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【論文摘要】The Effects of Low-intensity Pulsed Ultrasound Combined Vitamin B12 on Functional Recovery in Rats With Brachial Plexus Stretch Injury

Background and Purpose: Brachial plexus stretch injury (BPSI) may result in lasting functional deficits including motor and sensory dysfunction, however, the management on promoting functional recovery is unsatisfied. A conservative treatment of low-intensity pulsed ultrasound (LIPUS) or vitamin B12 supplement has been commonly used on nerve regeneration, but their effects are still limited. The purpose of this study was to explore the therapeutic effects of LIPUS combined with vitamin B12 on functional recovery in rats with BPSI. Methods: After BPSI or sham operation, adult male Sprague Dawley rats (250-300g, n = 50) were randomly divided into 7 groups including BPSI treated with LIPUS (BL, n = 8), sham-LIPUS (BsL, n = 8), vitamin B12 (BV, n = 6), vehicle (BsV, n = 6), and LIPUS combined with vitamin B12 (BLV, n = 6), as well as sham-BPSI treated with LIPUS (sBL, n = 8) and sham-LIPUS (sBsL, n = 8). Animals treated with LIPUS (1 MHz, 100 mW/cm^2, 20% of pulsed mode, 5 minutes) and vitamin B12 injection (1 mg/ kg) were started three days after BPSI and continued for 2 weeks. Sensory, motor and electrophysiological examinations were measured before, 3, 7, 14, 21, and 28 days after BPSI operation. Results: There were significant improvements on mechanical and cold thresholds of paw withdrawals, grooming and toe spread behaviors and electrophysiological studies in BL, BV and BLV groups when compared to their controls (p ＜ 0.05). Moreover, markedly enhanced functional recovery was also demonstrated in the BLV group when compared to the groups receiving a single treatment (p ＜ 0.05). Conclusions: LIPUS combined with vitamin B12 supplement could achieve better results in functional recovery than a conventional treatment of LIPUS or vitamin B12 alone. Clinical Relevance: LIPUS combined with vitamin B12 is capable of enhancing peripheral nerve regeneration following a stretch injury.

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【論文摘要】Effect of Fatigue on Coordination of Lower Limb Joints During Roundhouse Kick in Taekwondo Athletes

Background and Purpose: Taekwondo (TKD) is a combat sport emphasizing sophisticated kicking skills. Fatigue of lower limb muscles is likely to affect the coordination among joints during kick despite not being well understood. Therefore, this study aims to investigate the effect of muscle fatigue on the coordination of lower limb joints during roundhouse kick in TKD athletes. Methods: Six TKD athletes were recruited and underwent a simulated game test. The simulated game test included three 2-minute rounds, with a 1-minute inter-round break. In each round, participants were asked to conduct 30 roundhouse kicks according to the instructions displayed on the screen, and the instructions included the standing pose (right or left lead), kick leg (front or rear), and kick position (high, middle, and low). Bilateral hip and knee angles were measured using 6 inertial measurement units placed over lower thorax, sacrum, bilateral thighs, and bilateral legs. A kick movement was divided into the chambering phase (from the kick leg take off to maximum knee flexion) and the attacking phase (from maximum knee flexion to target impact). The chambering phase relates to kick preparation and target aiming, and the attacking phase relates to leg acceleration. The continuous relative phase was used to assess the coordination between the hip and knee joints. Variability of coordination during chambering and attacking phases for each participant was calculated using the deviation phase (DP) of the continuous relative phase between hip and knee. The DP calculated the standard deviations of every measurement epoch on the continuous relative phase curves across kicks and then averaged. Higher DP indicates greater variability on hip-knee coordination. Analysis of variance (ANOVA) with repeated measures were used to investigate the effect of fatigue (round 1, 2, and 3) and kick leg (front or rear) on hip-knee coordination during chambering and attacking phases, respectively. Results: All participants completed the simulated game test. In the chambering phase, a significant fatigue main effect (F = 15.42, p = 0.01) and fatigue-leg interaction (F = 10.28, p = 0.02) were found. Generally, round 3 (86.95 ± 15.29) showed a significantly higher DP than round 1 (75.02 ± 18.22, p = 0.02) and round 2 (72.39 ± 16.82, p = 0.01). In addition, rear leg kicks during round 3 (102.17 ± 24.29) showed even higher DP than front leg kicks (82.34 ± 17.56, p = 0.03). In the attacking phase, a significant fatigue-leg interaction (F = 9.71, p = 0.03) was found. Post-hoc analysis showed that rear leg kicks during round 3 (20.80 ± 13.25) showed higher DP than front leg kicks (13.50 ± 7.21, p = 0.04). Conclusion: Our results showed that hip-knee coordination, especially in rear leg kicks, was altered with an increased variability due to the development of muscle fatigue. Clinical Relevance: During a roundhouse kick, the increased variability on hip-knee coordination in the chambering phase affects the target aiming, and the increased variability on hip-knee coordination in the attacking phase indicates inefficient leg acceleration.

