臺灣博碩士論文加值系統

對於中樞神經受損疾患而言，無法行走是個案面臨最主要的問題。神經科學的重大進展為中樞神經受損的預後提供新概念。本研究目的是以較明確的步驟與具體的執行方式，探討動作再學習計畫相較於一般傳統物理治療應用在中樞神經疾患行走能力的療效。動作再學習計畫介入：包括任務動作分析、練習任務欠缺的動作成份、練習整個任務、訓練任務的轉移。本篇論文分為兩個單元：第一單元探討動作再學習計畫介入中樞神經損傷之特殊個案在走路功能表現的療效-以嚴重退化性小腦共濟失調個案為例。介入時間為每週三次，每次45~60分鐘，為期八週；第二單元探討動作再學習計畫對腦中風患者介入後在走路功能表現的療效，並以兩個主題呈現：主題一為個案系列研究；主題二為臨床隨機控制試驗。介入時間為每週三次，每次60分鐘，為期12週。主題一是針對3位具有異常步態的個案作分析探討；主題二則是雙盲隨機的臨床實驗設計。將符合篩檢條件且有意願參與實驗之個案分為實驗組(動作再學習組15人)及控制組(傳統物理治療組13人)。計畫執行時間自2017年01月01日起至2017年12月31日止。第一單元的實驗結果顯示嚴重退化性小腦共濟失調患者的行走能力與站立平衡在介入後有明顯改善；第二單元的個案系列研究發現3個案例的異常步態、行走速度及行走距離也在介入後有進步。第二單元的雙盲隨機臨床實驗，以共變數分析檢定兩組後測結果，顯示除了歐洲五維健康量表(F=12.1, p< 0.001)及膝後頂角度(F= 5.3, p= 0.03)在兩組間呈現顯著差異外，其餘參數包括髖屈曲力量(F =0.69, p = 0.41 )、膝伸直肌力量(F = 1.77, p = 0.20 )、六分鐘行走測試(F = 0.59, p = 0.45)、步速(F = 0.01, p =0.94)等則未呈現顯著差異。本研究的雙盲隨機臨床實驗並無法證實動作再學習計畫在腦中風疾患功能的改善及行走速度的增加，會優於一般傳統物理治療。不過，本研究發現腦中風患者在膝後頂的改善及生活品質的提升卻是優於控制組。由於中樞神經患者的變異性較大，未來仍需增加收案數量，以及謹慎控制實驗參數，以澄清動作再學習計畫對腦中風後患者走路表現與其他動作功能的影響。

Difficulty walking is a major problem faced by central nervoud system (CNS) lesion patients. The current neuroscience provides a new concept for the prognosis of CNS lesion.The purpose of this study was to explore the efficacy of Motor Relearning Program (MRP) on walking ability inpatientswith CNS lesionsas compared with the conventional physical therapy. The MRP including task analysis, practice missing component, practice the entire task and transfer training mission.This thesis is divided into two parts. First, MRP was adopted in a severe degenerative cerebellar ataxia patient which received a three-week, 45~60minute, eightweek training. In the second part, Stroke patients were enrolled in the case series and randomized control trial for a three-week, 60-minute, 12-week training.The plan is from January 01, 2017 until December 31, 2017. The first part of the thesis show that the ability of walking and standing balance improved significantly after intervention.The second part of the three stroke patients with abnormal gait, walking speed and distance are relatively improved.The results of the double-blind randomized control trials showed that the EQ5D(F=12.1, p<0.001) and the posterior knee angle(F=5.30, p=0.03) has significant change , there was no significant difference between hip flexion strength (F=0.69, p= 0.41), knee extensor muscle strength (F= 1.77, p= 0.20), six minute walk test (F= 0.59, p=0.45), gait speed (F=0.01, p= 0.94). Due to the large variability of CNS disorders, follow-up studies are still needed in the future to clarify the contribution of each factor in the MRP program.

