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研究生:高宜暄
研究生(外文):Yi-Hsuan Kao
論文名稱:動作控制運動介入對於慢性頸痛患者的本體感覺、頸部肌肉活動及姿勢控制的改善
論文名稱(外文):Changes in Proprioception, Muscle Activation and Postural Control after Motor Control Exercise Training in Subjects with Chronic Neck Pain
指導教授:施怡芬施怡芬引用關係
指導教授(外文):Yi-Fen Shih
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:英文
論文頁數:209
中文關鍵詞:動作控制運動本體感覺肌肉活動姿勢控制慢性頸痛
外文關鍵詞:motor contorl exerciseproprioceptionmuscle activationpostural controlneck pain
相關次數:
  • 被引用被引用:3
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  • 下載下載:137
  • 收藏至我的研究室書目清單書目收藏:0
前言: 頸部疼痛是常見的骨骼肌肉痠痛,發生率相當地高,甚至造成頸痛患者及醫療機構的龐大經濟負擔。造成頸痛的原因有非常多種,包含了外傷、柔軟度較差、頸部肌力不足、神經肌肉控制較差等原因。近年來頸痛患者的神經肌肉控制能力被廣為探討,並且發現頸痛患者的頭頸部本體感覺、頸部肌肉控制和姿勢控制能力較差。運動訓練已被證實可以有效改善頸痛患者在本體感覺、頸部肌肉及姿勢控制的能力,但是這些運動訓練的療效可否反應在頸痛患者日常生活中的功能性活動仍是未知的。
方法: 本實驗總共收取三十位頸痛患者,並將患者隨機分成兩組,分別為動作控制運動組(15位)和常規醫院治療組(15位)。常規醫院治療組接受醫院對頸痛患者的一般治療,動作控制運動組則除了醫院常規治療外還加上了動作控制運動的訓練。治療介入期間為四至六星期,治療次數為十二次。介入前後患者會接受多項量測,項目包含頸部關節活動度、頸部肌肉力量、頭及肩胛骨的動作分析、兩側胸鎖乳突肌及上斜方肌的肌電圖測量、頭頸部本體感覺及疼痛和功能量表評估。
統計分析: 獨立t檢定 (Independent t test) 及卡方檢定 (chi-square test) 用來比較兩組在介入前的測量資料。 重複測量變異數分析(Repeated measures ANCOVA)用來比較兩組在介入前後在各個量測項目的差異,並用事後t檢定 (post hoc t test) 去做後續分析。若是統計值小於0.05,則定為統計上有顯著差異。
結果:治療介入後,和常規醫院治療組相比,動作控制運動介入可增加較多的頸部右轉活動角度(p=0.03)。在三十分鐘的電腦活動中,動作控制組有較多的頭前彎動作 (p=0.02-0.05) 和左側肩胛骨下轉 (p=0.01)。此外,動作控制治療能較有效的降低頸部疼痛 (p=0.04)。
結論: 本篇研究發現動作控制組與常規醫院治療組比較能更有效的降低疼痛、增進關節活動角度及增進姿勢控制。因此,建議以動作控制運動介入搭配其他止痛的治療作為治療頸痛患者的方針。
Introduction: Neck pain is a common musculoskeletal disorder which causes economic burden of medical service and patients. Recently, the importance of neuromuscular control in subjects with neck pain has been highlighted. Previous studies showed different characteristics of the proprioception, muscle activation and posture control in subjects with and without chronic neck pain; and exercise could successively improve the proprioception and cranio-cervical posture control and reduce superficial muscle activities in patients with chronic neck pain. The effect of exercise training on these neuromuscular control characteristics during functional activities were nevertheless unknown. Therefore, we designed this study to investigate the effect of the motor control exercise on head and scapular posture control, muscle performance and cervical proprioception during bilateral arm elevation and a 30-minute computer task in individuals with chronic neck pain.
Methods: Thirty subjects with chronic neck pain were randomly assigned to the motor control group (n=15) or to the regular hospital care group (n=15). Regular hospital care group received routine hospital management for chronic neck pain, and motor control group received motor control exercise in addition to the routine hospital care. The intervention period lasted 4-6 weeks. Outcome measures consisted of cervical ROM and muscle strength, head and scapular kinematics, EMG activity of the upper trapezius and scernocleidomastoid muscles, cervical proprioception, and pain and dysfunction of the neck.
Statistical Analysis: Independent t test and chi-square test were used to compare differences of basic data between two groups. Repeated measures ANCOVA was used to examine the exercise effect between two groups. Post hoc t tests were used for subsequent analyses. The significant level was set at 0.05.
Results: After exercise training, the motor control group had greater improvement in right rotation range of motion (ROM) (p=0.03) than the regular hospital care group. During the 30 minutes of computer task, subjects receiving motor control training showed increased head flexion (p=0.02-0.05) and left scapular downward rotation (p=0.01). Besides, subjects in the motor control group experienced more pain reduction compared to subjects of the regular hospital care group (p=0.04).
Conclusions: Compared to the routine hospital management, motor control exercise training could effectively reduce neck pain, improve ROM as well as posture control during functional activities. This type of exercise should be used in conjunction with other pain management methods when treating patients with chronic neck pain problems.
Table of Contents i
Acknowledgements iv
List of Tables v
List of Figures ix
摘要 xiv
Abstract xvi
Chapter 1 Introduction 1
Chapter 2 Literature review 3
Chronic neck pain 3
Risk factors of neck pain 3
Motor control characteristics in subjects with chronic neck pain 4
Postural control in subjects with chronic neck pain 5
Proprioception in subjects with neck pain 6
Muscle activation in subjects with neck pain 7
Effect of exercise training in subjects with chronic neck pain 9
Summary 11
Purpose 11
Study hypothesis 11
Chapter 3 Methods 13
Study design 13
Subjects 13
Instrumentation 14
Outcome measures 15
Testing procedure 18
Intervention program 22
Study flow 24
Data management and statistical analysis 24
Chapter 4 Results 28
Basic data 28
Pilot analysis: reliability of the outcome measures 28
Pilot analysis: effect of neck pain location and arm dominance on kinematics and EMG activities 30
Baseline data 30
Comparisons of the exercise effect between the motor control exercise group and the regular hospital care group 32
Cervical range of motion 33
Muscle strength 33
Proprioception 33
Bilateral arm elevation task 34
Computer task 34
Pain and disability measurement 36
Chapter 5 Discussion 37
Cervical range of motion 37
Proprioception 39
Postural control and muscle performance during bilateral arm elevation task 40
Postural control and muscle performance during the computer task 42
Pain and function assessment 45
Limitations 47
Conclusions 47
References 49
Tables 62
Figures 127
Appendices 174
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