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【論文摘要】Effect of Fatigue on Lower Limb Symmetry During Roundhouse Kick in Taekwondo Athletes

Background and Purpose: Studies have reported Taekwondo (TKD) athletes show remarkable bilateral symmetry in kicking. However, the development of fatigue during combat may probably show different impacts on the dominant and non-dominant side and reduce the level of symmetry, despite not being well studied. Therefore, this study aims to investigate the effect of fatigue on lower limb symmetry during roundhouse kick in TKD athletes. Methods: Six TKD athletes (age: 19.67 ± 1.37 years, height: 168.75 ± 9.16 cm, weight: 58.59 ± 5.22 kg, 3 females) were recruited and underwent a simulated game test. The simulated game test included three 2-minute rounds, with a 1-minute inter-round break. In each round, participants were asked to conduct 30 roundhouse kicks according to the instructions displayed on the screen, and the instructions included the standing pose (right or left lead), kick leg (front or rear), and kick position (high, middle, and low). Bilateral hip and knee angles were measured using 6 inertial measurement units placed over lower thorax, sacrum, bilateral thighs, and bilateral legs. The chambering phase was the interval between the kick leg taking off and maximum knee flexion. The attacking phase was the interval between maximum knee flexion and target impact. The maximum hip and knee angular velocities during the chambering and attacking phases were measured. The lower limb symmetry was calculated using the symmetry angle (SA), with 0% indicates a perfect symmetry and 100% indicates a perfect opposite. An analysis of variance (ANOVA) with repeated measures was used to investigate the effect of fatigue (round 1, 2, and 3) and kick position (high, middle, and low) on SA of hip and knee maximum angular velocities during the chambering and attacking phases in a roundhouse kick. Results: All participants completed the simulated game test. In the chambering phase, a significant position main effect (F = 8.47, p = 0.03) and a fatigue-position interaction (F = 12.43, p ＜ 0.01) were found in hip. Generally, high kicks showed a significantly higher hip SA (5.43 ± 2.92%) than the middle (4.02 ± 2.33%, p = 0.04) and low kicks (3.52 ± 2.51%, p = 0.02). In addition, high kicks during round 3 showed even higher hip SA (6.17 ± 3.51%) than those during round 1 (5.01 ± 2.92%, p = 0.03) and round 2 (5.11 ± 3.03%, p = 0.04). In the attacking phase, all fatigue main effect, position main effect, and the interaction effect were not significant in hip and knee joints. Conclusion: Our results showed that high kicks demonstrate greater asymmetry between the dominant and non-dominant legs than middle and low kicks during the chambering phase, which characterizes a quick flexion of hip and knee. And such asymmetry exacerbates further with the development of fatigue. Clinical Relevance: This study offers TKD coaches and athletes an important insight into the influencing factors of kick skill and attack efficiency.

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【論文摘要】Effect of Fatigue on Trunk Lateral Inclination During Roundhouse Kick in Taekwondo Athletes