致謝 1
中文摘要 2
英文摘要 3
第一章 緒論 6
第一節 中樞神經損傷的異常步態 8
第二節 改善中樞神經損傷患者行走能力的治療策略 9
第三節 動作再學習計畫(Motor Relearning Programme) 12
第四節 異常動作缺失成分的文獻回顧 14
第二章 研究背景 19
第一節 研究動機 19
第二節 研究目的 20
第三章 實驗材料與方法 21
第一節 小腦共濟失調患者動作再學習計畫介入(個案報告) 21
第二節 腦中風患者動作再學習計畫介入(案例系列) 27
第三節 腦中風患者動作再學習計畫介入(隨機控制試驗） 45
第四章 研究結果 49
第一節 小腦共濟失調患者動作再學習計畫介入(個案報告) 49
第二節 腦中風患者動作再學習計畫介入(案例系列) 50
第三節 腦中風患者動作再學習計畫介入(隨機控制試驗) 51
第五章 討論與結論 52
第一節 小腦共濟失調患者動作再學習計畫介入(個案報告) 52
第二節 腦中風患者動作再學習計畫介入(案例系列) 54
第三節 腦中風患者動作再學習計畫介入(隨機控制試驗) 55
第四節 研究限制 57
第五節 未來展望 58
附表 59
參考文獻： 68

 

參考文獻：
1.McGinley JL, Morris ME, Greenwood KM, Goldie PA, Olney SJ. Accuracy of clinical observations of push-off during gait after stroke. Arch Phys Med Rehabil. 2006;87(6):779-785.
2.Carr JH, Shepherd RB. Stroke Rehbilitation: guidelines for exercise and training to optimize motor skill. Philadelphia: Butterworth-Heinemann; 2003.
3.Holden MK, Gill KM, Magliozzi MR. Gait assessment for neurologically impaired patients. Standards for outcome assessment. Physical therapy. 1986;66(10):1530-1539.
4.廖建彰、李采娟、林瑞雄、宋鴻樟。2000年台灣腦中風發生率與盛行率的城鄉差異。台灣公共衛生雜誌。2006;25(3):223-230。
5.Hesse S, Schattat N, Mehrholz J, Werner C. Evidence of end-effector based gait machines in gait rehabilitation after CNS lesion. NeuroRehabilitation. 2013;33(1):77-84.
6.Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil. 1995;76(1):27-32.
7.Friedman PJ. Gait recovery after hemiplegic stroke. International disability studies. 1990;12(3):119-122.
8.Galea SL, Lee M-J, English C, Ada L. Sedentary versus active behavior in people after stroke. Physical Therapy Reviews. 2015;20(1).
9.Perry J, Garrett M, Gronley JK, Mulroy SJ. Classification of walking handicap in the stroke population. Stroke; a journal of cerebral circulation. 1995;26(6):982-989.
10.Hill K, Ellis P, Bernhardt J, Maggs P, Hull S. Balance and mobility outcomes for stroke patients: a comprehensive audit. Aust J Physiother. 1997;43(3):173-180.
11.Patterson KK, Parafianowicz I, Danells CJ, et al. Gait asymmetry in community-ambulating stroke survivors. Arch Phys Med Rehabil. 2008;89(2):304-310.
12.Dodd KJ, Morris ME. Lateral pelvic displacement during gait: abnormalities after stroke and changes during the first month of rehabilitation. Arch Phys Med Rehabil. 2003;84(8):1200-1205.
13.Kizony R, Levin MF, Hughey L, Perez C, Fung J. Cognitive load and dual-task performance during locomotion poststroke: a feasibility study using a functional virtual environment. Physical therapy. 2010;90(2):252-260.
14.Ilg W, Synofzik M, Brotz D, Burkard S, Giese MA, Schols L. Intensive coordinative training improves motor performance in degenerative cerebellar disease. Neurology. 2009;73(22):1823-1830.
15.Martin CL, Tan D, Bragge P, Bialocerkowski A. Effectiveness of physiotherapy for adults with cerebellar dysfunction: a systematic review. Clinical rehabilitation. 2009;23(1):15-26.
16.Miyai I, Ito M, Hattori N, et al. Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases. Neurorehabilitation and neural repair. 2012;26(5):515-522.
17.Synofzik M, Ilg W. Motor training in degenerative spinocerebellar disease: ataxia-specific improvements by intensive physiotherapy and exergames. Biomed Res Int. 2014;2014:583507.
18.Ilg W, Bastian AJ, Boesch S, et al. Consensus paper: management of degenerative cerebellar disorders. Cerebellum. 2014;13(2):248-268.
19.Carr JH, Shepherd RB. Neurological Rehabilitation: optimizing motor performance. Oxford: Butterworth-Heinemann; 1999.
20.Balliet R, Harbst KB, Kim D, Stewart RV. Retraining of functional gait through the reduction of upper extremity weight-bearing in chronic cerebellar ataxia. Int Rehabil Med. 1987;8(4):148-153.
