摘要
背景及目的: 腦中風是造成肢體障礙的主要原因之一，百分之六十以上的中風患者發病後半年以上仍受上肢動作障礙困擾。當代行為介入治療，如:鏡像治療證明能改善動作恢復，以及提升日常生活功能。近年來，研究顯示在復健過程中併用擴增性回饋能夠在動作學習中獲得動作結果的回饋，增強動作學習的效率、提升受試者復健動機並增加患側手使用次數，進而改善動作品質。因此，本研究欲探討利用加速規是否能夠提升鏡像治療療效、提升動作學習以及增加受試者對於治療的服從度，促進動作恢復朝功能性邁進。主要目的為：(1) 檢驗在鏡像治療中加入外在回饋後在慢性中風個案相較於一般鏡像治療是否有加成的療效；(2) 檢驗鏡像治療併用加速規回饋組在患側日常使用次數上是否優於一般鏡像療法。
研究設計: 隨機分派、前測後測比較，初探型試驗。
施測環境: 醫院之復健科部。
方法: 所有受試者(N=9)皆接受為期四週，每週五天，每天1.5小時的治療。受試者被隨機分派至兩組: 鏡像治療併用回饋組及鏡像治療組。主要評估工具包含傅格-梅爾動作評估量表(Fugl-Meyer Assessment, FMA)、功能獨立量表(Functional Independence Measure, FIM)以及動作活動日誌(Motor Activity Log, MAL)；次要評估工具包含沃夫動作功能測驗(Wolf Motor Function Test, WFMT)、修訂版諾丁漢感覺評估量表(Revised Nottingham Sensory Assessment, rNSA)、加速規(Actigraph)以及中風衝擊量表(Stroke Impact Scale, SIS)。
結果: 在鏡像治療合併擴增性回饋組，受試者的動作功能及動作品質於前後測的改善有顯著進步，亦發現合併回饋的組別在傅格梅爾量表近端分數進步量達到顯著進步 (p < .05)，但組間差異還未達顯著。在日常生活功能方面，患側使用量及執行日常生活任務方面，回饋組之前後測進步量也有達顯著差異 (p < .05)，且明顯高於鏡像治療，組間差異亦有達高度效果值(p < .05, r > .5)。在生活品質方面，在力量、情緒、移行能力、患側手功能、自覺恢復程度、社會參與度以及總分的前後測進步量皆有顯著進步，且顯著高於鏡像治療組(p < .05)。感覺部分，兩組則沒有明顯差異。
結論: 鏡像治療合併擴增性回饋相較於鏡像治療的確有帶來加成效果，可改善慢性中風患者之動作功能與表現，促進偏癱側的使用量，改善動作品質，以及提升一般日常生活功能，間接也提升受試者的自覺生活品質。本研究顯示擴增性回饋可提升原鏡像治療的療效，增進受試者平日患側使用量與生活品質，未來仍需要招募更多受試者以彌補統計檢定力的不足。
關鍵詞: 鏡像治療、擴增性回饋、加速規、中風復健、混合療法。

目錄
致謝 1
中文摘要 2
英文摘要 4
目錄 6
表目錄 8
圖目錄 9
第一章 背景與介紹 10
第一節 文獻回顧 10
第二節 研究假設 15
第三節 研究目的 15
第二章 研究方法 16
第一節 研究設計 16
第二節 樣本數統計 16
第三節 受試者 16
第四節 介入方式 17
一、療程 17
二、鏡箱簡介 17
三、鏡像治療介紹 17
四、鏡像治療合併回饋組介紹 18
五、加速規的解讀與分析 18
六、功能性活動 19
第五節 評估工具 19
一、主要評估工具 19
二、次要評估工具 21
第六節 統計分析方法 22
第三章 結果 23
第一節 受試者人口學特徵 23
第二節 主要評估工具結果 23
一、傅格梅爾動作量表 23
二、功能性獨立量表 24
三、動作活動日誌 24
第三節 次要評估工具結果 25
一、沃夫動作功能量表 25
二、改良式諾汀漢感覺量表 25
三、加速規 25
四、中風衝擊量表 26
第四章 討論 27
第一節 擴增性回饋所帶來的加成效益 27
第二節 患側使用次數 30
第三節 治療反應較佳者之個案特徵 31
第五章 結論 33
第六章 研究限制 35
參考文獻 36
附錄 42

表目錄
表1 受試者人口學特徵 42
表2 主要評估工具之前後測結果 43
表3 在主要評估工具上改變量達到MCID值之人數比例 44
表4-1 次要評估工具之前後測結果 45
表4-2 次要評估工具之前後測結果(續) 46
表5-1 次要評估工具進步量達到MCID值之人數比例 47
表5-2 次要評估工具進步量達到MCID值之人數比例(續) 48
表6 受試者招募過程 49
表7 本研究中鏡像治療使用的活動分級 50

圖目錄
圖1-1 研究設置_ 鏡箱 51
圖1-2 研究設置_ 加速規 51
圖2-1 實驗組執行不及物動作 52
圖2-2 控制組執行不及物動作 52
圖3-1實驗組執行及物動作 52
圖3-2控制組執行及物動作 52
圖4-1實驗組執行任務型動作 52
圖4-2 控制組執行任務型動作 52
圖5 加速規顯示範例 53
圖6 研究流程 54

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