Background and Purpose: The scoring rules in Taekwondo (TKD) encourage athletes to perform high kicks. A successful high kick requires both great mobility of trunk and hip joints, and delicate control of posture stability. However, the fatigue of proximal hip muscles may affect the conduction of high kicks, and athletes may adjust their trunk motion as compensation despite the current evidence are scarce. Therefore, this study aims to investigate the effect of fatigue on the trunk lateral inclination (inclination) during roundhouse kick in TKD athletes. Methods: Six TKD athletes (age: 19.67 ± 1.37 years, height: 168.75 ± 9.16 cm, weight: 58.59 ± 5.22 kg, 3 females) were recruited and underwent a simulated game test. The simulated game test included three 2-minute rounds, with a 1-minute inter-round break. In each round, participants were asked to conduct 30 roundhouse kicks according to the instructions displayed on the screen, and the instructions included the standing pose (right or left lead), kick leg (front or rear), and kick position (high, middle, and low). Trunk inclination and hip angles were measured using 4 inertial measurement units placed over lower thorax, sacrum, and bilateral thighs. An analysis of variance (ANOVA) with repeated measures was used to investigate the effect of fatigue (round 1, 2, and 3) and kick position (high, middle, and low) on trunk inclination and hip abduction during roundhouse kick. Results: All participants completed the simulated game test. In maximum trunk inclination, a significant position main effect (F = 27.41, p ＜ 0.01) and fatigue-position interaction was found (F = 9.72, p = 0.03). Generally, high kicks showed a significantly higher trunk inclination (22.48 ± 7.42°) than middle (15.22 ± 6.42°, p ＜ 0.01) and low (12.70 ± 7.83°, p ＜ 0.01) kicks. In addition, high kicks during the round 3 showed even higher trunk inclination (24.21 ± 6.02°) than those during the round 1 (21.03 ± 7.15°, p = 0.02) and round 2 (22.51 ± 6.82°, p = 0.03). In maximum hip abduction, a significant position main effect (F = 45.72, p ＜ 0.01) and fatigue-position interaction was found (F = 10.72, p = 0.02). Generally, high kicks showed a significantly higher hip abduction (41.22 ± 8.05°) than middle (37.31 ± 8.71°, p ＜ 0.01) and low kicks (35.71 ± 9.25°, p ＜ 0.01). However, high kicks during round 2 (40.25 ± 9.62°) and round 3 (38.82 ± 8.71°) showed lower hip abduction than those during round 1 (43.90 ± 10.62°, p = 0.03 and 0.02, respectively). Conclusion: Our results showed that high kicks require large trunk and hip mobility. Throughout the simulated game test, athletes showed a gradually increased trunk inclination and gradually decreased hip abduction, probably due to the development of fatigue in hip muscles. Clinical Relevance: The strategy adapted by TKD athletes to compensate hip muscle fatigue may maintain the kick height at the cost of postural instability despite the current evidence is scarce.

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【論文摘要】The Use of Automatic Kinect-based Assessment System for Physical Fitness and Cognitive Tests in Middle Aged Adults

Background and Purpose: Previous research has shown that the onset age of dementia and chronic diseases is getting younger. The physical fitness and cognitive functional tests should be started at middle-age to prevent the occurrence of disability and dementia in later life. Applying the automated system will enhance the assessment efficiency. The purposes of the study are to compare the trends of age-related changes in physical and cognitive performances, and to investigate the factors influencing both function in the middle-aged. Methodology: In this study, 150 convenient sample of middle-aged (40-64 years old; male and female) community adults were recruited and divided into five age groups (40-45, 46-50, 50-55, 56- 60, 60-64). Within around 35 minutes, each participant was assessed by two newly developed automatic systems, one was physical fitness test with infrared red camera to detect the body movement, and the other one was electric version of the Montreal Cognitive Assessment (MoCA). Results: Two-way ANOVA showed an interaction effect of age and gender group only in muscle strength (MS) (p = 0.024). There're gender main effects in MS (p = 0.03), body mass index (BMI) (p = 0.000) and flexibility (p = 0.017), age main effects in MS (p = 0.029), visuospatial (p = 0.038), naming (p = 0.001), attention (p = 0.000), language (p = 0.009), orientation (p = 0.005), and total MoCA score (p = 0.000). Post hoc analyses of age differences were provided. The significant factors influencing cognitive changes were age (p = 0.023), education (p = 0.012), flexibility (p = 0.013), and MS (p ＜ 0.001). Significant factors influenced the 6 domains of physical fitness changes were gender, education, BMI, flexibility, and MS, respectively. Conclusions: The age-related physical and cognitive performances generally did not show significant changes till late fifty. There seems a threshold for cognition decline in early sixty. Age, education, flexibility and muscular strength significantly correlated with cognitive changes. Clinical Relevance: Our results provide important information to help early screening and prevention of physical and cognitive function decline in community middle-aged adults.

