌脊髓神經迴路興奮性和肌肉特性改變量皆未達顯著差異。結論：中風病患進行單次20分鐘向前與向後踩車運動可能促使比目魚肌彈性與僵硬度減少之立即效應，並不會增加脊髓神經迴路興奮性。臨床意義：初步結果可以提供臨床中風患者執行不同踩車運動模式用於調控比目魚肌神經肌肉特性之參考。

關鍵字

中風 ； 踩車運動 ； H反射 ； 比目魚肌 ； 肌肉張力

並列摘要

Background and Purpose: Cycling exercise is a simple training program in stroke rehabilitation. Previous studies have shown that backward treadmill walking could improve spinal circuit excitability of lower extremity in stroke patients. However, the effect of backward cycling on neuromuscular properties of the lower extremity in stroke patients has not been investigated. The purpose of this study was to compare the immediate effect between forward and backward cycling exercise on neuromuscular properties of the lower extremity in patients with stroke. Methods: Twelve individuals with stroke who were willing and eligible were recruited by convenience sampling. Each subject was instructed to perform both 20-minute forward and 20-minute backward cycling in random order. The neuromuscular properties of the soleus muscle were immediately evaluated before, and after the cycling exercise in both directions. The Myoton® PRO device was used to measure the soleus muscle tone, elasticity, and stiffness. The spinal circuit excitability was assessed by peripheral electrical stimulation to measure the Hoffmann reflex/M wave ratio (H/M ratio) of the soleus muscle. Results: Compared with the pretest baseline, the soleus stiffness was significant decreases with positive immediate effect (F_((2,22)) =10.2, p = 0.001); however, the elasticity was significant decreases (F_((2,22)) = 5.1, p = 0.001) with a negative immediate effect after the cycling exercise of both forward and backward directions. Comparing forward and backward cycling exercises, the amount of changes on H/M ratio, muscle tone, elasticity, and stiffness of the soleus after cycling exercise were not significantly different. Conclusion: The results showed a single 20-minute session of forward or backward cycling exercise may have an immediate beneficial effect on muscle elasticity and stiffness, without increasing the spinal circuit excitability, on the soleus muscle in patients with stroke. Clinical Relevance: The preliminary findings may provide a reference using cycling exercise modes to regulate neuromuscular properties of soleus muscle for stroke patients.

並列關鍵字

Stroke ； Cycling exercise ； H reflex ； Soleus muscle ； Muscle tone