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研究生:陳亭羽
研究生(外文):Ting-Yu Chen
論文名稱:無彈性貼紮對早產兒於嬰兒早期姿勢控制的效果
論文名稱(外文):The Effects of Non-elastic Taping on Posture Control in Preterm Infants during Early Infancy
指導教授:羅鴻基羅鴻基引用關係
指導教授(外文):Hong-Ji Luo
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:2016
畢業學年度:104
語文別:中文
論文頁數:75
中文關鍵詞:早產兒姿勢控制貼紮治療身體壓力中心線性與非線性分析
外文關鍵詞:preterm infantposture controltaping therapycenter of pressurelinear and nonlinear measure
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研究背景:從過往的文獻當中可知,早產兒在早期階段就顯現出有姿勢控制失能的問題,舉例來說:早產兒常使用較固定或單一的姿勢控制策略和姿勢調節能力較差。目前臨床上主要是藉由擺位和神經動作發展的治療手法來處理早產兒姿勢控制失能的問題,然而這些方法多仰賴治療師直接執行在早產兒身上,面臨到治療師介入時間有限的問題和早產兒長時間擺位不易或因應多樣化或特殊擺位的需求,因此還是有其不足之處。近年來,貼紮治療被用來促進肌肉的收縮、矯正姿勢的排列和提供感覺的刺激,因此貼紮治療或許有益於早期姿勢控制的改善。研究目的:探討無彈性貼紮治療對於懷孕週數小於32週且出生體重小於2000公克早產兒之姿勢控制的立即效果和短期效果。研究設計:隨機分派的臨床試驗、縱貫型研究。研究方法:早產兒皆無腦傷(包括:大腦側室周圍白質軟化、腦室內出血III-IV度)、周邊神經損傷、壞死性腸炎、骨折、先天性疾病或染色體異常。受測者將隨機分派成實驗組與控制組,實驗組為接受無彈力貼紮治療合併常規物理治療,控制組為僅接受常規物理治療。姿勢控制的檢測從懷孕週數40週至矯正年齡3個月,每個月進行一次檢測,共計四次。取樣頻率設為100赫茲,紀錄早產兒仰躺在壓力板(Zebris: FDM-S)上的一分鐘自主動作,接著使用線性分析法-方均根(Root mean square)與非線性分析法-近似熵(Approximate entropy)、多尺度熵(Multi-scale entropy)來分析身體壓力中心(center of pressure)的軌跡變化,且分為頭-尾(caudal-cephalic)方向和內-外(medial-lateral)方向進行討論。最後,基本資料和併發症使用曼-惠特尼檢定和卡方檢定;成效指標(Log RMS-CC, Log RMS-ML, ApEn-CC, ApEn-ML, MSE-CC, MSE-ML)使用線性分析模式、曼-惠特尼檢定、魏克生符號檢定和描述性統計;每日居家療育活動和貼布貼用天數使用曼-惠特尼檢定和描述性統計;每日居家療育活動執行度、貼布貼用天數與成效指標(Log RMS-CC, Log RMS-ML, ApEn-CC, ApEn-ML)的相關性使用皮爾森相關係數。結果:共有17名早產兒完成此研究,分別是實驗組11人(GA = 28.64 ± 2.2 週, BW = 1150 ± 370 公克)和控制組6人(GA = 27.93 ± 1.0週, BW = 936 ± 157公克),其基本資料兩組無顯著差異。併發症的部分顯示控制組有較高比例的敗血症(P = 0.046)。姿勢控制表現之立即效果的部分,只有在實驗組矯正年齡2個月的Log RMS-CC有顯著差異(P = 0.011),指出在治療介入之後減少頭-尾方向的位移,其餘成效指標則無顯著差異。姿勢控制表現之短期效果的部分,在懷孕週數40週Log RMS-ML有顯著差異(P = 0.019),指出實驗組在內-外方向的位移大於控制組;Log RMS-ML有受到時間因素的影響(P = 0.005),指出隨著年齡的增加內-外方向的位移也會增加;懷孕週數40週MSE-CC 在1-9個尺度之下有顯著差異(P ≦ 0.05),指出實驗組在頭-尾方向的動作複雜度高於控制組,其餘成效指標則無顯著差異。每日居家療育活動天數(P = 0.022)與執行度(P = 0.007)皆為實驗組大於控制組。貼布貼用天數與ApEn-CC有正相關(P = 0.021;相關係數 = 0.384),與Log RMS-CC、Log RMS-ML、ApEn_ML則無相關;每日居家療育活動執行度與成效指標皆無相關。結論:無彈性貼紮治療合併常規物理治療的介入方法可能改善嬰兒早期的姿勢控制表現。線性與非線性分析法的使用,可以更清楚地呈現早產兒姿勢控制的改變。此為研究的初步結果,未來還需更多的資料來加以佐證。關鍵字:早產兒、姿勢控制、貼紮治療、身體壓力中心、線性與非線性分析
Background. Several reports have indicated that preterm infants may exhibit dysfunctions in postural control during early infancy, such as stereotyped postural control strategies and poor ability to modulate posture responses. Clinically, the main approaches to the management of dysfunctional posture control in preterm infants are body positioning and neuromotor handling. However, such methods heavily relay on the therapists’ direct hands on interventions that are not feasible for most settings. Furthermore, preterm infants weren't easy to set-up for a long time or they needed special placement for treatment. Recently, tape therapy had been used to enhance muscle performance, correct postural alignment, and provide sensory stimulation that may be also beneficial for improving posture control. Purpose. This study aimed to investigate the immediate and short term effects of non-elastic taping on the posture control in preterm infants whose gestation age (GA) less than 32 