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研究生:黃婉婷
研究生(外文):Wan Ting Huang
論文名稱:探討腳踏車訓練對脊髓小腦共濟失調症患者交互抑制的影響
論文名稱(外文):The Effect of Cycling Training on the Reciprocal inhibition in individuals with Spinocerebellar Ataxia
指導教授:張雅如張雅如引用關係
指導教授(外文):Y. J. Chang
學位類別:碩士
校院名稱:長庚大學
系所名稱:復健科學研究所
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:2009
畢業學年度:97
論文頁數:144
中文關鍵詞:交互抑制交替收縮脊髓小腦共濟失調症腳踏車運動
外文關鍵詞:reciprocal inhibitionalternated contractionSpinocerebellar ataxiabicycle training
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漸進性運動失調為脊髓小腦共濟失調症常見的症狀,運動失調可能與交互抑制的調節不良有關,而交互抑制主要在調控主動肌與拮抗肌間的平衡。臨床上對於小腦疾病有運動失調的患者常使用交替式收縮的訓練,之前研究顯示交替收縮的方式可以調節健康人交互抑制的強度,但對運動失調的患者是否有相同的交互抑制與調節,且是否長期訓練後可使調節趨向正常化仍不清楚。本研究的目的在探討脊髓小腦共濟失調症的患者在休息狀態下交互抑制的表現,短期活動調節量與健康成年人的異同,另一目的為探討脊髓小腦共濟失調症的患者在經由腳踏車訓練後對交互抑制強度與調節的影響。本實驗徵召二十位脊髓小腦共濟失調症的患者及二十位年齡相符的健康受試者,給予電刺激於總腓神經與脛神經,產生比目魚肌交互的抑制反射,並在十五分鐘腳踏車活動後做相同測試。將患者隨機分派成訓練組與非訓練組,訓練組接受的居家腳踏車訓練,四週之後測量交互抑制的強度,十五分鐘腳踏車活動的調節與下肢運動協調性。結果發現在脊髓小腦共濟失調症的患者,在休息狀態下交互抑制量小於健康人,十五分鐘腳踏車活動後健康人交互抑制強度增加但患者減小。四週後訓練組交互抑制強度有減少的趨勢,十五分鐘腳踏車活動後訓練組交互抑制強度增加,國際的運動失調評分表分數尤其平衡相關子項目分數在訓練後有顯著進步。我們認為四週的腳踏車訓練可以使交互抑制的調節趨向正常化,並增進患者平衡能力。
Background and Purpose: Progressive ataxia is a common symptom in individuals with Spinocerebellar ataxia. Ataxia might be related to the mal-modulation of the reciprocal inhibition which can modulate the balance of agonist and antagonist muscles.The alternated contraction training is commonly used for ataxia rehabilitation. Previous study showed that alternated contractions increased the strength of reciprocal inhibition in the individual without physical
disability. It is not clear if the reciprocal inhibition in individual with ataxia can be modulated with alternated contraction using bicycle training. The first purpose of
this study was to investigate the difference of reciprocal inhibition between individuals with spinocerebellar ataxia and healthy subjects. The second purpose was to investigate the effect of cycling training on the reciprocal inhibition in individuals with spinocerebellar ataxia. Methods: Twenty individuals withspinocerebellar ataxia and 20 age-matched healthy subjects were recruited. A conditioning stimulation was at the common peroneal nerve to induce the reciprocal inhibition of the soleus H reflex .The reciprocal inhibition was tested again after 15 minute cycling exercise. The subjects with SCA were randomly assigned to training and non-training groups. Subjects in the training group received four weeks of home cycling training program. The reciprocal inhibition and International cooperative ataxia rating scale(ICARS) were evaluated after four weeks. Results:The amount of reciprocal inhibition in SCA was less than healthy subjects .The inhibition strength increased after 15 minutes bicycle training in healthy subjects, but decreased in individuals with SCA. After four weeks of
training, the inhibition strength decreased in training group at rest . And the strength of reciprocal inhibition increased after 15 minutes of bicycle exercise only in training group. The grade of ICARS in training group was improved significantly and especially improved in the subscale for balance test. Conclusion: Four weeks of bicycle training can normalize the modulation of reciprocal
inhibition and improve the balance for individuals with SCA.
