跳到主要內容

臺灣博碩士論文加值系統

(18.97.9.169) 您好!臺灣時間:2025/02/18 20:09
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:劉子瑛
研究生(外文):Tzu-Ying Liu
論文名稱:懸吊訓練介入對健康成年人和非特異性慢性下背痛患者執行功能性動作的肌肉預期性收縮和皮質肌肉共調性的影響
論文名稱(外文):The Effects of Suspension Exercise for Healthy Adults and Non-specific Chronic Low Back Pain Patient on Muscle Anticipatory Contraction and Corticomuscular Coherence
指導教授:周立偉周立偉引用關係
指導教授(外文):Li-Wei Chou
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:2017
畢業學年度:105
語文別:中文
論文頁數:66
中文關鍵詞:慢性下背痛核心肌群懸吊訓練皮質肌肉共調性
外文關鍵詞:Chronic low back painCore muscleSuspension trainingCorticomuscular coherence
相關次數:
  • 被引用被引用:1
  • 點閱點閱:371
  • 評分評分:
  • 下載下載:105
  • 收藏至我的研究室書目清單書目收藏:1
背景:下背痛是常見慢性疼痛之一且多為非特異性診斷,此類患者有肌肉不平衡、動作控制障礙、本體感覺受損等負面問題。現今強調核心肌群的運動治療已被證實可有效改善下背痛患者疼痛、功能和動作控制的問題,然而目前研究尚缺乏於執行功能性動作任務時,同步觀察肌肉和大腦皮質的狀態與動作表現。
目的:探討六週懸吊運動訓練介入對於非特異性慢性下背痛患者疼痛與功能之成效;而另一主要目的為以皮質肌肉共調性探討懸吊運動訓練對於健康成年人和非特異性慢性下背痛患者在執行功能性動作時,大腦與肌肉間功能性連結的變化,並觀察腹橫肌/腹內斜肌預期性收縮的功能於訓練前後的改變。
方法:徵召15位健康成年人(健康組)和8位非特異性慢性下背痛患者(背痛組),進行每週兩次每次40分鐘共六週的懸吊運動訓練。受試者於訓練前、後進行兩項功能性測試,包含快速擺手動作任務與手持5公斤重物下重複軀幹彎曲-伸直動作任務。任務過程中,以數字疼痛評分量表量測疼痛程度、以歐式下背痛失能量表量測失能程度、以肌電儀量測前三角肌、左右側腹橫肌/腹內斜肌、腰束脊肌和胸束脊肌等肌肉活化,以及以腦波儀量測腦波。透過以上數據分析出疼痛與失能分數、左側腹橫肌/腹內斜肌預期性收縮時序與共調性數值(β和γ頻帶)。再使用魏克森符號等級檢定法觀察各組內各參數之差異;使用曼-惠特尼U檢驗進行兩組間各參數之比較。
結果:背痛組於懸吊訓練介入後顯著改善疼痛(p=0.01)和失能(p=0.024)程度。快速擺手動作任務下,在六週訓練後,健康組左側腹橫肌/腹內斜肌有顯著提早收縮(p=0.027),這使兩組間達顯著差異(p=0.033),而背痛組於訓練後的收縮時序更趨近於健康組之表現。此外,訓練前健康組的左側腹橫肌/腹內斜肌和腰部束脊肌於β頻帶共調性數值顯著高於背痛組(p=0.024與p=0.039),另外健康組在訓練後於左側腹橫肌/腹內斜肌γ頻帶也顯著高於背痛組(p=0.045)。在手持5公斤重物之重複彎曲-伸直軀幹任務,發現在左側腹橫肌/腹內斜肌γ頻帶,訓練前(p=0.003)是背痛組的共調性數值顯著高於健康組,背痛組經訓練後在胸束脊肌γ頻帶則有顯著下降(p=0.049)。
結論:六週懸吊運動訓練介入可有效改善非特異性慢性下背痛病人的疼痛和失能程度,同時也改善功能性動作中的皮質肌肉共調性,進而縮短左側腹橫肌/腹內斜肌的預期性收縮時序,使患者更趨近於一般健康成年人之表現。
Background: Low back pain (LBP) is one of the common chronic pain and most is with non-specific diagnosis, such patients may contain muscle imbalance, motor control dysfunction, proprioception impairment and other negative problems. Nowadays, core muscle exercise therapy has been shown to improve pain, function, and motor control in patients with LBP. However, it is still unclear how improvements is related to synchronization between muscle and cerebral cortex during functional movements.