weeks and birth body weight (BW) less than 2000 g. Design. RCT and longitudinal design. Methods. All preterm were without brain injury (such as PVL, IVH grade III-IV), peripheral nerve injury, necrotizing enterocolitis, fracture, congenital disorder or gene abnormalities. Participants were randomized into experimental and control groups. Experimental group (EG) received non-elastic taping and conventional physical therapy but control group (CG) received only conventional physical therapy. The assessment of posture control implemented monthly from gestation age (GA) 40 weeks to corrected age (CA) 3 months. Center of pressure (COP) data were recorded at 100 Hz for one minutes while preterm infants lying supine on a pressure mat (Zebris: FDM-S). Linear and nonlinear measure were utilized, such as Root mean square (RMS), Approximate entropy (ApEn) and Multi-scale entropy (MSE) to described the trajectory of COP in the caudal-cephalic and medial-lateral directions. Comparison of basic and perinatal data between groups was analyzed using Mann-Whitney and Chi-squared test. Outcome variables (Log RMS-CC, Log RMS-ML, ApEn-CC, ApEn-ML, MSE-CC, MSE-ML) were examined using General linear model repeated measure, Mann-Whitney, Wilcoxon signed-rank and descriptive statistics. Home programs and the day of tapping used were analyzed using Mann-Whitney and descriptive statistics. The correlation among the execution of home programs, the day of tapping and outcome variables (Log RMS-CC, Log RMS-ML, ApEn-CC, ApEn-ML) was examined using Person correlation analysis. Results. This study included seventeen preterm infants. Eleven preterm infants were in the EG (GA = 28.64 ± 2.2 weeks, BW = 1150 ± 370 g) and six preterm infants were in the CG (GA = 27.93 ± 1.0 weeks, BW = 936 ± 157 g). The basic data weren't significantly different between groups. The proportion of septicemia was higher in CG than EG (P = 0.046). As to immediate effects of posture control, only the Log RMS-CC at CA2 months in EG revealed significant difference (P = 0.011) with decreasing magnitude after interventions. The other outcomes weren't significant. As to short term effects of posture control, Log RMS-ML at GA 40 weeks had a significant group effect (P = 0.019) with EG was higher than CG. A significant time effect (P = 0.005) was found for the Log RMS-ML revealing an increasing magnitude by age. MSE-CC at GA 40 weeks revealed a significant group effect (P≦0.05 ) with EG was higher than CG for 1-9 scales. The others outcomes weren't significantly different between groups. Both the day of home programs (P = 0.022) and execution (P = 0.007) were higher in EG than CG. The day of tapping was positive correlation (correlation coefficient = 0.384) to ApEn-CC only. The execution of home programs had no association with Log RMS-CC、Log RMS-ML、ApEn-CC、ApEn_ML. Conclusion. Using non-elastic taping and conventional physical therapy might improve posture control. In combination, linear and nonlinear analysis exhibited the change of posture control of preterm clearly. The findings of this study were preliminary, future study was needed with a larger sample size.
