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研究生:陳昭蓉
研究生(外文):Chao Jung Chen
論文名稱:探討連續合併有氧運動及電腦化認知訓練於認知減退腦血管病患的成效:隨機對照試驗
論文名稱(外文):Effects of sequential combination of aerobic exercise and computer-based cognitive training in stroke patients with cognitive decline: A randomized controlled trial
指導教授:吳菁宜吳菁宜引用關係
指導教授(外文):C. Y. Wu
學位類別:碩士
校院名稱:長庚大學
系所名稱:職能治療學系
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2018
畢業學年度:106
語文別:中文
論文頁數:115
中文關鍵詞:中風認知復健有氧運動訓練電腦化認知訓練連續合併運動與認知訓練
外文關鍵詞:stroke cognitive rehabilitationaerobic exercise trainingcomputerized cognitive trainingsequential combination exercise and cognitive training
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背景
中風後認知減退是值得探討的議題。連續結合式有氧運動與認知訓練介入於輕度認知減退的中風族群相關介入療效尚無定論。本研究為比較連續結合式訓練對比傳統訓練的訓練效益。驗證接受連續訓練模式後,於認知功能、動作功能、生活品質相關的評量效益。
方法
本研究為單盲、隨機控制試驗。介入於台灣天主教靈醫會羅東聖母醫院。23位輕度認知減退的慢性中風個案隨機分派至連續組 (Sequence group, SEQ) (n=11) 或控制組 (Control group, CT) (n=12)。連續組是有氧運動訓練後進行電腦化認知訓練,控制組為傳統職能治療訓練。每組治療劑量為每週2~3次,每次60分鐘,共36次訓練。於治療前後各接受一次臨床評估,內容包含認知、動作、日常生活與生活品質。採用無母數分析評估結果量測變化。認知結果量測:(1) 蒙特利爾認知測驗 (Montreal Cognitive Assessment, MoCA) 評估整體認知功能;(2) 魏氏記憶量表-第三版 (Wechsler Memory Scale – Third Edition ,WMS–III) 評估記憶功能;(3) 史楚普字色測驗 (Stroop Color-Word test) 評估處理速度、執行功能;(4) 雙重任務行走測驗 (Dual task walking test) 評估認知處理能力以及動作行為相互作用的表現。動作結果量測:(1) 計時起走測驗 (Timed up and go, TUG) 評估移動與動態平衡能力;(2) 6分鐘行走測驗 (6-minute walking test) 評估下肢耐力;(3) 肌肉力量 (等長收縮):患側與非患側之膝伸直肌力、膝彎曲肌力 (等長收縮)。日常生活與生活品質量測:(1) 功能性獨立量表 (Functional Independence Measure, FIM):評估日常生活獨立性;(2) Lawton工具性日常生活量表 (Lawton Instrumental Activities of Daily Living Scale, Lawton IADL) 評估生活於社區的獨立性;(3) 腦血管疾病衝擊量表 (Stroke Impact Scale, SIS) 評估健康相關的生活品質。
結果
經過36次治療後,二組整體認知功能前後測組內比較有顯著差異,組間則無,顯示提供高密度的治療訓練對認知減退之慢性中風族群而言,整體認知可達改善。在動作層面,以連續組下肢耐力為有較佳的成效;連續組在自然步調之行走速度 (公尺/秒)、自然步調合併計算連續減法之行走速度 (公尺/秒) 前後測組內比較皆有顯著差異,組間則無。在生活品質改善以連續組為有較佳的成效。
結論
本研究結果顯示無論是連續結合式運動與認知訓練或是治療劑量相當的復健治療,皆能有效改善認知減退慢性中風族群的認知功能,至於連續有氧運動與電腦化認知訓練的治療效益,在整體認知能力、下肢耐力、生活品質成效較佳,表示連續結合訓練模式提供認知減退慢性中風族群可行的介入方式。未來應持續進行更大樣本的研究並關注療效影響因子以協助訂定合適的治療計畫。
Background
Post-stroke cognitive decline has been a noteworthy issue, while the efficacy of sequential interventions, where aerobic exercise training followed by cognitive training, in chronic stroke patients with cognitive decline has remained controversial. This study aimed to compare the efficacy of sequential intervention with the efficacy of traditional intervention.
Method
This study is a single-blinded randomized controlled trial. A total of 23 chronic stroke patient with cognitive decline were recruited in Saint Mary’s Hospital, Luodong, Taiwan since August, 2015 to June, 2017 and were randomly assigned to either sequential intervention group (SEQ group, combined aerobic exercise and computerized cognitive training, n=11) or control group (CT group, traditional intervention, n=12). Cognitive function, physical activity, activities of daily living and quality of life were assessed before and after 36 times of intervention (2-3 times per week, 60 minutes each time).
Outcome measurement tools included Montreal Cognitive Assessment (MoCA), Wechsler Memory Scale-Third Edition (WMS-III), Stroop color-word test, dual test walking test, time up and go (TUG), 6-minute walking test, isometric contraction of lower limbs, functoin independence measure (FIM), Lawton instrumental activities of daily living scale (Lawton IADL) and stroke impact scale (SIS).