21.Boyd LA, Winstein CJ. Cerebellar stroke impairs temporal but not spatial accuracy during implicit motor learning. Neurorehabilitation and neural repair. 2004;18(3):134-143.
22.Diener HC, Dichgans J, Guschlbauer B, Bacher M, Rapp H, Klockgether T. The coordination of posture and voluntary movement in patients with cerebellar dysfunction. Mov Disord. 1992;7(1):14-22.
23.Morris ME, Matyas TA, Bach TM, Goldie PA. Electrogoniometric feedback: its effect on genu recurvatum in stroke. Arch Phys Med Rehabil. 1992;73(12):1147-1154.
24.Bleyenheuft C, Bleyenheuft Y, Hanson P, Deltombe T. Treatment of genu recurvatum in hemiparetic adult patients: a systematic literature review. Ann Phys Rehabil Med. 2010;53(3):189-199.
25.Dean CM, Ada L, Lindley RI. Treadmill training provides greater benefit to the subgroup of community-dwelling people after stroke who walk faster than 0.4m/s: a randomised trial. Journal of physiotherapy. 2014;60(2):97-101.
26.Olney SJ, C. R. Hemiparetic gait following stroke. Part 1:Characteristics. Gait & posture. 1996;4:136-148.
27.Schmid A, Duncan PW, Studenski S, et al. Improvements in speed-based gait classifications are meaningful. Stroke; a journal of cerebral circulation. 2007;38(7):2096-2100.
28.Andrenelli E, Ippoliti E, Coccia M, et al. Features and predictors of activity limitations and participation restriction 2 years after intensive rehabilitation following first-ever stroke. European journal of physical and rehabilitation medicine. 2015;51(5):575-585.
29.Ada L, Dean CM, Lindley R, Lloyd G. Improving community ambulation after stroke: the AMBULATE Trial. BMC neurology. 2009;9:8.
30.Riley PO, Kerrigan DC. Torque action of two-joint muscles in the swing period of stiff-legged gait: a forward dynamic model analysis. Journal of biomechanics. 1998;31(9):835-840.
31.Stoquart GG, Detrembleur C, Palumbo S, Deltombe T, Lejeune TM. Effect of botulinum toxin injection in the rectus femoris on stiff-knee gait in people with stroke: a prospective observational study. Arch Phys Med Rehabil. 2008;89(1):56-61.
32.Gage JR, Perry J, Hicks RR, Koop S, Werntz JR. Rectus femoris transfer to improve knee function of children with cerebral palsy. Developmental medicine and child neurology. 1987;29(2):159-166.
33.Mathiowetz V, Haugen JB. Motor behavior research: implications for therapeutic approaches to central nervous system dysfunction. The American journal of occupational therapy : official publication of the American Occupational Therapy Association. 1994;48(8):733-745.
34.胡名霞。中風病患之物理治療-現代觀念及效益。中華民國物理治療學會雜誌。1998;23(3):202-210。
35.Dickstein R, Hocherman S, Pillar T, Shaham R. Stroke rehabilitation. Three exercise therapy approaches. Physical therapy. 1986;66(8):1233-1238.
36.Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clinical rehabilitation. 2000;14(4):361-369.
37.Chen JC, Shaw FZ. Recent progress in physical therapy of the upper-limb rehabilitation after stroke: emphasis on thermal intervention. The Journal of cardiovascular nursing. 2006;21(6):469-473.
38.Brunnstrom S. Motor testing procedures in hemiplegia: based on sequential recovery stages. Physical therapy. 1966;46(4):357-375.
39.Mikolajewska E. Associations between results of post-stroke NDT-Bobath rehabilitation in gait parameters, ADL and hand functions. Advances in clinical and experimental medicine : official organ Wroclaw Medical University. 2013;22(5):731-738.
40.Mudie MH, Winzeler-Mercay U, Radwan S, Lee L. Training symmetry of weight distribution after stroke: a randomized controlled pilot study comparing task-related reach, Bobath and feedback training approaches. Clinical rehabilitation. 2002;16(6):582-592.
41.Kim K, Lee DK, Jung SI. Effect of coordination movement using the PNF pattern underwater on the balance and gait of stroke patients. Journal of physical therapy science. 2015;27(12):3699-3701.
42.Malouin F, Potvin M, Prevost J, Richards CL, Wood-Dauphinee S. Use of an intensive task-oriented gait training program in a series of patients with acute cerebrovascular accidents. Physical therapy. 1992;72(11):781-789; discussion 789-793.