Key words. Preterm infant, posture control, taping therapy, center of pressure, linear and nonlinear measure

目錄
誌謝 I
中文摘要 II
Abstract IV
目錄 VII
圖目錄 X
表目錄 XI
第一章 簡介 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究假說 2
第四節 重要性 2
第二章 文獻回顧 3
第一節 早產兒發生率與存活率 3
第二節 早產兒併發症與發展問題 4
第三節 早產兒早期姿勢控制表現對於預後的影響 6
第四節 早期姿勢控制之評估工具與成效指標 7
第五節 早產兒姿勢控制之特性 8
第六節 線性與非線性分析法應用於姿勢控制 10
第七節 改善早產兒姿勢控制的物理治療介入與相關研究 12
第八節 無彈性貼紮治療應用理論與相關研究 15
第三章 研究方法 18
第一節 研究設計與研究架構 18
一、研究設計 18
二、研究架構 18
第二節 研究流程與研究材料 18
一、研究對象 18
二、研究流程 19
三、研究介入 19
四、成效評量 21
五、檢測工具與方式 21
第三節 資料處理與統計分析 22
一、資料處理 22
二、統計分析 22
第四章 結果 24
第一節 個案之基本資料與相關併發症 24
第二節 個案之居家療育活動執行情形與實驗組貼布貼用天數 24
第三節 立即效果 25
第四節 短期效果 27
第五章 討論 29
第一節 個案之基本資料與相關併發症對於姿勢控制的影響 29
第二節 無彈性貼紮治療對於姿勢控制的立即效果 29
第三節 無彈性貼紮治療對於姿勢控制的短期效果 31
第四節 實驗組貼布貼用天數對於姿勢控制的影響 34
第五節 個案之每日居家療育活動對於姿勢控制的影響 35
第六節 無彈性貼紮治療對於姿勢控制之效果與臨床應用 38
第七節 本研究特色、限制與未來建議 40
第六章 結論 42
參考文獻 43
附錄 人體試驗委員會同意臨床試驗證明書 75

圖目錄
圖一、流程圖 53
圖二、範例3M膠帶(灰色長方形)貼紮於嬰兒正面、背部位置 54
圖三、範例優肌絆(白色長方形)貼紮於嬰兒正面位置 54
圖四、壓力板與軟體介面 54
圖五、住院期間姿勢控制檢測的環境示意圖 55
圖六、回診期間姿勢控制檢測的環境示意圖 55
圖七、實驗組與控制組:Log RMS-CC、Log RMS-ML、ApEn-CC、ApEn-ML分別在懷孕週數40週至矯正年齡3個月之前測與後測結果 57
圖八、實驗組與控制組:MSE-CC分別在懷孕週數40週至矯正年齡3個月之結果 61
圖九、實驗組與控制組:MSE-ML分別在懷孕週數40週至矯正年齡3個月之結果 65

表目錄
表一、實驗組與控制組執行項目與頻率 66
表二、個案回診情況 67
表三、實驗組和控制組納入分析的人數 68
表四、個案基本資料 69
表五、併發症 70
表六、組別、時間、組別-時間交互作用對於成效指標Log RMS 和ApEn之影響 72
表七、組別對於成效指標Log RMS 和ApEn之差異 73
表八、治療前測與後測在成效指標Log RMS 和ApEn之差異 74


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