臺灣博碩士論文加值系統

背景: 慢性中風病人時常主訴因伸肌無力或屈肌高張，致抓握過程中難以自主打開患側手的手部失能。先前文獻提及中風後會降低獨立性，因此在中風後的手部復健是必要的。侷限誘發動作治療已被證實有較佳的療效，但此方法之限制需個案本身已俱備些微的腕部及手指伸直動作。本研究目的為探討3D列印動態手部裝置結合任務導向性方法之療效比較。
方法: 本研究納入10位受試者並隨機指派至實驗組(n=5)或控制組(n=5)。實驗組在任務導向性方法介入時全程配戴動態手部裝置，但控制組僅接受傳統的任務導向性訓練。兩組均接受單次30分鐘，每週2次的實驗室訓練以及每週5次的居家訓練課程，共為期四週。在兩週的追蹤期，受試者進行自我居家訓練課程且沒有治療師的密切追蹤。結果測量包含指腹捏力、指側捏力、握力、箱子與積木測驗及傅格梅爾評估量表。
結果: 本研究結果顯示實驗組之指腹捏力有顯著進步，但控制組沒有。實驗組亦能保留傳統介入對於指側捏力、握力、手部靈巧度以及整體上肢功能之效果。在追蹤期，實驗組的居家復健時間為每天56.8分鐘，但控制組僅26.4分鐘。顯示3D列印始部裝置可顯著的提高個案執行居家復健的復健動機。
結論: 本研究結果顯示此3D列印動態手部裝置是一個有效的治療輔具，以提升慢性中風病人之捏力、握力、手部靈巧度、整體上肢功能以及復健動機，特別是可以顯著的提升指腹捏力以及復健動機。

Background: Chronic stroke patients often have complaints about hand dysfunction due to flexor hypertonia and extensor weakness, which makes it difficult to open their affected hand for functional grasp. Past studies reported individual with stroke would reduce the independence. Hand rehabilitation after stroke is essential for restoring functional independence. Constraint-induced movement therapy has showed to be a successful treatment for patients who have acquired certain level of wrist and finger extension. The goal of this study was to investigate the feasibility of task-oriented approach incorporating 3D-printed dynamic hand device by evaluating hand functional performance and motivation during home program.
Methods: In this study, 10 participants were recruited and randomly assigned to either the experimental group (n=5) or the control group (n=5). The experimental group engaged task-oriented approach with dynamic hand device while the control group received only task-oriented approach. Both groups participated in 30-minute on-site treatment twice a week and were prescribed with home program 5 days a week for 4 weeks. During 2-week follow-up phase, all participants engaged in home program without following closely by therapist. Outcome measurements include palmar pinch force (PPF), lateral pinch force (LPF), grip force (GF), Box and Blocks Test (BBT) and Fugl-Meyer assessment (FMA).
Results: The results of study revealed the improvement of PPF in experimental group but not in control group. Meanwhile, improvement in LPF, GF, BBT, and FMA can be found in both groups. During follow-up phase, the mean time of home program in experimental group was 56.8 minutes per day but only 26.4 minutes in control group. This suggested significant enhanced motivation of executing home-based training.
Conclusion: This study demonstrates that the 3D-printed dynamic hand device is an effective therapeutic assistive device to improve pinch force, grasp force, dexterity, function of upper extremity and facilitate motivation during home program in individuals with chronic stroke.

