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研究生:黃佳琦
研究生(外文):Chia-Chi Huang
論文名稱:早期軀幹運動訓練促進中風患者之恢復
論文名稱(外文):Early trunk exercises enhance recovery of stroke
指導教授:王瑞瑤
指導教授(外文):Ray-Yau Wang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療研究所
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:2004
畢業學年度:92
語文別:中文
論文頁數:90
中文關鍵詞:早期軀幹運動軀幹控制姿勢控制中風
外文關鍵詞:Early trunk exercisetrunk controlposture controlstroke
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背景:姿勢控制能力對於中風病患的日常生活及步態相當重要。在復健治療初期,回復軀幹控制是重獲姿勢控制的優先步驟。良好的軀幹控制能使中風患者有能力在日常活動或行走當中,穩定中軸或將身體移至空間中的不同位置。過去研究已證實,在不同時期的中風受試者皆有軀幹肌力及控制不足的現象;而中風初期的軀幹控制能力,亦能預測患者日常生活功能及行走能力。針對中風患者,臨床治療多會進行強調軀幹控制的訓練,但其療效卻仍未被建立。研究目的:設計隨機、控制之臨床試驗,以瞭解軀幹控制運動對於中風受試者在軀幹控制、姿勢控制、上下肢動作恢復及日常生活能力獨立之療效。方法:由大台北地區醫院選取20位中風受試者,經過隨機分組將受試者分入實驗組及對照組。實驗組(n = 10)除接受常規物理治療外,另外接受20分鐘軀幹運動訓練,每週3次進行2週。對照組(n = 10)接受常規物理治療30分鐘及外加被動上肢運動20分鐘,每週3次,進行2週。分別在前測(訓練前)、後測(訓練後)及追蹤測試(訓練後四週)進行評估,評估項目包括(1)利用軀幹控制量表評估軀幹表現;(2)使用肌肉力量測量儀測試各方向軀幹肌力,包括屈肌、伸肌及健側與患側外屈肌;(3)利用姿勢控制量表評估姿勢控制能力;(4)福格-摩爾量表評估上下肢動作功能,及利用被動活動測試上下肢肌肉張力(5)使用功能獨立量表代表受試者日常生活獨立能力。使用二因子變異數重複性測試分析比較兩組的軀幹肌力、姿勢控制量表及功能獨立量表分數,在不同評估時間之差異及組別與時間之交互作用;軀幹測試量表及福格-摩爾量表分數則以無母數統計方法分析。顯著水準訂在0.05。結果與討論:在姿勢控制能力及上下肢動作功能方面,實驗組進展明顯優於對照組。實驗組在後測時之姿勢控制分數為22.70 ± 8.30分,而對照組僅有13.60 ± 6.33分,兩組不論在時間或時間與組別交互作用都有顯著差異。實驗組前後測間,上肢動作分數由5分進步至12.5分,後測時與對照組差異接近顯著水準(p=0.06);追蹤測試時,兩組得分各為42及7.5分,有明顯統計上差異(p<0.05)。下肢部分兩組在後測及追蹤時得分,實驗組為20及24分,控制組為8.5及15分,皆有統計上差異。兩組軀幹肌力隨者時間皆有進步(p<0.001),但並無組間差異。兩組在軀幹控制量表亦沒有顯著差異。但實驗組在治療介入期間,其進展趨勢較對照組快。在本研究證實軀幹訓練運動有助於中風受試者在姿勢控制及肢體的恢復。然而這樣的能力未能轉移至日常生活功能的表現,可能是因為中風患者日常生活獨立能力受到許多因子影響,而非單一因子所能解釋。
Background: Posture control is important for activities of daily living and gait, and trunk control is essential for both static and dynamic posture control. Weakness of trunk muscle strength and decreased trunk control in stroke patients at acute stage has been documented. Regain trunk control is the very first step of recovery of posture control at acute stage. Further, the ability of trunk control can predict the functional outcomes in patients with stroke. Although trunk control is emphasized at the early stage of stroke rehabilitation, its effectiveness has not been established. Subjects: Twenty acute stroke patients who suffered from supratetorial infarction or hemorrhage within 4 weeks onset duration were randomly assigned into the experimental group or the control group (n = 10 at each group). Procedures: Subjects in the experimental group received routine physical therapy treatment for 30 min and additional 20 min trunk exercises progressing with patient’s position, hand support and level of assistance. Subjects in the control group received routine physical therapy for 30 min and passive range of motion of arm for another 20 min. The treatment session was carried out 3 times a week for 2 weeks. Main outcome measures: Subjects in each group were assessed at pre-, post-intervention, and 4-weeks follow up. The assessments included (1) trunk control by trunk control test(TCT); (2) trunk muscles strength, including trunk flexors, extensors and side flexors by a hand-held dynamometer; (3) posture control by posture assessment score for stroke patients (PASS);(4) motor function of upper and lower extremity by Fugl-Meyer motor assessment scale(FMA); and (5) ability of ADL by functional independent measure (FIM). Statistical analysis: A two-way ANOVA with repeated measures was used to compare trunk strength, PASS and FIM between two groups across time. The Mann-Witney U test was used to compare TCT and FMA of the two groups. The a lever was set at 0.05. Results and discussion: Improvements in posture control and upper/lower extremity motor function were significantly better in experimental groups. The means of PASS scores in experimental group improved from 10.20 ± 4.69 to 22.70 ± 8.30 and 27.77 ± 6.65 in different assessment time. In control group, PASS scores were 9.10 ± 5.04, 13.6 ± 6.33 and 20.70 ± 6.90. Significant time effect and time × group effect were found (p<0.05). Trunk muscles strength improved in all subjects across time (p < 0.001) but no significant difference was found between group comparisons. There was no significant difference in between-group comparison regarding the trunk control test. However, subjects in experimental group seemed to improve better in trunk strength and trunk control. There was no difference between groups in FIM. According to our results, early trunk exercise was effective on improvement of posture control ability and extremity motor function in subjects with stroke.
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