臺灣博碩士論文加值系統

體感覺輸入對於精確的運動表現及學習一個新的動作技巧為一個必要因素。在健康人類中，超過動作閾值的周邊神經刺激會使刺激肢體運動路徑興奮性增加。本篇研究的目的是去探討感覺或肌肉傳入對於運動路徑的興奮性調節的重要性。受試者為8名感覺缺損之脊髓損傷患者及9名健康人。重複性電刺激(25Hz, 刺激時間/休息時間=800毫秒/800毫秒)正中神經30分鐘於刺激前、中、後以及停止電刺激30分鐘後，紀錄120%動作閾值之皮質磁場刺激強度於橈側屈腕肌上引發動作誘發電位與靜止時期以及周邊電刺激引發之H反射。結果發現在健康受試者的動作誘發電位平均值在重複電刺激後增加至154±29%(P=0.01)，停止電刺激30分鐘後振幅的平均值仍大於初始值，但未達統計上顯著差異。值仍無恢復。在脊髓損傷患者中，動作誘發電位沒有變化。而H反射和低頻抑制比率在所有受試者皆無改變。我們推斷感覺傳入對於促進皮質運動神經元興奮性為一個重要因子。

Somatosensory input was required for accurate motor performance and for new motor skill learning. In humans, above motor threshold peripheral nerve stimulation resulted in an increased excitability of the motor pathway to the stimulated body parts. The purpose of this study was to investigate whether peripheral sensory afferents was essential in facilitation of motor pathway by electrical stimulation. Eight subjects with sensory impairment following SCI and nine healthy subjects were recruited. Motor evoked potentials (MEP), silent period(SP) elicited by 120% motor threshold transcranial magnetic stimulation (TMS), and H-reflex elicited by median nerve stimulation were recorded on flexor carpi radialis (FCR) muscle before, during, immediately and 30 minutes after repetitive electrical stimulation (25 Hz, on/off=800ms/ 800 ms) on median nerve. In healthy subjects, the averaged amplitude of MEP increased to 154±29% of initial (P=0.01) after repetitive electrical stimulation. This increment became statically non-significant 30 min after the stimulation stopped. In subjects with SCI, the MEP did not change. The H-reflex and low frequency depression ratio did not change in both subjects. We concluded that the sensory afferent input was essential to facilitate the corticomotoneuronal excitability during peripheral nerve stimulation.

目錄
指導教授推薦書…………………………………………………….
口試委員會審定書………………………………………………….
授權書………………………………………………………………. iii
中文摘要…………………………………………………………… iv
英文摘要…………………………………………………………… v
誌謝..................................................................................................... vi
第一章 緒論……………………………………………………… 1
1.1 研究背景與動機…………………………………………… 1
1.2 研究目的…………………………………………………… 5
1.3 研究假設…………………………………………………… 6
1.4 研究範圍與限制…………………………………………… 7
1.5 名詞解釋及操作型定義…………………………………… 8
第二章 文獻探討………………………………………………… 10
2.1 影響感覺動作皮質之可塑性及再整合因素……………… 10
2.2 皮質磁場刺激用於中樞興奮性之評估…………………… 13
2.3 運動神經元池興奮性之測量………………………………. 18
2.4 感覺輸入對中樞傳導路徑興奮性之研究………………… 20
2.5脊髓損傷患者在受傷後之中樞再整合變化………………… 23
第三章 研究方法與步驟………………………………………… 25
3.1 研究對象…………………………………………………… 25
3.2 實驗儀器與設備…………………………………………… 26
3.3 實驗設計…………………………………………………… 30
3.4 實驗步驟…………………………………………………… 31
3.5 資料處理與分析…………………………………………… 34
3.6 統計方法…………………………………………………… 36
第四章 結果……………………………………………………… 44
4.1正常人與感覺缺損之脊髓損傷病人在經由周邊神經電刺激前後之動作誘發電位變化…………………………………
45
4.2 健康人在經由周邊神經電刺激前後靜止時期之改變…… 47
4.3 健康人與感覺缺損之脊髓損傷病人在經由周邊神經電刺激前後之H反射改變……………………………………………
48
4.4 正常人與感覺缺損之脊髓損傷病人在經由周邊神經電刺激前後之低頻抑制改變…………………………………………
49
第五章 討論……………………………………………………… 63
5.1 動作誘發電位在周邊神經電刺激前後之變化…………… 63
5.2 靜止時期在周邊神經電刺激前後之改變………………… 69
5.3 H反射在周邊神經電刺激後之改變……………………… 71
5.4 低頻抑制在周邊神經電刺激後之改變…………………… 73
5.5 未來研究…………………………………………………… 74
結論………………………………………………………………… 75
參考文獻………………………………………………………… 76
附錄………………………………………………………………… 82
附錄一 脊髓損傷患者與健康人個別詳細資料………………… 82
附錄二 健康人和脊髓損傷患者在周邊神經電刺激過程之最大M波變化圖與統計表…………………………………
83
附錄三 最大M波、動作誘發電位、H反射、低頻抑制之雙因子變異數分析統計表……………………………………
84
附錄四 健康人在經周邊神經電刺激過程中，受試者個別動作誘發電位與休息值之比率變化…………………………
86
附錄五 脊髓損傷患者在經周邊神經電刺激過程中，受試者個別動作誘發電位百分比變化……………………………
87
附錄六 健康人在經周邊神經電刺激過程中，受試者個別靜止時期之變化………………………………………………
88
附錄七 健康人與脊髓損傷患者靜止時期之肌電原始訊號圖… 89
附錄八 健康人在經周邊神經電刺激過程中，受試者個別H反射與休息值之比率變化…………………………………
90
附錄九 脊髓損傷患者在經周邊神經電刺激過程中，受試者個別H反射百分比變化…………………………………...
91
附錄十 健康人在經周邊神經電刺激過程中，受試者個別低頻抑制比率百分比變化…………………………………..
92
附錄十一 脊髓損傷患者在經周邊神經電刺激過程中，受試者個別低頻抑制比率百分比變化……………………...
93

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