不同雙側上肢訓練模式對中風復健成效之文獻回顧

Effects of Different Bilateral Arm Training in Stroke Rehabilitation: A Literature Review

黃琬倩(Wan-Chien Huang) ； 楊婕淩(Chieh-Ling Yang) ； 吳菁宜(Ching-Yi Wu) ； 林克忠(Keh-Chung Lin)

《職能治療學會雜誌》 27卷2期 (2009/12) Pp. 29-48

https://doi.org/10.6594/JTOTA.2009.27(2).03

摘要

雙側上肢訓練為目前暢行的上肢復健途徑之一，現有之雙側練習文獻以對稱性雙側訓練之研究為主。本文歸納分析所有類型雙側上肢訓練之治療模式及療效，並統整各實證研究之證據力層級，以提供臨床治療師應用或未來研究之指引。
經由PubMed等文獻搜尋引擎，檢索中風雙側上肢訓練之實證文獻，根據執行任務是否具對稱性分為對稱與不對稱性兩類，對稱性訓練再依不同治療模式分成機械輔助式、非機械輔助式及結合式三種類型。療效評估之種類係依國際健康功能與身心障礙分類架構分析。
本回顧共收錄28篇實證研究，經分析後，總體而言發現雙側上肢訓練較一般復健呈現較佳療效。在對稱性雙側訓練的多種方案中，對於重度動作受損病患，適合用純機器手臂輔助之雙側訓練，中至輕度病患，可用節律性聽覺指引之雙側訓練、非機械輔助式，或合併神經肌肉刺激之雙側訓練。療效大多呈現在身體結構層級，對於活動層級與參與層級的成效較有限，可能因為對稱性雙側任務在日常生活所占比例較低。此回顧所收錄之研究文獻中，不對稱性僅一篇，結果無法突顯該訓練的優勢，未來研究值得透過隨機控制試驗探討不對稱性雙側任務訓練之成效。
此篇文獻回顧透過分析各種模式雙側上肢訓練，提供臨床上針對不同類型的中風病患選擇合適的治療模式的參考依據；雙側訓練療效在日常生活或參與層級的概化程度，建議未來研究上可以選擇與上肢相關的評量項目做進一步的分析。

關鍵字

雙側上肢訓練 ； 中風 ； 神經復健

並列摘要

Bilateral arm training (BAT) is one of the contemporary treatment approaches to upper-limb rehabilitation. Previous research on BAT has focused on symmetrical BAT. The purpose of this review was to synthesize the empirical studies of BAT including symmetrical or asymmetrical movement patterns, together with analysis of level of evidence for each study.
PubMed databases were used to identify relevant studies involving controlled trials of BAT for stroke patients. Twenty-eight eligible studies were located. We classified BAT, according to the protocols, into training that involved symmetrical or asymmetrical patterns of movements. Three types of symmetrical BAT including mechanical, non-mechanical and coupled protocols were identified. Most studies presented positive outcome in favor of BAT. However, effects of training were demonstrated primarily in the level of body structure. Limited evidence was reported for outcomes in the level of activities and participation. One possible reason is that bilateral symmetrical tasks are less commonly encountered in daily life than asymmetrical tasks. One article involving asymmetrical BAT was identified. Future research may further study the effects of asymmetrical BAT using randomized controlled trials.
This review analyzing diverse types of bilateral training programs provided clinicians guidelines for clinical practice for different levels of severity of stroke patients. Future research may employ clinical measures evaluating the movement domains of ADL and QOL to further understand the efficacy of BAT at the activity and QOL levels.

並列關鍵字

Bilateral arm training ； Stroke ； Neurorehabilitation