43.Polese JC, Ada L, Dean CM, Nascimento LR, Teixeira-Salmela LF. Treadmill training is effective for ambulatory adults with stroke: a systematic review. Journal of physiotherapy. 2013;59(2):73-80.
44.Ada L, Dean CM, Hall JM, Bampton J, Crompton S. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Arch Phys Med Rehabil. 2003;84(10):1486-1491.
45.Sabari JS, Kane L, Flanagan SR, Steinberg A. Constraint-induced motor relearning after stroke: a naturalistic case report. Arch Phys Med Rehabil. 2001;82(4):524-528.
46.莊國瑋、王榮俊、黃亭韶、陳克銘、于瑛輝、高木榮。限制-誘發動作治療於中風病人復健之療效。北市醫學雜誌。2008;5(1):1-14。
47.Yang YR, Tsai MP, Chuang TY, Sung WH, Wang RY. Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial. Gait & posture. 2008;28(2):201-206.
48.何正宇、王志龍、盧玉強、孫淑芬、張兆宏、蔡欣宜。以Wii建構虛擬實境輔助慢性中風患者復健訓練之療效評估。台灣復健醫學雜誌。2010;38(1):11-18。
49.蘇桂瑢、林克忠、盧時雨、吳菁宜。現代任務導向中風復健途徑之文獻回顧。臺灣職能治療研究與實務雜誌。2010;6(1):50-65。
50.Langhammer B, Stanghelle JK. Bobath or motor relearning programme? A follow-up one and four years post stroke. Clinical rehabilitation. 2003;17(7):731-734.
51.Chan DY, Chan CC, Au DK. Motor relearning programme for stroke patients: a randomized controlled trial. Clinical rehabilitation. 2006;20(3):191-200.
52.Fonteyn EM, Keus SH, Verstappen CC, Schols L, de Groot IJ, van de Warrenburg BP. The effectiveness of allied health care in patients with ataxia: a systematic review. J Neurol. 2014;261(2):251-258.
53.Ilg W, Timmann D. Gait ataxia--specific cerebellar influences and their rehabilitation. Movement disorders : official journal of the Movement Disorder Society. 2013;28(11):1566-1575.
54.Burciu RG, Fritsche N, Granert O, et al. Brain changes associated with postural training in patients with cerebellar degeneration: a voxel-based morphometry study. J Neurosci. 2013;33(10):4594-4604.
55.Wessel K, Zeffiro T, Lou JS, Toro C, Hallett M. Regional cerebral blood flow during a self-paced sequential finger opposition task in patients with cerebellar degeneration. Brain. 1995;118 ( Pt 2):379-393.
56.Gilbert PF, Thach WT. Purkinje cell activity during motor learning. Brain Res. 1977;128(2):309-328.
57.Gonshor A, Jones GM. Short-term adaptive changes in the human vestibulo-ocular reflex arc. J Physiol. 1976;256(2):361-379.
58.陳文玲、鄭裕南。膝背屈現象與腦中風患者膝部慢速肌力表現。中華民國物理治療學會雜誌。1993;18(1):49-57。
59.Cooper A, Alghamdi GA, Alghamdi MA, Altowaijri A, Richardson S. The relationship of lower limb muscle strength and knee joint hyperextension during the stance phase of gait in hemiparetic stroke patients. Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 2012;17(3):150-156.
60.Gross R, Delporte L, Arsenault L, et al. Does the rectus femoris nerve block improve knee recurvatum in adult stroke patients? A kinematic and electromyographic study. Gait & posture. 2014;39(2):761-766.
61.Perry J. Gait analysis: normal and pathological function. Slack Incorporated. 1992.
62.Sung DH, Bang HJ. Motor branch block of the rectus femoris: its effectiveness in stiff-legged gait in spastic paresis. Arch Phys Med Rehabil. 2000;81(7):910-915.
63.Chantraine F, Detrembleur C, Lejeune TM. Effect of the rectus femoris motor branch block on post-stroke stiff-legged gait. Acta neurologica Belgica. 2005;105(3):171-177.
64.Robertson JV, Pradon D, Bensmail D, Fermanian C, Bussel B, Roche N. Relevance of botulinum toxin injection and nerve block of rectus femoris to kinematic and functional parameters of stiff knee gait in hemiplegic adults. Gait & posture. 2009;29(1):108-112.
65.Caty GD, Detrembleur C, Bleyenheuft C, Deltombe T, Lejeune TM. Effect of simultaneous botulinum toxin injections into several muscles on impairment, activity, participation, and quality of life among stroke patients presenting with a stiff knee gait. Stroke; a journal of cerebral circulation. 2008;39(10):2803-2808.
