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研究生:戚居暘
研究生(外文):Ju-Yang Chi
論文名稱:應用重複經顱磁刺激改善中風亞急性期患者之下肢功能
論文名稱(外文):Enhancing Motor Recovery by applying Repetitive Transcranial Magnetic Stimulation to Subacute Stroke Patients
指導教授:沈淵瑤沈淵瑤引用關係
指導教授(外文):Ein-Yiao Shen
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:針灸研究所碩士班
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:58
中文關鍵詞:重覆性穿顱磁刺激動作平衡療效下肢中風
外文關鍵詞:repetitive transcranial magnetic stimulationmotor evoked potentiallower extremitystroke
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研究背景:重複經顱磁刺激係藉由多次地磁場刺激造成加乘的效果,用來調節大腦皮質的活性,增進中風後的適應性神經塑型。以重複經顱磁刺激初級運動皮質區域,並透過調整刺激頻率調控其部位的興奮性,在過去已有許多研究針對中風患者的偏癱側,進行重複經顱磁刺激並配合動作訓練,發現其恢復比起單純動作訓練能達到更好的效果。
研究目的:本研究主要探討低頻重複經顱磁刺激配合常規復健,對於亞急性期中風患者下肢功能改善。
研究方法:本研究共有28位中風患者參與,經隨機分配後實驗組或對照組。所有病人皆完成前測評估,並接受每次15分鐘低頻重複經顱磁刺激治療健側皮質下肢區域,隨後進行45分鐘之物理治療,每週5次共15個療程。評估項目包括動作恢復進程(下肢動作能力、平衡能力、膝關節主動關節活動度、膝痙攣程度、膝伸直肌力)、整體嚴重程度改善和日常生活功能以及下肢皮質區域之動作誘發電位,並於3週治療後再次評估。
結果:經治療後,實驗組比對照組在平衡能力、中風後嚴重程度、日常生活功能部分有顯著的改善,但在下肢動作控制能力和患側膝關節的活動、肌力、痙攣程度方面比較兩組間的改變量和進步人數上沒有顯著差別。在下肢皮質區域活化度上,雙側腦部腦部動作誘發電位振幅治療前後的改變量兩組沒有顯著差異,然而在患側活動時動作閾值部分明顯看到實驗組的數值下降,對照組上升,且實驗組在治療後兩側大腦活性的對稱性顯著增加,對照組兩側活性則是愈不對稱。
結論:本研究針對中風亞急性期病人進行3週15次的低頻重複經顱磁刺激合併常規復健,結果顯示對患者的平衡能力、中風後嚴重程度、日常生活功能部分能有顯著的改善。在下肢皮質區域之動作誘發電位方面,使用低頻重複經顱磁刺激治療後能降低中風病人患側下肢的動作閾值,並改善中風兩側大腦活性不對稱,顯示低頻重複經顱磁刺激配合常規復健能透過抑制健側腦部,提升患側腦部的活性,增加患者的平衡能力,改善中風後嚴重程度以及日常生活功能。

Backgound: Transcranial magnetic stimulation is an one-point stimulation that produces a transitory electric current by generating a local magnetic field on the brain. Based on this mechanism, repetitive transcranial magnetic stimulation, so-called rTMS, is delivering repetitive magnetic pulses to modulated the cortical excitability and promote adaptive reorganization of the brain after stroke. This kind of stimulation has been proven to improve motor function among chronic stroke patients. However, there is still lack of evidence of treatment effects of rTMS for early stroke patients.
Objective: The purpose of this present study is to investigate the functional and neurophysiologic effects of rTMS under conventional physical therapy intervention in subacute stroke patients with motor disabilities.
Method: A total of 28 patients participated in this study and were ramdomized into an experimental group and a control group. Participants received 15-minute rTMS (experimental group) or sham rTMS (control group) followed by conventional physical therapy (45 minutes) for 15 sessions over 3 weeks. Repetitive TMS was applied at a 1-Hz frequency over the leg area of the motor cortex of the unaffected hemisphere. Outcome measures included functional outcomes such as Fugl-Meyer lower limb scores (FMA-LE), Postural Assessment Scale for Stroke Patients score (PASS), Balance portion of Tinetti’s Performance Oriented Mobility Assessment score (BPOMA), active range of motion and muscle strength of affected leg, Modified Ashworth scale assessing affected leg spasticity, NIH Stroke Scale (NIHSS), Barthel index and modified Rankin Scale (mRS); neurophysiological outcomes were investigated by motor-evoked potential (MEP) of both hemispheres. All of measures were assessed for 3 months after the end of treatment.
Result: In between-group comparisons, including NIHSS, PASS, BPOMA, Barthel index, mRS and motor threshold were significantly improved after treatment sessions in experimental group. In addition, patients receiving 1-Hz rTMS demonstrated a tendency to rebalance motor cortex hemispheric activation and regaining walking ability at the end of the treatment session.
Conclusion: To sum up, this study demonstrates that combined 1-Hz rTMS and conventional physical therapy might possibly increase the functional activities and neurophysiologic recovery in subacute hemiplegic patients after stroke.


目錄
圖目錄
表目錄
中文摘要
第一章 緒論.....................................................1
第一節 研究動機與重要性.........................................1
第二節 研究目的 .........................................3
第三節 研究問題與假設...........................................3
第二章 文獻回顧 .........................................4
第一節 大腦受傷後的神經塑形.....................................4
第二節 中風後的下肢動作功能缺損.................................5
第三節 從中醫的觀點看中風與其後遺症.............................6
第四節 針刺治療腦中風...........................................7
第五節 重複經顱磁刺激...........................................9
第六節 重複經顱磁刺激的安全性..................................12
第三章 研究方法 ........................................13
第一節 研究設計 ........................................13
第二節 研究對象 ........................................13
第三節 研究流程 ........................................14
第四節 治療介入 ........................................15
第五節 評估方法 ........................................16
第六節 統計分析 ........................................19
第四章 結果....................................................20
第一節 受試者基本資料..........................................20
第二節 下肢動作能力與平衡能力.........................................21
第三節 患側膝關節主動關節活動度、膝伸直肌力 及膝痙攣程度.......22
第四節 中風整體嚴重程度和日常生活功能..........................23
第五節 雙側大腦下肢皮質區域之動作誘發電位......................24
第六節 其他....................................................25
第五章 討論....................................................26
第一節 受試者基本資料..........................................26
第二節 下肢動作能力與平衡能力..................................27
第三節 患側膝關節主動關節活動度、膝伸直肌力及膝痙攣程度........28
第四節 中風整體嚴重程度和日常生活功能..........................31
第五節 雙側大腦下肢皮質區域興奮度變化..........................32
第六節 治療機制 ........................................33
第七節 研究限制與未來建議......................................34
第六章 結論....................................................36
參考文獻 ................................................37
附錄............................................................48
英文摘要 ................................................56
謝辭............................................................58

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