Purpose: To examine the effects of six weeks of suspension exercise training on pain and function in patients with non-specific chronic LBP, NSCLBP. And the other main purpose is to explore the mechanisms behind functional improvement with suspension exercise training by investigating the effects of suspension exercise training for healthy adults and NSCLBP patients on the changes of functional link between cortical cortex and muscle during the functional movement tasks, and observe the anticipatory contraction function of transversus abdominis / internal oblique muscle (TrA/IO) before and after training.
Methods: 15 healthy adults (healthy group) and 8 patients with NSCLBP (back pain group) were recruited to participate suspension exercise training for a total of six weeks of twice a week for 40 minutes each time. Subjects performed two functional tests before and after training, including quick arm lifting task and repeated trunk flexion - extension task with 5 kg weight load. In the course of the task, the Numeric Rating Scale was used to measure the degree of pain, the degree of disability was measured by the Oswestry Disability Index, the surface electromyography was used to measure the muscle activation of anterior deltoid, left and right TrA/IO, and thoracic and lumbar erector spinae (TES and LES), and the electroencephalogram was used to detect brainwaves. The main dependent variables were pain and disability scores, left TrA/IO anticipatory contraction timing and coherence values (β and γ band). Wilcoxon Signed Ranks Test and the Mann-Whitney U test was used to compare the parameters between the two groups.
Results: Back pain group significantly improved pain (p = 0.01) and disability (p = 0.024) after suspension training. Of quick arm lifting task, after a six-week training, the healthy group resulted in significant earlier anticipatory contraction timing (p = 0.027), which resulted in significant differences between the two groups (p = 0.033), and the performance of anticipatory contraction timing of back pain group was improved and became closer to healthy group. In addition, before training, the coherence of the left TrA/IO and LES in the β band of the healthy group was significantly higher than that in the back pain group (p = 0.024 and p = 0.039), and after training, the γ band in the left TrA/IO of healthy group was also significantly higher than that in the back pain group (p = 0.045). Of repeated trunk flexion-extension task with 5kg weight load, before training, the coherence of the left TrA/IO in the γ band was significantly higher in the back pain group than in the healthy group (p = 0.003), and the back pain group after training the coherence of the TES in the γ band was significantly decreased (p = 0.049).
Conclusion: Six weeks of suspension exercise training can effectively improve the NSCLBP patients with pain and disability, and also improve the corticomuscular coherence during functional task, and thus shorten the left TrA/IO anticipatory contraction timing, making the performance of the patient closer to the general healthy adults.