66.Gatti MA, Freixes O, Fernandez SA, et al. Effects of ankle foot orthosis in stiff knee gait in adults with hemiplegia. Journal of biomechanics. 2012;45(15):2658-2661.
67.Apti A, Akalan NE, Kuchimov S, Ozdincler AR, Temelli Y, Nene A. Plantar flexor muscle weakness may cause stiff-knee gait. Gait & posture. 2016;46:201-207.
68.Piazza SJ, Delp SL. The influence of muscles on knee flexion during the swing phase of gait. Journal of biomechanics. 1996;29(6):723-733.
69.Gage JR. The treatment of gait problems in cerebral palsy. 2004.
70.Kerrigan DC, Gronley J, Perry J. Stiff-legged gait in spastic paresis. A study of quadriceps and hamstrings muscle activity. Am J Phys Med Rehabil. 1991;70(6):294-300.
71.Kerrigan DC, Frates EP, Rogan S, Riley PO. Hip hiking and circumduction: quantitative definitions. Am J Phys Med Rehabil. 2000;79(3):247-252.
72.Petrofsky JS. The use of electromyogram biofeedback to reduce Trendelenburg gait. Eur J Appl Physiol. 2001;85(5):491-495.
73.Sheffler LR, Taylor PN, Gunzler DD, Buurke JH, Ijzerman MJ, Chae J. Randomized controlled trial of surface peroneal nerve stimulation for motor relearning in lower limb hemiparesis. Arch Phys Med Rehabil. 2013;94(6):1007-1014.
74.Pollock A, Baer G, Langhorne P, Pomeroy V. Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke: a systematic review. Clinical rehabilitation. 2007;21(5):395-410.
75.Pollock A, Baer G, Campbell P, et al. Physical rehabilitation approaches for the recovery of function and mobility following stroke. The Cochrane database of systematic reviews. 2014(4):Cd001920.
76.Freund JE, Stetts DM. Use of trunk stabilization and locomotor training in an adult with cerebellar ataxia: a single system design. Physiother Theory Pract. 2010;26(7):447-458.
77.Vaz DV, Schettino Rde C, Rolla de Castro TR, Teixeira VR, Cavalcanti Furtado SR, de Mello Figueiredo E. Treadmill training for ataxic patients: a single-subject experimental design. Clin Rehabil. 2008;22(3):234-241.
78.Ilg W, Brotz D, Burkard S, Giese MA, Schols L, Synofzik M. Long-term effects of coordinative training in degenerative cerebellar disease. Movement disorders : official journal of the Movement Disorder Society. 2010;25(13):2239-2246.
79.Miyai I, Ito M, Hattori N, et al. Cerebellar ataxia rehabilitation trial in degenerative cerebellar diseases. Neurorehabil Neural Repair. 2012;26(5):515-522.
80.Sarva H, Shanker VL. Treatment Options in Degenerative Cerebellar Ataxia: A Systematic Review. Movement Disorders Clinical Practice. 2014;1(4):291-298.
81.Muntner P, Garrett E, Klag MJ, Coresh J. Trends in Stroke Prevalence Between 1973 and 1991 in the US Population 25 to 74 Years of Age. Stroke; a journal of cerebral circulation. 2002;33(5):1209-1213.
82.郭婉伶、蘇郁涵、張凱萍、張凱傑、嚴曉晴。臨床問題：小腦失能之運動失調步態的運動介入。物理治療。2012;37(3):253-263。
83.Schmitz-Hubsch T, du Montcel ST, Baliko L, et al. Scale for the assessment and rating of ataxia: development of a new clinical scale. Neurology. 2006;66(11):1717-1720.
84.van Iersel MB, Munneke M, Esselink RA, Benraad CE, Olde Rikkert MG. Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients. Journal of clinical epidemiology. 2008;61(2):186-191.
85.ATS statement: guidelines for the six-minute walk test. American journal of respiratory and critical care medicine. 2002;166(1):111-117.
86.羅文琪、湯佩芳。簡介傅格-梅爾評估量表及其在中風復健之應用。物理治療。2000;25(4):239-250。
87.Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Physical therapy. 2000;80(9):896-903.