目錄
致謝 i
中文摘要 ii
Abstract iii
目錄 v
圖目錄 viii
表目錄 ix
第一章 緒論 1
1-1 前言 1
1-2 中風之流行病學 2
1-3 中風的手部失能 3
1-4 中風復健的理論基礎與介入方法 5
1-4-1 中風傷後復原之理論基礎 5
1-4-2 中風介入方法 5
1-4-3 非動力式動態手部裝置 7
1-5 3D列印應用 13
1-6 研究動機與目的 18
第二章 材料與方法 19
2-1 3D列印動態手部裝置之設計理念及製造流程 19
2-1-1 設計理念及實驗流程 19
2-1-2 研究設備 21
2-2 3D列印動態手部裝置之開發階段 24
2-2-1 動態機構模擬 24
2-2-2 模型建立 26
2-2-3 模型成型 29
2-3 臨床實驗階段 31
2-3-1 個案收集與分組 31
2-3-2 實驗流程 32
2-3-3 介入計劃及流程 33
2-3-4 評估參數與評估工具 34
2-3-4.1 力量參數 35
2-3-4.2 手部靈巧度測驗 37
2-3-4.3 上肢動作功能量表 38
2-3-5 統計分析 39
2-3-5.1 初始能力之組間比較 39
2-3-5.2 兩組間之比較 39
2-3-5.3 各組內前測、後測、追蹤測之比較 40
第三章 結果 41
3-1 受試者之分組資料 41
3-2 力量參數 42
3-2-1 指腹捏力 42
3-2-2 指側捏力 43
3-2-3 握力 44
3-3 箱子與積木測驗參數 45
3-4 傅格梅爾上肢評估量表 46
3-5 追蹤期自主居家訓練之平均時間 47
第四章 討論 48
4-1 與現有產品之差異 48
4-2 力量參數之探討 48
4-2-1 指腹捏力之介入療效探討 49
4-2-2 指側捏力及握力之介入療效探討 50
4-3 手部靈巧度之介入療效探討 51
4-4 整體上肢動作功能表現之介入療效探討 52
4-5 動態手部裝置可增進個案居家復健之動機 54
4-6 產品開發及臨床實驗階段之研究限制 55
4-7 未來研究方向 56
第五章 結論 59
參考文獻 60
附錄 66

圖目錄
圖 1-1常見的中風個案拇指動作 4
圖 1-2 SaeboFlex orthosis 8
圖 1-3動態機能輔助手 8
圖 1-4動態手功能訓練器 9
圖 1-5 Dynamic Hand Splint, DHS 9
圖 1-6球型抓握 12
圖 1-7指腹抓握 12
圖 1-8 3D列印流程 13
圖 1-9 Robohand之3D列印義肢手開源模型 15
圖 1-10 Robohand之3D列印義肢手穿戴圖 16
圖 1-11 Cyborg Beast之3D列印義肢手開源模型 16
圖 1-12日本EXiii公司的handiii 17
圖 1-13 3D列印輔助手Aquahand 17
圖 1-14 3D列印輔助手Spiderhand 18
圖 2-1完整實驗流程 20
圖 2-2「UP! Box」3D印表機 22
圖 2-3 Flashforge Dreamer 22
圖 2-4 Flashforge Finder 23
圖 2-5 CR-10 23
圖 2-6 3D掃描器iSense 23
圖 2-7裝置開發流程 24
圖 2-8桿件標記及模擬手部張開圖 25
圖 2-9桿件模擬抓握圖 25
圖 2-10桿件實際測試圖 26
圖 2-11載入之模型原檔 27
圖 2-12分離後外殼 27
圖 2-13動態手部裝置側視圖 28
圖 2-14指套側視圖 28
圖 2-15切片軟體UP!印列預覽圖 29
圖 2-16切片軟體Cura列印預覽圖 30
圖 2-17切片軟體Flashprint列印預覽圖 30
圖 2-18手部動態裝置實體圖 31
圖 2-19臨床實驗階段之流程圖 33
圖 2-20捏力計及測試擺位 36
圖 2-21握力計及測試擺位 37
圖 2-22箱子與積木測驗評估工具及施測方式 38
圖 3-1指腹捏力在不同時間點的結果比較 42
圖 3-2指側捏力在不同時間點的結果比較 43
圖 3-3握力在不同時間點的結果比較 44
圖 3-4箱子與積木測驗在不同時間點的結果比較 45
圖 3-5傅格梅爾上肢評估量表參數在不同時間點的結果比較 46
圖 3-6追蹤期自主居家訓練之平均時間比較 47

表目錄
表 2-1訓練課程架構 34
表 3-1兩組之基本資料 41
表 3-2兩組之起始能力 42
表 4-1動態手部裝置差異之表格 48
表 4-2傅格梅爾量表之進步幅度比較 54

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