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【論文摘要】多元運動介入對社區老人衰弱指標與功能性體適能之影響

背景與目的：預防及延緩失能與衰弱（frailty）為長照2.0重要政策項目之一，研究證實多元運動（multi-component exercise）可以減緩失能及改善衰弱狀況。本研究目的是探討多元運動課程介入對於社區老人衰弱指標及功能性體適能（functional fitness）之改善成效。方法：以類實驗設計方式進行研究，立意取樣雙北地區及桃園的社區據點65歲以上老人（n=151，年齡平均75.38歲±7.56歲，女性占82.12%）參加本實驗。實驗組為參加「衛生福利部預防及延緩失能照護方案」社區老人，參與每週1次，每次120分鐘，共12週的多元運動訓練課程（n=65）；控制組為未參加課程之一般社區老人（n=86）。研究期間自2018年11月9日至2019年4月17日，研究工具以結構式問卷、Fried's Frailty Phenotype及Study of Osteoporotic Fractures（SOF）衰弱評估量表及功能性體適能檢測所收集之資料為研究範圍，樣本為立意取樣、意向分析，使用SPSS 22.0多元線性迴歸分析運動介入及衰弱與體適能指標之關係。結果：多元運動介入雖對改善老人衰弱未達到迴歸模型的統計顯著差異，但實驗組在Fried's Phenotype或SOF衰弱指標中，衰弱改善比例較控制組高，例如SOF「衰弱前期」樣本數從22人減至12人（-45.46%）、Fried's Phenotype「衰弱」樣本數從8人減至7人（-12.50%）；控制組衰弱惡化比例較實驗組高，SOF「衰弱」樣本數從6人增至7人（+16.67%）、Fried's Phenotype「衰弱」樣本數從8人增至12人（+50.00%）。在功能性體適能指標中，唯有「兩分鐘踏步」實驗組明顯進步優於控制組（β=14.048，p＜0.01），其餘變項皆未達顯著。結論：本研究顯示多元運動對於老人衰弱改善上未達統計顯著差異，但仍顯示改善的趨勢。然而，多元運動對於老人心肺功能是有顯著改善成效的。臨床意義：多元運動課程可能幫助延緩及預防老人衰弱發生，且對於高齡體適能改善是有助益的。方案之活動強度與頻率、課程成效是否有實證證據、課程內容改善與精進，值得被有關單位進一步檢視，以達到長照2.0往前推移至預防失能的政策目標。

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【論文摘要】評估橢圓機訓練促進亞急性期中風患者功能性恢復的效果

背景與目的：腦部出血或梗塞引起偏癱會導致上下肢動作功能障礙和日常生活困難。腦中風亞急性期病患的復健計畫，以增加病患的功能性活動、獨立移行能力及恢復日常生活功能為主。固定式腳踏車常作為早期介入腦中風病患的訓練方式之一，其缺點在主要著重在下肢訓練，缺乏上肢的參與，無法模擬行走時所產生的交互擺動及缺乏上下肢協調及動作整合。利用橢圓機可同時交替式訓練上下肢，增加上下肢的協調能力及刺激中樞神經系統整合支配四肢肌肉的效果。推測橢圓機訓練可以同時強化患側上下肢動作功能及平衡能力及模擬行走技巧中的交替式協調性的動作。但針對橢圓機訓練在亞急性中風病人的應用成效，則較少有文獻作探討。因此，本項研究目的主要在評估橢圓機訓練對亞急性中風患者功能性恢復的成效。方法：徵招24位亞急性期的中風患者並隨機分為兩組：橢圓機訓練組（n=12）及控制組（n=12）。所有受試者除接受60分鐘的常規復健治療外，橢圓機訓練組需再介入20分鐘的橢圓機訓練，每週5次，為期3週。在治療前後患者評估日常生活功能、動作功能和平衡功能等功能性恢復的效果。評估工具為巴氏量表（Barthel Index）、傅格－梅爾動作評估量表（Fugl-Meyer Motor Assessment）、柏格氏平衡量表（Berg Balance Scale）及10公尺步行測試（10-Meter Walk Test），本研究使用SPSS 20.0版軟體中的Mann-Whitney U Test及Wilcoxon signed-rank test進行分析。結果：橢圓機訓練組和控制組在巴氏量表、柏格氏平衡量表和傅格－梅爾動作評估量表上下肢動作能力的分數，治療前與治療後相比均達到顯著改善（p＜0.05）。在橢圓機訓練組中，柏格氏平衡量表分數和傅格-梅爾動作評估量表中上肢及下肢動作功能分數的治療前後差異值，則明顯大於控制組（p＜0.05）。結論：研究結果顯示，額外的橢圓機訓練在促進亞急性期中風患者之平衡能力和動作功能方面的功能性恢復效果較控制組佳。臨床意義：橢圓機訓練可作為亞急性中風患者復健計畫的可行性策略之一，尤其針對平衡能力及上下肢動作功能方面。