88.李曉惠、朱靜宜、胡柏婷、胡名霞。計時起走測驗之信度研究。物理治療. 2002;27(3):131-138。
89.Plummer P, Behrman AL, Duncan PW, et al. Effects of stroke severity and training duration on locomotor recovery after stroke: a pilot study. Neurorehabilitation and neural repair. 2007;21(2):137-151.
90.Olney SJ, Griffin MP, McBride ID. Temporal, kinematic, and kinetic variables related to gait speed in subjects with hemiplegia: a regression approach. Physical therapy. 1994;74(9):872-885.
91.Richardson S, Cooper A, Alghamdi G, Alghamdi M, Altowaijri A. Assessing knee hyperextension in patients following stroke: A comparison of Siliconcoach movement analysis software and experienced clinical observation. International Journal of Therapy and Rehabilitation. 2012:pp. 163-168.
92.Krutulyte G, Kimtys A, Krisciunas A. [The effectiveness of physical therapy methods (Bobath and motor relearning program) in rehabilitation of stroke patients]. Medicina (Kaunas). 2003;39(9):889-895.
93.Hatakenaka M, Miyai I, Mihara M, Yagura H, Hattori N. Impaired motor learning by a pursuit rotor test reduces functional outcomes during rehabilitation of poststroke ataxia. Neurorehabilitation and neural repair. 2012;26(3):293-300.
94.Marsden J, Harris C. Cerebellar ataxia: pathophysiology and rehabilitation. Clin Rehabil. 2011;25(3):195-216.
95.Deluca C, Moretto G, Di Matteo A, et al. Ataxia in posterior circulation stroke: clinical-MRI correlations. J Neurol Sci. 2011;300(1-2):39-46.
96.Matsugi A. Physical Therapy for Cerebellar Ataxia. In: Suzuki T, ed. Neurological Physical Therapy. Rijeka: InTech; 2017:157-173.
97.Marquer A, Barbieri G, Perennou D. The assessment and treatment of postural disorders in cerebellar ataxia: a systematic review. Ann Phys Rehabil Med. 2014;57(2):67-78.
98.Celnik P. Understanding and modulating motor learning with cerebellar stimulation. Cerebellum. 2015;14(2):171-174.
99.Molinari M, Leggio MG, Solida A, et al. Cerebellum and procedural learning: evidence from focal cerebellar lesions. Brain. 1997;120 ( Pt 10):1753-1762.
100.Fernandez-Seara MA, Aznarez-Sanado M, Mengual E, Loayza FR, Pastor MA. Continuous performance of a novel motor sequence leads to highly correlated striatal and hippocampal perfusion increases. Neuroimage. 2009;47(4):1797-1808.
101.Taylor JA, Klemfuss NM, Ivry RB. An explicit strategy prevails when the cerebellum fails to compute movement errors. Cerebellum. 2010;9(4):580-586.
102.Ilg W, Golla H, Thier P, Giese MA. Specific influences of cerebellar dysfunctions on gait. Brain : a journal of neurology. 2007;130(Pt 3):786-798.
103.Lee SM, Cynn HS, Yoon TL, Lee JH. Effects of different heel-raise-lower exercise interventions on the strength of plantarflexion, balance, and gait parameters in stroke survivors. Physiotherapy theory and practice. 2017;33(9):706-715.
104.Goldmann JP, Bruggemann GP. The potential of human toe flexor muscles to produce force. Journal of anatomy. 2012;221(2):187-194.
105.Dean CM, Richards CL, Malouin F. Task-related circuit training improves performance of locomotor tasks in chronic stroke: a randomized, controlled pilot trial. Arch Phys Med Rehabil. 2000;81(4):409-417.
106.Kwakkel G, Wagenaar RC, Twisk JW, Lankhorst GJ, Koetsier JC. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet (London, England). 1999;354(9174):191-196.
107.陳綉儀、湯佩芳、胡名霞。中風病患任務導向治療模式臨床效果之系統性文獻回顧。物理治療。2007;32(6):308-315。
108.Choi-Kwon S, Choi JM, Kwon SU, Kang DW, Kim JS. Factors that Affect the Quality of Life at 3 Years Post-Stroke. Journal of clinical neurology (Seoul, Korea). 2006;2(1):34-41.
109.許書旋、湯佩芳、胡名霞。擴增性回饋對動作學習的影響-中樞神經損傷患者是否遵循如健康者之動作學習原則？物理治療。2006;31(4):252-260。
110.Goldberg SR, Ounpuu S, Delp SL. The importance of swing-phase initial conditions in stiff-knee gait. Journal of biomechanics. 2003;36(8):1111-1116.