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研究生:江忠豪
研究生(外文):Chung-Hao Chiang
論文名稱:比較胸椎矯正術、鬆動術及胸椎運動對成年健康受試者心率變異度的立即效果
論文名稱(外文):Comparison of the Immediate Effects between Thoracic Manipulation, Thoracic Mobilization and Cat Camel Exercise to the Thoracic Spine by Heart Rate Variability in Healthy Adults.
指導教授:王子娟王子娟引用關係
指導教授(外文):Tzyy-Jiuan Wang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療暨輔助科技學系
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
語文別:中文
論文頁數:94
中文關鍵詞:矯正術鬆動術胸椎運動心率變異度自主神經
外文關鍵詞:manipulationmobilizationcat and camel exerciseheart rate variabilityautonomic nerve system
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研究背景:研究顯示不同的無害身體刺激(innocuous somatic stimulation),包括各項徒手治療手法,具有調整心跳、血壓與部分血流狀況的功能;近年來也有研究顯示徒手治療可影響交感神經功能。由於自主神經系統位置與胸椎相近,故胸椎活動功能受限失調時可能影響交感神經,但過去研究多著重探討針對頸椎之徒手治療(如頸椎矯正術、頸椎鬆動術)以及胸椎矯正術(manipulation)對交感神經的影響,並無研究著墨於胸椎鬆動術(thoracic mobilization)及胸椎運動(cat camel exercise)對交感神經的影響,而且比較此兩項治療與胸椎矯正術(thoracic manipulation)之間的療效研究也付之闕如。
研究目的:本研究目的在於比較胸椎矯正術、胸椎鬆動術以及胸椎運動施用在成年健康受試者,其心率變異度(heart rate variability)指數以及胸椎活動度的變化;其次,本研究也欲探討胸椎活動度與心率變異度指數之間的關係。
方法:本研究招募了35位健康受試者,每位受試者都接受了三種手法介入(胸椎矯正術、胸椎鬆動術、胸椎運動)。介入的先後順序是以抽籤的方式決定。所有受試者在實驗時都接受介入前(基準點)、靜躺十分鐘後(前測)及介入後(後測)的資料收集,包含受試者靜止姿勢的胸椎後凸角度,心率變異度指數的高頻 (high frequency)功率、低頻 (low frequency)功率、高頻功率比(HF%)、低頻功率比(LF%)、低高頻功率比(LF/HF)和胸椎活動度(胸椎屈曲、伸直及側彎)等數據。
實驗設計:單受試者接受不同治療介入(single subject design with alternative intervention)的交叉實驗設計(cross-over design)
統計:以SPSS第16.0版做各項統計分析。基準點與前測資料的差異設定為參考值(reference value);前測與後測之差異設定為改變量(change after treatment)。各項治療效果以雙因子重複測量變異數分析(two-way repeated measures ANOVA)事前對比(planned contrasts)檢驗法來分析比較三種治療手法在組內及組間,其心率變異度指數以及胸椎活動度的差異。體型分組及身體質量指數分組與治療介入的關係是以單因子變異數分析(one-way ANOVA)做分析。而身體質量指數以及胸椎後凸與胸椎活動度改變量和心率變異度改變量的關係,以及胸椎活動度改變量與心率變異度改變量的關係則以皮爾森相關係數(Pearson’s correlation coefficients)作分析,顯著效果皆定義於��<0.05。
結果:在胸椎活動度的部分,胸椎矯正術與胸椎運動對胸椎屈曲度的增加皆有顯著效果,胸椎運動對胸椎伸直度的增加達到顯著效果(p<0.05)。在胸椎側彎的改變,則三種手法均未達到顯著效果。在心率變異度指數方面,胸椎矯正術對低頻功率比有顯著效果,胸椎鬆動術對低頻功率、低頻功率比以及低高頻功率比有顯著上升,高頻功率比顯著下降,胸椎運動則對心率變異度指數沒有顯著影響。此外,胸椎改變量與心率變異度改變量間沒有顯著相關,體型、身體質量指數和胸椎後凸與介入後改變亦無顯著相關。
討論與結論:本研究發現胸椎矯正術與胸椎運動確實都可增進胸椎的活動度,這與過去學者提出藉由力學機制改善胸椎活動度的理論相符。胸椎矯正術與胸椎鬆動術可以增進交感神經功能的活性,亦即我們可藉由胸椎矯正術與胸椎鬆動術的神經生理機制來影響交感神經;而胸椎運動則可藉由鬆動胸椎而影響交感神經功能的理論並未在本實驗結果中被證實。此外,胸椎活動度改變量與心率變異度改變量沒有顯著相關。
臨床意義:在臨床上,胸椎運動可有效達到增加胸椎活動度的效果,且較胸椎鬆動術及胸椎矯正術效果更好;但與胸椎運動以及胸椎矯正術比較,胸椎鬆動術較能影響交感神經活性。未來若有更進一步以病患為族群的研究,自主神經功能的臨床應用意義才能更加被確立。
Background: Various forms of innocuous somatic stimulation have been shown to modulate aspects of cardiovascular function including heart rate (HR), blood pressure, and regional blood flow. Previous studies have investigated the effects of the cervical manipulation, mobilization, and thoracic spine manipulation on autonomic nervous system. No study was found to compare the effect among thoracic manipulation, thoracic mobilization and cat camel exercise to the thoracic spine on heart rate variability (HRV) and thoracic spine mobility.