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【論文摘要】比較單次漸進性單一任務跑步機行走訓練與雙重任務跑步機行走訓練對健康年輕人步態與認知之效果

背景與目的：行走時執行認知任務是日常生活常有的活動，可能導致行走速度變慢、步長變短、步態變異性增加、及降低認知表現。過去研究指出跑步機運動對於認知有正向影響，及雙重任務行走訓練可以提升雙重任務表現。藉此比較單次漸進性跑步機訓練與雙重任務跑步機訓練對健康年輕人步態與認知之效果。方法：本研究共招募30名年輕人（18至30歲，平均20.83歲，標準差1.26歲），隨機分配至雙重任務跑步機行走訓練組（dual-task treadmill walking training，DT組），或單一任務跑步機行走訓練組（single-task treadmill walking training，ST組），每組15人。DT組同時接受單次漸進性跑步機行走加上認知訓練（雙重任務訓練）30分鐘，而ST組僅接受單次漸進性跑步機行走訓練（單一任務訓練）30分鐘。受測者在訓練前及訓練後一周內皆評估其單一任務及雙重任務步態與認知表現。正式測試前，先進行認知任務（史楚普任務）的練習，再分別測試其單一認知任務及單一任務跑步機行走表現（分為一般速度及快速行走）後，最後進行雙重任務測試（跑步機行走時同時執行史楚普任務）。結果：ST組在單一行走任務中顯著改善一般速度行走的兩腳步長、左腳步長變異數、與快速行走的兩腳步長（p ＜ 0.05）；而DT組則無顯著進步（p ＞ 0.05）。且ST組在單一任務快速行走中的右腳步長訓練前後的改變量，顯著優於DT組（p = 0.02）。ST組亦顯著改善單一認知任務史楚普測試的複合分數（p = 0.005）；而DT組則無明顯改善（p = 0.45）。ST組在雙重任務測試顯著改善一般速度行走兩腳的步長、快速行走的右腳步長與左腳步長變異數（p ＜ 0.05）；而DT組則無顯著進步（p ＞ 0.05）。且ST組在雙重任務測試顯著改善一般速度行走與快速行走的史楚普測驗複合分數（p ＜ 0.05）；而DT組則只有在快速行走時的史楚普複合分數有顯著的進步（p = 0.003）。結論：單次漸進性跑步機行走訓練對於提升年輕人的行走表現、認知表現、及雙重任務行走與認知表現，皆明顯優於單次漸進性雙重任務跑步機行走訓練。臨床意義：單次漸進性跑步機行走訓練可以作為提升年輕人行走、認知、與雙重任務表現最佳的訓練策略。

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【論文摘要】認知雙重任務行走訓練相對於單一任務行走訓練對慢性中風患者在單一任務與雙重任務情境下時間空間步態參數之影響：系統性回顧與統合分析

