- 期刊
腦中風後肢體痙攣的評估與保守治療
Clinical Assessment and Conservative Treatment for Post-Stroke Spasticity
摘要
對於腦中風的患者而言，肢體痙攣是常見造成疼痛、關節活動受限、生活品質下降以及自我照顧機能減退的重要原因之一。在開始痙攣治療前，正確的評估與解決導致痙攣惡化的背後原因是十分重要的。臨床上常見評估痙攣的方法，包括徒手測試、電生理檢查、錄影檢查下肢擺盪角度、以及問卷評估痙攣發生頻率和對日常生活造成的影響等。臨床處置可分為保守治療、藥物治療以及外科手術治療。文獻中針對痙攣的保守治療包羅萬象，從最基本的拉筋、擺位、肌力訓練，到貼紮術、輔具、超音波、震波、局部肌肉震動、電療、顱外磁刺激、針灸、限制誘發動作療法、機器人復健、虛擬實境治療、以及人機介面治療，均已在過去文獻中證實對於痙攣治療有一定程度的療效。因此，臨床醫師對於腦中風後出現肢體痙攣的患者，除了使用口服藥物或注射肉毒桿菌素以外，亦可考慮合併本文中所提到的保守治療，以增進療效及更進一步改善病患的生活品質。
並列摘要
Spasticity is not an unusual neurological sequelae after stroke, and it frequently cause pain, limited range of motion, impaired quality of life, and deteriorated self care ability for stroke patients. Appropriate clinical assessment and careful dealing with the reasons behind the development of spasticity is crucial before the formal treatment of spasticity. Common ways of spasticity assessment include Modified Ashworth scale, Modified Tardieu scale, Pendulum test, electrophysiological studies, Penn spasm frequency score, Leeds arm spasticity impact scale, and visual analogue scale. Treatment options for spasticity can be divided as conservative treatment, medications, and surgery. Past literatures have proven the therapeutic effects of several conservative treatments ranging from stretching, positioning, strengthening, splinting, kinesiotaping, ultrasound, shockwave, vibration, transcranial magnetic stimulation, electrical stimulation, repetitive facilitative exercise, constraint-induced movement therapy, acupuncture, to robotic, virtual reality and brain computer interface training. Therefore, healthcare workers should consider adding conservative treatments to medications in order to improve the therapeutic effect on spasticity, and facilitate better quality of life for this group of patients.