指導教授同意書
口試委員審定書
長庚大學授權書 iii
致謝 iv
中文摘要 v
英文摘要 vii
目錄 viii
表目錄 xii
圖目錄 xiii
第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 8
第三節 研究假設 9
第四節 名詞解釋與操作型定義 10
第二章 文獻回顧 11
第一節 脊髓小腦共濟失調症分類、病因、症狀 11
第二節 小腦的神經路徑及功能 13
第一項 小腦的解剖區位 13
第二項 小腦的輸出路徑 14
第三項 小腦的輸入路徑與功能 15
第三節 交互抑制 18
第一項 交互抑制在脊髓階層的作用 18
第二項 交互抑制在脊髓上階層的作用 21
第四節 主動肌與拮抗肌自主收縮對交互抑制的影響 23
第五節 小腦損傷患者神經電生理上的表現 26
第六節 小腦功能受損患者的臨床訓練 29
第七節 腳踏車訓練 30
第一項 腳踏車訓練的臨床應用 30
第二項 下肢交替式訓練對H反射的影響 33
第八節小腦功能損傷患者的臨床評估 35
第三章 研究方法 38
第一節 研究設計 38
第二節 研究對象 38
第三節 實驗儀器 38
第四節 實驗步驟 40
第五節 資料處理與分析 41
第六節 統計方法 42
第四章 實驗結果 51
第一節 脊髓小腦共濟失調症患者在休息狀態下測得的交互抑制量與健康受試者的比較 51
第二節 脊髓小腦共濟失調症患者在經由十五分鐘腳踏車訓練後交互抑制強度的調節量與健康受試者的比較 52
第三節 脊髓小腦共濟失調症患者的訓練組在經由四週腳踏車訓練後,休息時交互抑制量與非訓練組的比較 53
第四節 四週後,訓練組和非訓練組於十五分鐘腳踏車活動後交互抑制的調節量上之比較 54
第五節 脊髓小腦共濟失調症患者在經由四週腳踏車訓練前後,對於功能性表現的影響 55
第六節 四週訓練前後功能性測試與交互抑制強度改變的相關性 56
第七節 脊髓小腦共濟失調症患者在經由四週腳踏車訓練前後,對於自覺用力指數表現的影響 57
第八節 結果總結 57
第五章 討論 79
第一節 結果與假設的支持與反對 79
第二節 本研究健康受試者交互抑制現象和過去文獻比較 79
第三節 本研究脊髓小腦共濟失調症患者交互抑制現象 81
第四節 腳踏車活動對於健康受試者交互抑制調節的可能機制 83
第五節 腳踏車活動對於脊髓小腦共濟失調症患者交互抑制調節異於健康受試者調控的可能機制 86
第六節 脊髓小腦共濟失調症患者訓練組四週訓練後造成交互抑制強度改變 88
第七節 脊髓小腦共濟失調症患者訓練四週後功能表現進步 89
第八節 結論 91
第九節 臨床意義與應用 92
第十節 未來研究方向 93
參考文獻 94
附錄 98
表目錄
表3-1受試者基本資料表 44
表4- 1在休息狀態下,年齡相符的健康受試者和脊髓小腦共濟失調症患者在不同時間間隔下的交互抑制量 59
表4-2 經過十五分鐘腳踏車活動後,年齡相符的健康受試者與脊髓小腦共濟失調症患者在不同時間間隔下,訓練前與訓練後的交互抑量 60
表4-3經過腳踏車訓練,脊髓小腦共濟失調症患者訓練組與非訓練組在不同時間間隔下,訓練前與訓練後交互抑制量 61
表4-4訓練前後,脊髓小腦共濟失調症患者訓練組與非訓練組,十五分鐘腳踏車活動後在不同時間間隔下交互抑制調節量大小 62
表4-5四週訓練前後功能性測試ICARS與交互抑制強度改變的相關性 63
圖目錄
圖2- 1健康成年人Ia交互抑制表現圖 45
圖2- 2健康成年人D1抑制表現圖 46
圖3- 1 周邊神經電刺激器圖 47
圖3- 2 自製力矩量測系統圖 47
圖3- 3 生物肌電測量儀圖 48
圖3- 4 生理訊號放大器圖 48
圖3- 5控制組H反射峰對峰振幅分析圖 49
圖3- 6條件電刺激與測試電刺激H反射的峰對峰振幅分析圖 49
圖3- 7 實驗流程圖 49
圖4-1 20位脊髓小腦共濟失調症患者與20位健康受試者,休息狀態下交互抑制量大小的比較圖 64
圖4-2 20位健康受試者與20位脊髓小腦共濟失調症患者,十五分鐘腳踏車活動前後交互抑制的調節量 65
圖4-3-1 10位脊髓小腦共濟失調症患者訓練組與10位非訓練組,四週訓練前後在兩刺激時間間隔2毫秒時的交互抑制量 66
圖4-3-2 10位脊髓小腦共濟失調症患者訓練組與10位非訓練組,四週訓練前後在兩刺激時間間隔3毫秒時的交互抑制量 67
圖4-3-3 10位脊髓小腦共濟失調症患者訓練組與10位非訓練組,四週訓練前後在兩刺激時間間隔20毫秒時的交互抑制量 68
圖4-4-1 10位脊髓小腦共濟失調症患者訓練組與10位非訓練組,四週訓練前後,在兩刺激時間間隔2毫秒時,十五分鐘腳踏車活動後的調節量 69
圖4-4-2 10位脊髓小腦共濟失調症患者訓練組與10位非訓練組,四週訓練前後,在兩刺激時間間隔3毫秒時,十五分鐘腳踏車活動後的調節量 70
圖4-4-3 10位脊髓小腦共濟失調症患者訓練組與10位非訓練組,四週訓練前後,在兩刺激時間間隔20毫秒時,十五分鐘腳踏車活動後的調節量 71
圖4-5 10位脊髓小腦共濟失調症患者訓練組與10位非訓練組,四週腳踏車訓練前後,ICARS分數的平均數±標準差 72
圖4-6 四週前後交互抑制變化量與ICARS各細項相關圖 73
圖4-7脊髓小腦共濟失調症患者訓練組四週腳踏車訓練前後,自覺用力指數的分數改變差異 76
圖4-8 受試者接受腳踏車活動前後,所測得交互抑制(條件與測試電刺激時間間隔3毫秒)的H反射原始圖 77
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