臺灣博碩士論文加值系統

背景：對於中期的帕金森氏症患者而言，平衡能力及功能性移行能力需仰賴藥物及非藥物的治療，近來有研究指出全身性震動治療能改善個案的動作功能，然而目前此療法對於帕金森氏症患者的感覺動作功能療效尚不明確。目的：探討全身性震動治療對於帕金森氏症患者感覺動作功能之立即療效。方法：本研究招募34位年齡介於50至65歲的帕金森氏症患者，以單盲隨機控制試驗設計，受試者被隨機分派至全身性震動治療組及常規治療組，並在治療前後進行感覺動作功能的評估，包括上肢本體覺敏感度測量、膝關節位置覺評估、統一帕金森氏症評定量表中動作功能、功能性前伸測試、起身行走測試，所有資料以重複量測的二因子變異數分析進行統計分析。結果：所有評估結果並未發現全身性震動治療及常規治療組有顯著差異，但兩組皆於治療前後在統一帕金森氏症評定量表中動作功能(p= 0.030)、較差側的功能性前伸測試(p= 0.017)及起身行走測試(p=0.010)有顯著的進步。結論：全身性震動治療和常規治療對於帕金森氏症患者的感覺動作功能之療效並無顯著差異，但全身性震動治療提供一被動且安全的非藥物治療方式，可作為臨床上對於有動作功能損傷或平衡障礙的帕金森氏症患者治療選擇之一。

Background: For individuals with moderate Parkinson’s Disease (PD), it is necessary to combine both pharmacological and non-pharmacological treatment to improve balance function and functional mobility. Previous studies reported that whole body vibration (WBV) has the potential impact on balance and walking abilities in individuals with Parkinson’s disease; however, the inconsistent treatment protocols and different experimental designs lead to inconclusive results. OBJECTIVES: To investigate the immediate effect of WBV on sensorimotor function for individual with PD. METHODS: The experimental design was single-blinded randomized controlled trial. 34 participants with age range 50~60 years were recruited and randomly assigned into WBV group and conventional therapy group. Outcome measures included proprioceptive sensitivity threshold of upper limb, position sense test of the knee joint, Unified Parkinson’s disease rating scale-motor (UPDRS motor), functional reach test (FRT), and time up and go test (TUG). Each participant was evaluated before and after treatment. Two-way repeated measure analysis of variance was used to analyze within-group and between-group differences. RESULTS: No statistically significant difference was found between groups. However, both groups showed significant improvement in motor function after treatment, including UPDRS motor (p= 0.030), less affected side of FRT (P= 0.017) and TUG (P=0.010). CONCLUSIONS: Although the effect of WBV was not superior than conventional therapy, it provided a passive and safe clinical intervention as an alternative treatment, especially for individuals with motor impairment or poor balance function.

指導教授推薦書…………………………………………………………………………………………………………………………
口試委員會審定書……………………………………………………………………………………………………………………
致謝…………………………………………………………………………………………………………………………………………… iii
中文摘要…………………………………………………………………………………………………………………………………… v
英文摘要…………………………………………………………………………………………………………………………………… vi
目錄……………………………………………………………………………………………………………………………………………… viii
表目錄………………………………………………………………………………………………………………………………………… x
圖目錄………………………………………………………………………………………………………………………………………… xi
第一章 前言…………………………………………………………………………………………………………………………… 1
第二章 文獻回顧………………………………………………………………………………………………………………… 3
2.1帕金森氏症簡介…………………………………………………………………………………………………………… 3
2.2疾病分期………………………………………………………………………………………………………………………… 8
2.3治療方式………………………………………………………………………………………………………………………… 10
2.4全身性震動治療相關研究……………………………………………………………………………………… 13
2.5總結………………………………………………………………………………………………………………………………… 18
2.6研究目的………………………………………………………………………………………………………………………… 26
2.6研究假設………………………………………………………………………………………………………………………… 26
第三章 方法………………………………………………………………………………………………………………………… 27
3.1 研究設計……………………………………………………………………………………………………………………… 27
3.2 受試者…………………………………………………………………………………………………………………………… 27
3.3 評估工具……………………………………………………………………………………………………………………… 29
3.4 治療方案……………………………………………………………………………………………………………………… 34
3.5 實驗流程……………………………………………………………………………………………………………………… 35
3.6 數據處理……………………………………………………………………………………………………………………… 38
3.7統計分析………………………………………………………………………………………………………………………… 39
第四章 結果………………………………………………………………………………………………………………………… 40
4.1 人口統計學資料……………………………………………………………………………………………………… 40
4.2 臨床評估結果…………………………………………………………………………………………………………… 42
第五章 討論………………………………………………………………………………………………………………………… 50
第六章 結論………………………………………………………………………………………………………………………… 57
6.1研究限制與未來建議………………………………………………………………………………………………… 57
6.2臨床應用………………………………………………………………………………………………………………………… 58
參考文獻………………………………………………………………………………………………………………………………… 59


表目錄
表一、十篇使用探討全身性震動治療於帕金森氏症患者的療效研究
之比較…………………………………………………………………………………………………………………………………… 20
表二、非隨機全身性震動組及常規治療組人口統計學資料………………………… 42
表三、非隨機全身性震動治療和常規治療組的感覺動作功能基準值
………………………………………………………………………………………………………………………………………………… 45
表四、非隨機全身性震動治療組和常規治療組在治療前後的感覺動
作功能結果………………………………………………………………………………………………………………………… 46


圖目錄
圖一、本體覺敏感度評估之實驗設置…………………………………………………………………… 31
圖二、實驗流程圖………………………………………………………………………………………………………… 37
圖三、心理計量函數…………………………………………………………………………………………………… 38
圖四、收案流程……………………………………………………………………………………………………………… 41
圖五、非隨機全身性震動治療組和常規治療組在治療前後的感覺功
能結果之長條圖……………………………………………………………………………………………………………… 48
圖六、非隨機全身性震動治療組和常規治療組在治療前後的動作功
能結果之長條圖……………………………………………………………………………………………………………… 49

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