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研究生:陳怡安
研究生(外文):Yi An Chen
論文名稱:中風患者上肢動作治療方案之療效研究:運動學與臨床評估
論文名稱(外文):Effects of Upper Extremity Training Programs on Motor Performance in Patients with Stroke: Kinematic and clinical analyses
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:臨床行為科學研究所
學門:社會及行為科學學門
學類:心理學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
論文頁數:130
中文關鍵詞:侷限誘發療法運動學分析軀幹控制手臂與軀幹協調中風雙側動作訓練
外文關鍵詞:constraint-induced therapykinematics analysistrunk controlarm-trunk coordinationstrokebilateral arm training
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Chapter 1
無摘要

Chapter 2
分散式侷限誘發療法對腦中風患者之軀幹影響

目的:
病人中風後的手臂-軀幹協調能力較差,與正常人表現不同,但先前的侷限誘發療法研究,並未探討手臂和軀幹動作之間的關係是否因治療而產生變化;然而中風病人常見的軀幹代償動作可能會明顯影響進步,甚至限制患側手動作功能的改善,因此本文將嘗試探討慢性中風病人接受分散式侷限誘發療法後,其手臂-軀幹協調的情形與軀幹代償的改善程度。

方法:
將16位發病6個月以上的慢性中風病人隨機分成兩組,其中8位為分散式侷限誘發療法組,每天接受2小時、每週5天的患側手訓練,及6小時的健側手侷限,為期3周;另外8位則為控制組,接受等量的傳統復健。治療前後,以運動學分析評估單/雙手情境的動作表現,並以臨床評估--獨立功能測驗(FIM)及中風-特定生活品質量表(SSQOL)量測其日常生活功能的參與度與生活品質。

結果:
隨機分派後,兩組受試者的特徵皆無顯著差異(p > 0.05)。單手按鈴的運動學結果中,兩組於手肘伸展角度變化(p = 0.030)、軀幹屈曲角度變化(p = 0.045)、手肘伸展-軀幹屈曲角度關聯性(p = 0.020),及前後期和整體軀幹參與的斜率比值上,達統計顯著差異(p < 0.05);於雙手按鈴時,則於手肘伸展角度變化(p = 0.017)、軀幹-手臂動作結束的時間差(p = 0.030),及整體軀幹參與的斜率比值(p = 0.033)達統計顯著差異。另也發現,兩組於「獨立功能測驗」(FIM)的轉位(Transfer)類別(p = 0.046),及「中風-特定生活品質量表」(SSQOL)的家庭角色(Family role)達顯著差異(p = 0.013)。

結論:
經3週的分散式侷限誘發療法治療後,不論是單手或雙手按鈴,病人患側手的手肘關節角度控制都有明顯的改善,推論因而能使得軀幹代償動作明顯減小,也較接近正常人的表現,且病人的手臂-軀幹協調也有明顯進步,證實其功能進步並非依賴代償動作達成;部份日常生活功能參與度與生活品質也都有較好的表現。

Chapter 3
無中文摘要
Chapter 1
No abstract

Chapter 2
Trunk Study of Distributed Constraint-Induced Therapy
in Patients with Chronic Stroke

Objective:
Patients showed impairments of arm trunk coordination after stroke. Previous studies didn’t investigate the interventions’ effects on arm-trunk coordination after constraint-induced therapy (CIT). However, the trunk compensation often used by stroke patients may limit the improvement of the affected arm. Therefore, we tried to discuss the influence on arm trunk coordination and trunk compensation strategy after the intervention of distributed CIT.

Methods:
A total of 16 participants (at least 6 months post-onset) after stroke were randomly assigned to either distributed CIT group (practiced 2 hours every workday for 3 weeks and restrained the unaffected arm 6 hours per day) or control group (received traditional rehabilitation for equivalent intensity and duration). We used kinematics analysis (unilateral and bilateral tasks) to investigate the arm-trunk coordination and two clinical measures (Functional Independent Measure, FIM and Stroke Specific Quality of Life Scale, SSQOL) to assess functional ability and quality of life of the participants. All the outcomes were measured at the beginning and end of the 3-week intervention.