Result
Both groups showed significant improvement in cognitive function after the intervention, however, there were no significant difference between the groups. This indicated that high frequency of intervention could improve cognitive function for chronic stroke patients with cognitive decline. SEQ group has better outcome in dual task walking test and quality of life, but there was no significant difference between the groups.
Conclusion
Both SEQ group and CT group are able to improve the cognitive function of chronic stroke patients with cognitive decline. SEQ group showed better efficacy in cognitive function, lower-limb muscle endurance and quality of life, making it a feasible intervention for chronic stroke patients with cognitive decline. Further clinical studies with larger sample size will be needed to design appropriate combined intervention for stroke patients.
指導教授推薦書………………………………………………………
口試委員審定書………………………………………………………
謝辭……………………………………………………………………-iii-
中文摘要………………………………………………………………-iv-
英文摘要………………………………………………………………-vi-
第一章 研究緣起與研究動機………………………………………..-1-
第一節 研究背景………………………………………………....-1-
第二章 文獻回顧…………………………………………………....…-4-
第一節 中風後的認知受損之大腦機轉………………………....-4-
第二節 有氧運動訓練…………………………………………....-4-
第一項 有氧運動訓練模式之理論基礎………………..-4-
有二項 有氧運動訓練於中風族群認知之研究………..-6-
第三項 有氧運動訓練於中風族群之動作、日常生活與生
活品質………………………………………………..….-7-
第三節 電腦化認知訓練模式………………………………..….-8-
第一項 電腦化認知訓練模式之理論基礎……………-8-
第二項 電腦化認知訓練於中風族群認知之研究……..-9-
第三項 電腦化認知訓練於中風族群之動作、日常生活與生活品質…………………………………………………………………-10-
第四節 連續訓練式…………………………………….…..…..-10-
第一項 連續訓練模式之理論礎…………………..….-10-
第二項 連續訓練模式於健康成人之研究…………...-12-
第三項 連續訓練模式於中風族群之研究…………....-12-
第四項 連續訓練模式之順序性…………………………………-13-
第五節 目前研究限制…………………………………………..-14-
第三章 研究目的及研究假設…………………………………....…...-16-
第一節 研究目的………………………………………………………………..……-16-
第二節 研究假設…………………………………………………………………..…-16-
第四章 研究方法………………………………………………....…...-17-
第一節 取樣與分派方式………………………………………………………….-17-
第二節 受試者條件………………………………………………………………….-17-
第三節 研究設計與架構………………………………………..-18-
第一項 研究設計…………………………………………………….....-18-
第二項 研究流程……………………………………...-18-
第三項 變項定義……………………………………....-18-
第四節 治療介入……………………………………………......-19-
第一項 連續性運動與認知訓練組…………………....-20-
第二項 控制組………………………………………....-22-
第五節 療效評估工具……………………………………….......-22-
第一項 主要結果量測:認知功能…………………....-22-
第二項 次要結果量測:生理功能…………………....-25-
第三項 次要結果量測:日常生活、生活品質……....-26-
第六節 統計分析…………………………………………….......-28-
第五章 研究結果……………………………………………………..-30-
第一節 受試者人口學特徵……………………………………..-30-
第二節 臨床評估結果…………………………………………..-30-
第一項 認知功能……………………………………....-30-
第二項 動作功能……………………………………....-35-
第三項 日常生活與生活品質………………………...-36-
第六章 研究討論…………………………………………………….-38-
第一節 認知功能……………………………………………….-38-
第二節 動作功能……………………………………………….-46-
第三節 日常生活與生活品質………………………………….-48-
第四節 連續療效的趨勢……………………………………….-52-
第五節 研究限制……………………………………………….-53-
第七章 結論………………………………………………………….-54-
參考文獻……………………………………………………………...-55-
圖目錄………………………………………………………………...-86-
表目錄………………………………………………………………...-93-

圖目錄
圖1 分派流程圖……………………………………………………....-86-
圖2 蒙特利爾智能測驗……………………………………………....-87-
圖3 魏氏記憶量表測驗(立即性記憶)…………………………....-87-
圖4 魏氏記憶量表測驗(延宕記憶與工作記憶)………………....-88-
圖5 史楚普顏色字詞測驗 ..........................................……………....-88-
圖6 雙重任務(步行)..............................................................…………....-89-
圖7 雙重任務耗費...............................................................................-89-
圖8 計時起走測驗...............................................................................-90-
圖9 六分鐘行走測驗...........................................................................-90-
圖10 下肢肌肉力量.............................................................................-91-
圖11 功能性獨立量表.........................................................................-91-
圖12 Lawton工具性日常生活量表.....................................................-92-
圖13 腦血管疾病衝擊量表.................................................................-92-

表目錄
表1受試者人口統計學及臨床特徵....................................................-93-
表2蒙特利爾智能測驗........................................................................-93-
表3魏氏記憶量表測驗........................................................................-94-
表4史楚普顏色字詞測驗....................................................................-96-
表5雙重任務(步行)........................................................................-97-
表6雙重任務耗費................................................................................-98-
表7動作................................................................................................-99-
表8日常功能......................................................................................-101-
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