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研究生:鄭崴璟
研究生(外文):Wei-Jing Cheng
論文名稱:經顱直流電刺激合併神經肌肉電刺激對於中風病人大腦皮質興奮性的效應:經顱磁刺激初步研究
論文名稱(外文):Effects of Transcranial Direct Electrical Stimulation Combined with Neuromuscular Electrical Stimulation on Cortical Excitability in Patients with Stroke: a Transcranial Magnetic Stimulation Preliminary Study
指導教授:林昭宏林昭宏引用關係
指導教授(外文):Jau-Hong Lin
口試委員:陳怡璇陳嘉炘蕭世芬
口試委員(外文):I-Hsuan ChenChia-Hsin ChenShih-Fen Hsiao
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:物理治療學系碩士班
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:112
中文關鍵詞:中風經顱直流電刺激神經肌肉電刺激經顱磁刺激動作皮質
外文關鍵詞:StrokeTranscranial direct current stimulationNeuromuscular electrical stimulationTranscranial magnetic stimulationMotor cortex
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背景與目的:先前研究證實經顱直流電刺激(transcranial direct current stimulation, tDCS)與神經肌肉電刺激(neuromuscular electrical stimulation, NMES)於中風患者上肢功能恢復的效益,但同時合併兩種刺激對於大腦動作皮質興奮性的影響仍不清楚。本研究探討tDCS合併NMES對於大腦動作皮質興奮性變化的效應。方法:共徵召23位首次發病超過六個月缺血性中風患者,塊狀隨機分派至「tDCS合併NMES」、「tDCS合併假性NMES」或「假性tDCS合併假性NMES」三組。三組個案接受為期3週,每週5次,每天30分鐘,總共15次的介入治療。tDCS採雙極刺激模式,強度為2毫安培(mA),兩個電極置放於雙側大腦主要動作皮質區。兩個NMES主動電極強度設定在10〜20mA,分別置於橈側伸腕肌和伸指總肌的運動點。使用經顱磁刺激評估第一次介入前後及治療15次結束後損傷大腦動作皮質興奮性改變情形。結果:共計有20位受試者完成實驗介入及評估,大腦運動皮質興奮性的變化於第一次介入前後即時效應和15次介入後之治療效應三組受試者之間皆沒有顯著變化差異。結論:初步研究結果尚無法支持tDCS合併NMES介入模式能夠有效增加損傷大腦動作皮質興奮性。未來的研究需要招募更多的受試者並探討最佳介入組合的模式。
Background and purpose:Previous studies have demonstrated the transcranial direct current stimulation (tDCS) and neuromuscular electrical stimulation (NMES) intervention on motor recovery of upper extremity (UE) of stroke patients are evident, but changes of cortical excitability by combination of two neuromodulation instruments are still unknown. The aim of this study was to investigate the effects of tDCS combined with NMES on excitability of motor cortex in patients with stroke. Methods:Twenty three patients with first-ever ischemic stroke for more than six months were recruited and assigned into one of three groups (tDCS combined with NMES, tDCS combined with sham NMES, or sham tDCS combined with sham NMES) by block randomization. All participants received an intervention protocol with a total of 15 sessions for 3 weeks (5 times per week, 30 minutes daily). The tDCS intensity was set at 2mA with dual stimulation mode, the two electrodes were placed on the bilateral primary motor cortex. Two active electrodes of the NMES with intensity of 10 ~ 20mA were placed on the motor points of the extensor carpi radialis muscle and the extensor digitorum muscle. Transcranial magnetic stimulation was used to assess the changes in corticomotor excitability before and after the first and 15 interventions. Results:A total of twenty subjects completed the interventions and assessments. No significant changes in corticomotor excitability among three groups were found after the first and 15 interventions. Conclusion:Our preliminary findings did not support that the tDCS combined with NMES might increase effect in cortical excitability in lesioned hemisphere. Future studies need to recruit more subjects and identify the optimal settings of intervention mode.
第一章 研究背景與目的......1
第一節 腦中風流行病學......1
第二節 腦中風患者上肢動作與功能復健之重要性......2
第三節 腦中風患側上肢的復健訓練......3
第四節 「經顱磁刺激」探討療效......6
第五節 研究目的......7
第二章 文獻回顧......8
第一節 神經肌肉電刺激之療效文獻探討......8
第二節 經顱直流電刺激之療效文獻探討......11
第三節 合併性治療策略之療效文獻探討......14
第四節 經顱磁刺激評估工具之文獻探討......20
第三章 研究方法......22
第一節 實驗設計......22
第二節 實驗對象......23
第三節 實驗流程......24
第四節 介入儀器......26
第五節 療效評估......27
第六節 資料分析......30
第四章 研究結果......40
第一節 受試者基本資料......40
第二節 不同刺激模式於雙側大腦動作皮質區活化興奮改變之立即效應 ......41
第三節 不同刺激模式於雙側大腦動作皮質區活化興奮改變......42
第四節 比較經顱磁刺激和上肢臨床評估量表療效效應的相關性......44
第五章 討論......54
第一節 腦中風患者大腦主要動作皮質區興奮性之立即效應......54
第二節 腦中風患者大腦主要動作皮質區興奮性之療效效應......59
第三節 動作皮質區興奮性與上肢功能量表之間的相關性......62
第四節 臨床應用......64
第五節 研究限制......65
第六節 未來研究方向......66
第六章 結論......67
第七章 參考文獻......68
附件一. 人體試驗委員會審查通過之同意書......77
附件二. 人體試驗受試者同意書......78
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