背景與目的：比較認知雙重任務行走訓練與單一任務行走訓練對慢性中風患者在單一任務與雙重任務情境下時間空間步態參數之影響，以提供臨床應用和研究參考。方法：搜索以下資料庫文獻由2010年至2020年5月為止：Google Scholar，PubMed，Web of Science，MEDLINE，SCOPUS和PEDro，關鍵字為：dual-task、stroke、CVA、cognitive、gait，並使用Review Manager 5.3版軟體進行統合分析。結果：本研究納入4篇英文文獻進行系統回顧和統合分析，包含4個獨立的認知雙重任務行走訓練組（n = 107）。文獻品質在皮卓量表分數介於6到8分之間，證據水平為1b。相較於單一任務行走訓練，認知雙重任務行走訓練顯著提高介入前－後雙重任務步行速度的改變量（standard mean difference [SMD] = 0.92 cm/s; Z = 2.76; 95% confidence interval [CI]：0.27, 1.57; p = 0.007）和單一任務步行速度的改變量（SMD = 0.54 cm/s; Z = 2.71; 95% CI：0.15, 0.93; p = 0.006）。相較於單一任務行走訓練，認知雙重任務行走訓練顯著增加介入前－後單一任務步頻的改變量（SMD = 0.74 step/min; Z = 3.66; 95% CI: 0.34, 1.13; p = 0.0003），但雙重任務步頻的改變量雖有改善但未達顯著差異（SMD = 1.63 step/min; Z = 1.50;95% CI：-0.50, 3.76; p = 0.13）。與單一任務訓練組相比，認知雙重任務行走訓練改善介入前－後單一任務步幅的改變量，但未達顯著差異（SMD = 0.52 cm; Z = 1.45; 95% CI：-0.18, 1.22; p = 0.15），且雙重任務的步幅的改變量有改善，但亦未達顯著差異（SMD = 1.51cm; Z = 1.73; 95% CI: -0.20, 3.22; p = 0.08）。結論：認知雙重任務行走訓練在改善中風患者的單一任務與雙重任務步行速度及單一任務步頻，明顯優於單一任務行走訓練。臨床意義：認知雙重任務行走訓練具有潛在的優勢，可為改善慢性中風患者單一與雙重任務情境下步行速度的參考介入方式，為中風復健帶來新的前景。

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【論文摘要】Effectiveness of Sonography Feedback for Quadriceps Reeducation: A Case Report

Background Information and Aim: The clinical guideline for patients after custom-made TKR and allograft (limb salvage with reconstruction using gastrocnemius flap) is rare, and quadriceps weakness is commonly found in patients after knee operation. While functional electrical stimulation is often used in quadriceps reeducation, there is only a few reports using sonography biofeedback even it is a useful diagnostic tool and there is growing population in using it as biofeedback. Therefore, the aims of this report were (1) to illustrate the feasibility to sonography biofeedback in quadriceps reeducation and (2) to prove whether the common therapeutic exercise (wall slide, lunge and single leg squat) are effective for quadriceps reeducation for this kind of patient with sonography. Case Presentation: A 27 years old male patients with proximal tibial osteosarcoma s/p revision custom-made TKR and allograft (limb salvage with reconstruction using gastrocnemius flap), post operation for 10 weeks. His chief complain are that he cannot walk without assistive devices for more than 20 minutes without soreness over knee joint and he cannot climb one step stair up/ down per stride which has affected his daily life. Besides, there is localized pain spot on lateral knee during 30-50° of knee flexion in active and passive movement with verbal analogue scale rated as 6-8/10. It is found that there is no observable and palpable trace of muscle contraction in his quadriceps re-education program. Methods: Single leg squat, lunge and wall slide are known exercises with highest quadriceps activation according to the literature of Rebacca et al. in 2012. To illustrate how sonography is used in quadriceps reeducation as a biofeedback. The ultrasound traducer was placed on a specific site of quadriceps and the patient conducts the exercises above while watching sonography as the visual biofeedback (indicating the location of muscle on the monitor and observing the change in thickness) in order to find out the tailor-made exercise for activating quadriceps the most. Result: Sit to stand exercise from knee flexion 30-0° shows the greatest change in thickness of quadriceps while lunges and wall slide squat shows little observable change in thickness. The patient modified movement which they observe the greatest change in thickness. Conclusion: It is noted that massive amount of bone and soft tissue have been removed in this surgery which would leads change in morphological (e.g. muscle and bone) and neurological (e.g. proprioception) aspects. The perceived exertion of muscle contraction or palpation of muscle contraction may not be reliable. Sonography biofeedback may be helpful in prescription a more tailor-made program for patients with abnormal substitutive movement pattern of knee extension. Clinical Relevance: The result illustrates the feasibility of the sonography biofeedback application in quadriceps re-education for patients after revision of TKR and limb salvage with reconstruction using gastrocnemius flap in the future.