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研究生:董阜玲
研究生(外文):Fu-Ling Tung
論文名稱:坐到站訓練對中風病人平衡能力表現之療效
論文名稱(外文):The Effect of Sit-to-Stand (STS) Training on Balance Performance in Individuals with 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
中文關鍵詞:坐到站訓練平衡中風
外文關鍵詞:Sit-to-Stand trainingBalanceStroke
相關次數:
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研究背景及目的:平衡能力在日常生活功能上扮演著相當重要的角色,它不僅關係著是否能維持一靜止之姿勢,也關係著是否能在支撐底面積改變時執行動態之活動,而中風病患因疾病往往造成平衡能力之下降,故如何以最有效之治療方式來增進中風病患之平衡能力,長久以來皆為一熱門之研究主題。坐到站之活動為日常生活中最常使用到之轉位動作,若要成功地執行坐到站之活動需在不失去平衡的狀態下轉移身體之重心,且需靜態站立之平衡能力以達到完全站立之姿勢,故針對中風病患是否可藉由坐到站活動訓練其站立平衡及日常功能活動之平衡能力構成了本研究之主題。研究方法:32位第一次中風之病人以單盲設計隨機分組至實驗組及對照組。實驗組接受每週三次、為期四週之30分鐘之一般性物理治療及外加15分鐘不同困難度之坐到站訓練,對照組則接受每週三次、為期四週之30分鐘之一般性物理治療。坐到站訓練依膝關節彎曲不同之角度及地面之情形分為六種不同之情況,分別為:膝關節彎曲105度、90度及75度由一般地面站起之三種情況及膝關節彎曲105度、90度及75度由中等硬度之海綿墊站起之三種情況,共六種。治療前後各評估一次,評估內容除一般之基本資料外,主要所評估之項目為靜態站立時雙腳承重百分比、動態站立平衡中之最大位移量及方向性控制之量測及代表功能性平衡活動之伯格氏平衡量表之評估。統計上以雙向變異數分析方式檢定組間之差異,顯著差異水準訂為0.05。結果:共有實驗組16人、對照組16人完成本研究,研究結果顯示:實驗組及對照組除在動態站立平衡中之方向性控制(往前方及健側)因外加坐到站訓練而達到訓練後之改善效果(實驗組往前方及往健側之方向性控制前、後測分別為:47.4±36.6﹪, 62.6±26.1﹪及68.2±12.9﹪, 75.7±9.0﹪;對照組往前方及往健側之方向性控制前、後測分別為:68.7±16.7﹪, 62.8±29.7﹪及77.5±13.5﹪, 74.4±17.7﹪),且達統計上之顯著差異(F前=5.300, p前=0.028;F健=5.822, p健=0.022),其餘應變數皆無明顯差異。就實驗組組內前、後測之變化情形而言,則在所有平衡相關之應變數上皆有進步之情形,但對照組則於組內無一致性進步之情形。討論及結論:不同困難度之坐到站訓練的確對於動態站立平衡中之往前方及往健側之方向性控制有明顯改善,且若同時接受臨床一般物理治療合併不同困難度之坐到站訓練的確對於靜態及動態站立平衡、功能平衡性活動有所增進。以不同困難度之坐到站活動訓練中風病患之平衡能力,不僅兼具變化性及實用性,且此訓練本身更為日常生活中所常執行之功能性活動,因此建議訓練中風病患時可加上坐到站之訓練。
Background and Purpose: Balance is important in optimal function for the locomotor system and performance of many activities of daily living, such as sitting, standing, sit-to-stand and walking. To re-establish balance ability in patients with stroke is a primary concern in rehabilitation programs. Sit-to-stand (STS) is one functional task that people frequently use to change positions from a stable condition to a less stable condition without losing balance. The purpose of this study is to determine the sit-to-stand training in improving balance among the individuals with stroke. Methods: Thirty-two subjects with stroke were randomly assigned to the control and the experimental group (n=16 for each group). Subjects in the experimental group received a 30-min routine physical therapy program with an additional 15-min sit-to-stand training, 3 times a week for a total of 4 weeks. Subjects in the control group received a 30-min routine physical therapy program, 3 times a week for 4 weeks. The routine physical therapy intervention was based on the clinical therapist’s evaluation for each patient. The sit-to-stand training including 6 different conditions described as the following: standing up with knee flexion 105°, 90° and 75° from regular surface and median-dense-foam surface. The weight bearing distribution (WBD) during quiet standing, the directional control (DCL) and maximal excursion (MXE) during limits of stability (LOS) test and the scores of Berg Balance Scale were assessed before and after completing the total 12 treatment sessions. The dependent variables were analyzed using a two-way analysis of variance to examine the difference (p<0.05) between the two groups. Results: Our data (n=16 in each group) showed a significant difference between groups regarding the DCL (toward anterior and sound side) in LOS test. The values of directional control toward anterior and sound side in the experimental group were 47.4±36.6﹪, 62.6±26.1﹪ and 68.2±12.9﹪, 75.7±9.0﹪ in the pre- and post-training test. The values of directional control toward anterior and sound side in the control group were 68.7±16.7﹪, 62.8±29.7﹪ and 77.5±13.5﹪, 74.4±17.7﹪ in the pre- and post-training test(Fant.=5.300, pant.=0.028;Fsound=5.822, psound=0.022). The other dependent variables showed a trend of improvement including the WBD in quiet standing, the MXE (toward anterior, affected side and sound side) and the DCL (to the affected side) in the experimental group. But such trend in the control group was not consistent. Discussion and Conclusions: The sit-to-stand training improved the DCL (toward anterior and sound side) during LOS test in our study. By receiving the sit-to-stand training with the routine physical therapy program, improvements in static, dynamic and Berg Balance scores were noted in subjects with stroke. The sit-to-stand training is encouraged in clinical practice according to our results.
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