Results:
There were no differences between the groups at baseline (p > 0.05). The results showed that there were statistically different between the groups during the unilateral tasks on elbow extension angular change (p = 0.030), trunk flexion angular change (p = 0.045), elbow extension & trunk flexion correlation (p = 0.020), and early part, terminal part, and total of the trunk contribution slope (p < 0.05). There were also statistically different on elbow extension angular change (p = 0.017), trunk-arm delay (p = 0.030), and the total trunk contribution slope (p = 0.033) during the bilateral tasks. Statistically different on transfer domains of FIM (p = 0.046) and family role domain of SSQOL (p = 0.013) were noted as well.

Conclusion:
After 3-week distributed CIT, the participants reduced trunk compensation and performed normally as a result of gained better elbow joint control during both the unilateral or bilateral tasks. It showed that distributed CIT elicited better arm trunk coordination and improved greater motor control. Participants also had better performances in functional ability and quality of life after distributed CIT.

Chapter 3
Effects of Bilateral Arm Training in Patients
with Chronic Stroke

Objective:
To examine the effectiveness of bilateral arm training (BAT) on chronic stroke patients by measuring the performance of kinematics analysis, motor capacity and functional ability.

Methods:
A total of 33 patients (at least 6 months post-onset) after stroke were randomly assigned to either BAT or placebo-controlled traditional rehabilitation. All patients practiced 2 hours every workday for 3 weeks. The outcome measures were the performance of kinematics analysis (unilateral & bilateral tasks), motor capacity (the Fugl-Meyer Assessment, FMA) and functional ability (Functional Independent Measure, FIM), assessed at the beginning and end of treatment.

Results:
There were no significant differences between the groups at baseline (p > 0.05). We observed better performance in reaching kinematics of the affected arm after BAT as compared with the traditional rehabilitation by less nMT and nTD (p = 0.034; p = 0.039) during both unilateral and bilateral tasks. But a non-significant and small effect was found on PPV during the unilateral task (p = 0.396), rather than bilateral task (p = 0.001). Also, BAT showed a significant greater improvement in FMA than traditional rehabilitation (p = 0.041), but there were no differences in FIM (p > 0.05).

Conclusion:
BAT was associated with higher efficiency in the temporal and spatial aspects during the unilateral and bilateral tasks, also a greater preplanning control strategy during the bilateral tasks. Greater motor improvements were also observed by FMA. These findings provide some insight about the mechanisms that may be responsible for improved motor function of the affected arm after BAT. But we suggested that more studies were needed to examine the effect of BAT on functional ability.
授權書.......................................... iii
致謝............................................ v
目錄............................................ vi
表圖目錄........................................ xi

Chapter 1 侷限誘發療法與雙側動作訓練之概論

第一章 前言...................................... 1-1
第二章 文獻回顧.................................. 1-4
第一節 侷限誘發療法............................. 1-4
壹、歷史發展起源........................... 1-4
貳、治療原則與常見手法...................... 1-6
第二節 改良式侷限誘發療法........................ 1-6
壹、治療原則與常見手法...................... 1-7
貳、適用對象............................... 1-8
參、理論與機制............................. 1-8
肆、療效研究............................... 1-10
伍、追蹤療效研究........................... 1-12
陸、運動學分析............................. 1-13
第三節 雙側動作訓練............................. 1-13
壹、治療原則與常見手法...................... 1-14
貳、適用對象............................... 1-15
參、理論與機制............................. 1-15
肆、療效研究............................... 1-18
伍、追蹤療效研究........................... 1-19
陸、運動學分析............................. 1-19
參考文獻........................................ 1-21