Purposes: 1) To compare the immediate effect on HRV and thoracic mobility among thoracic manipulation, thoracic mobilization and cat camel exercise to the thoracic spine. 2) To determine the relationships among the change of the thoracic mobility and the HRV indices.
Study design: A sigle subject crossover design with alternative intervention.
Methods: We recruited 35 healthy adults to participate in this study. Each subject received three types of intervention (thoracic manipulation, thoracic mobilization, and cat camel exercise) on three different days. The order of intervention was decided by drawing. The experimental process included measurements of baseline data, pre-intervention data and post-intervention data which consisted of heart rate, heart rate variability indices such as low frequency (LF), high frequency (HF), LF%, HF%, LF/HF. Thoracic mobility was also measured.
Statistical analysis: All analyses were conducted by using the SPSS statistical package, version 16.0. Two-way repeated measures ANOVA with planned contrasts were used for the pairwise comparisons. Pearson correlation coefficients were used to examine the relationships among (1) thoracic mobility and HRV indices and (2) body mass index (BMI), thoracic kyphosis and the intervention effects on the thoracic mobility and HRV. One-way ANOVA was used to examine the differences among different body type groups, and BMI groups. The level of significance for each test was set at ��<0.05.
Results: In thoracic spine mobility, the cat camel exercise and thoracic manipulation significantly increased the range of thoracic flexion. Cat camel exercise also significantly increased the range of thoracic extension. None of the three interventions demonstrated significant effects on increasing the range of thoracic sideflexion. With regards to the HRV indices, thoracic mobilization significantly decreased the HF% and increased the LF, LF% and LF/HF. Thoracic manipulation significantly increased the LF%. Cat camel exercise did not cause any significant effects on the HRV indices. No significant correlations were found between the changes of the thoracic mobility and the HRV indices. Relationships among body type, BMI, intervention effects on thoracic kyphosis, thoracic mobility and HRV indices were also not significant.
Discussion: Cat camel exercise and thoracic manipulation demonstrated immediate effects on increasing thoracic mobility. Manual therapy including thoracic mobilization and manipulation but not the thoracic mobility exercise could significantly influence the autonomic system immediately by stimulating the sympathetic nerve system. Changes of the HRV indices cannot be explained by the increase of thoracic mobility.
Conclusion: Three physical therapy maneuvers could produce significant effects on the sympathetic nerve system and/or thoracic mobility in healthy subjects. However, results of this study cannot be generalized to the patient population. Future studies will be needed to investigate the effects of these maneuvers on HRV and thoracic mobility in patient group.
目錄………………………………………………………………………..………….iii
表目錄………………………………………………………………………………..vii
圖目錄………………………………………………………………………………...ix
中文摘要………………………………………………………………………………x
英文摘要…………………………………………………………………………….xiii
第一章 緒論…………………………………………………………………………..1
第一節 研究背景與動機……………………………………………………….1
第二節 研究目的……………………………………………………………….2
第三節 研究重要性…………………………………………………………….3
第二章 文獻回顧……………………………………………………………………..4
第一節 交感神經的各項功能與解剖構造…………………………………….4
第二節 交感神經與胸椎之間的關係與影響機制…………………………….4
第三節 交感神經與心率變異度之間的關係………………………………….6
第四節 矯正術的治療效果與機轉…………………………………………….7
一、 機械性假說…………………………………………………………8
二、 神經生理學假說……………………………………………………..9
三、 循環假說……………………………………………………………12
第五節 鬆動術的治療效果與機轉……………………………………..…….12
第六節 胸椎運動的治療效果與機轉………………………………….……..13
一、牽拉運動……………………………………………………...……..14
二、脊椎自我鬆動運動………………………………………………….14
三、脊椎肌肉動作控制訓練運動……………………………………….15
第七節 物理治療手法對交感神經系統的影響……………………………...15
第八節 實證醫學相關研究…………………………………………………...16
第三章 研究方法……………………………………………………………………18
第一節 研究設計與研究架構………………………………………………...18
第二節 研究流程……………………………………………………………...18
第三節 研究對象……………………………………………………………...19
一、選取條件……………………………………………………………19
二、排案條件…………………………...……………………………….19
三、分組流程……………………………………………………………20
第四節 治療介入……………………………………………………………...20
一、 胸椎矯正術執行步驟………………………………………………21
二、胸椎鬆動術執行步驟……………………………………………….21
三、胸椎運動執行步驟………………………………………………….21
第五節 評估項目與步驟……………………………………………………...22
一、心率變異度測量之執行步驟………………………………………22
二、胸椎活動度測量之執行步驟………………………………………23
第六節 資料處理與分析方法………………………………………………...24
第四章 研究結果……………………………………………………………………26
第一節 研究對象……………………………………………………………...26
第二節 測量工具施測者內信度檢驗結果…………………………………...26
第三節 三項治療介入對胸椎活動度的效果………………………………...27
一、胸椎屈曲角度的量測結果………………………………………….27
二、胸椎伸直角度的量測結果………………………………………….28
三、胸椎側彎的量測結果……………………………………………….28
第四節 三項治療介入對心率變異度的效果………………………………...29
一、低頻功率的量測結果……………………………………………….30
二、高頻功率的量測結果……………………………………………….30
三、低頻功率比的量測結果……………………………………………31
四、高頻功率比的量測結果……………………………………………32
五、低高頻功率比的量測結果…………………………………………33
第五節 體型、身體質量指數、胸椎後凸對治療介入的影響………………34
第六節 胸椎活動度與心率變異度改變量的關係…………………………...34
第五章 討論…………………………………………………………………………35
第一節 胸椎活動度…………………………………………………………...35
第二節 心率變異度…………………………………………………………...36
第三節 體型、身體質量指數、胸椎後凸對於治療介入的影響……………39
第四節 胸椎活動度與心率變異度間的影響………………………………...40
第五節 臨床意義……………………………………………………………...41
第六節 研究限制……………………………………………………………...42
第七節 未來研究………………………………………………………..…….44
第六章 結論…………………………………………………………………………46


參考文獻……………………………………………………………………………..47
附錄一 國立陽明大學人體試驗暨倫理委員會同意臨床試驗證明書……………89
附錄二 受試者同意書………………………………………………………………91
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