Chapter 2 分散式侷限誘發療法對腦中風患者之軀幹影響

中文摘要........................................ 2-1
英文摘要........................................ 2-3
第一章 緒論..................................... 2-5
第一節 前言................................... 2-5
第二節 研究目的............................... 2-9
第三節 研究假設............................... 2-9
第二章 研究方法................................. 2-11
第一節 受試者................................. 2-11
第二節 研究設計............................... 2-11
第三節 治療介入............................... 2-12
第四節 運動學分析.............................. 2-13
第五節 臨床評估............................... 2-18
第六節 資料分析............................... 2-19
第三章 結果..................................... 2-20
第一節 受試者特徵.............................. 2-20
第二節 運動學分析.............................. 2-20
第三節 臨床評估............................... 2-24
第四章 討論..................................... 2-26
第一節 運動學分析.............................. 2-27
第二節 臨床評估............................... 2-32
第三節 臨床應用............................... 2-34
第四節 研究限制與未來展望....................... 2-34
第五章 結論..................................... 2-36
參考文獻........................................ 2-37


Chapter 3
Effects of Bilateral Arm Training in Patients with Chronic Stroke

Abstract....................................... 3-1
I. Introduction................................ 3-3
1.1 Purpose................................. 3-6
1.2 Hypothesis.............................. 3-7
II. Methods.................................... 3-8
2.1 Participants............................ 3-8
2.2 Design.................................. 3-9
2.3 Intervention............................ 3-9
2.4 Outcome Measures—Kinematics Analysis.... 3-10
2.5 Outcome Measures—Motor impairment....... 3-13
2.6 Outcome Measures—Functional ability..... 3-14
2.7 Data Analysis........................... 3-15
III. Results................................... 3-16
3.1 Characteristics of Participants......... 3-16
3.2 Outcome Measures—Kinematics Analysis.... 3-16
3.3 Outcome Measures—Motor impairment....... 3-17
3.4 Outcome Measures—Functional ability..... 3-18
IV. Discussion................................. 3-19
4.1 Outcome Measures—Kinematics Analysis.... 3-19
4.2 Outcome Measures—Motor impairment....... 3-21
4.3 Outcome Measures—Functional ability..... 3-22
4.4 Limitation and Future Research.......... 3-23
V. Conclusion.................................. 3-25
Reference...................................... 3-26


表目錄

Chapter 2 分散式侷限誘發療法對腦中風患者之軀幹影響

表一 參與者人口學特徵............................ 2-44
表二 單手(患側)按鈴.............................. 2-45
表三 單手(患側)按鈴之統計結果................... 2-46
表四 雙手同時按鈴................................ 2-47
表五 雙手同時按鈴之統計結果....................... 2-48
表六 獨立功能測驗(FIM)......................... 2-49
表七 獨立功能測驗(FIM)之統計結果................ 2-50
表八 中風-特定生活品質量表(SSQOL)............... 2-51
表九 中風-特定生活品質量表(SSQOL)之統計結果...... 2-52

Chapter 3 
Effects of Bilateral Arm Training in Patients with Chronic Stroke

Table 1  Characteristics of Study Participants........3-33
Table 2  Descriptive and Inferential Statistics for Analysis of Reaching Kinematics Analysis.............. 3-34
Table 3  Descriptive and Inferential Statistics for Analysis of Motor Impairments (FMA) and Functional Ability (FIM)................................................. 3-35


圖目錄

Chapter 2 分散式侷限誘發療法對腦中風患者之軀幹影響
圖一 反光球位置................................. 2-53

Chapter 3
Effects of Bilateral Arm Training in Patients with Chronic Stroke
Figure 1  Makers............................... 3-36
中文參考文獻
張雅棻(民95)。修正式侷限誘發療法與雙側動作訓練對慢性中風病患之效應:機制與療效之初探。碩士論文,私立長庚大學臨床行為科學研究所職能治療組,桃園縣。

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