目錄
誌謝 I
中文摘要 III
英文摘要 V
目錄 VIII
表目錄 XI
圖目錄 XII
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 研究假設 3
第四節 重要性 3
第二章 文獻回顧 5
第一節 下背痛 5
一、 下背痛之定義與分類 5
二、 下背痛之流行病學 6
第二節 下背痛對核心肌群其肌肉活化的影響 7
第三節 疼痛對大腦的影響 9
第四節 下背痛運動治療的介入成效 10
第五節 懸吊訓練 11
第六節 皮質肌肉共調性 13
第七節 總結 14
第三章 研究方法 16
第一節 研究設計與研究架構 16
一、 研究設計 16
二、 研究架構 16
第二節 研究材料與研究方法 17
一、 研究流程 17
二、 研究對象 17
三、 實驗流程 18
四、 研究工具 19
第三節 資料處理與分析方法 21
一、 資料處理 21
二、 統計分析 22
第四章 結果 23
第一節 受試者基本資料 23
第二節 疼痛程度 23
第三節 失能等級 23
第四節 腹橫肌/腹內斜肌預期性收縮時序 24
第五節 快速擺手動作任務的皮質肌肉共調性 25
第六節 手持5公斤重物下重複彎曲–伸直軀幹任務的皮質肌肉共調性 27
第五章 討論 30
第一節 疼痛程度的下降和失能等級的改變 30
第二節 懸吊訓練對腹橫肌/腹內斜肌預期性收縮的影響 31
第三節 懸吊訓練對於快速擺手任務的共調性變化 32
第四節 懸吊訓練對於手持5公斤重物做重複軀幹彎曲-伸直任務的共調性變化 33
第五節 研究限制與未來研究之建議 34
第六章 結論 36
參考文獻 37
附錄一、 國立陽明大學人體研究暨倫理委員會同意人體研究證明書 63
附錄二、 佛教慈濟醫療財團法人台北慈濟醫院人體試驗審查委員會臨床試驗同意函 64
附錄三、 TRX訓練動作 65

表目錄
表一、 健康成年人基本資料 42
表二、 下背痛病人基本資料 43
表三、非特異性慢性下背痛病人背痛區域和症狀持續時間 44
表四、非特異性慢性下背痛組懸吊訓練前後疼痛和失能比較 44
表五、懸吊訓練前後兩組間腹橫肌/腹內斜肌預期性收縮時序比較 45
表六、懸吊訓練前後快速擺手動作任務的皮質肌肉共調性 46
表七、懸吊訓練前後手持5公斤重物下重複彎曲和伸直軀幹的皮質肌肉共調性 47


圖目錄
圖一、健康成年人之研究流程 48
圖二、非特異性慢性下背痛病人之研究流程 49
圖三、最大自主用力測試 A)前三角肌 B)腹橫肌/腹內斜肌 C)腰束脊肌、胸束脊肌 50
圖四、快速擺手動作任務示意圖 51
圖五、手持5公斤重物下重複彎曲-伸直軀幹任務示意圖 52
圖六、表面肌電圖BIOPAC System 52
圖七、電極貼片位置 A)腹橫肌/腹內斜肌 B)胸束脊肌 C)腰束脊肌 D)前三角肌 53
圖八、腦電波儀 54
圖九、腹橫肌/腹內斜肌活化時序之計算示意圖 55
圖十、β頻帶(13-30 Hz)和γ頻帶(31-60Hz)下,選取超過閾值的皮質肌肉共調性範圍計算面積和 55
圖十一、懸吊訓練前後的疼痛數字等級量表比較 56
圖十二、懸吊訓練前後的歐氏下背痛失能量表比較 56
圖十三、快速擺手動作任務之下,左側腹橫肌/腹內斜肌的預期性收縮訓練前後變化圖 57
圖十四、快速擺手動作任務之下,右側腹橫肌/腹內斜肌的預期性收縮訓練前後變化圖 57
圖十五、快速擺手動作任務之下,左側腹橫肌/腹內斜肌β頻帶的共調性訓練前後變化圖 58
圖十六、快速擺手動作任務之下,左側腹橫肌/腹內斜肌γ頻帶的共調性訓練前後變化圖 58
圖十七、快速擺手動作任務之下,左側腰束脊肌β頻帶的共調性訓練前後變化圖 59
圖十八、快速擺手動作任務之下,左側腰束脊肌γ頻帶的共調性訓練前後變化圖 59
圖十九、手持5公斤重物重複彎曲-伸直軀幹任務之下,左側腹橫肌/腹內斜肌β頻帶的共調性訓練前後變化圖 60
圖二十、手持5公斤重物重複彎曲-伸直軀幹任務之下,左側腹橫肌/腹內斜肌γ頻帶的共調性訓練前後變化圖 60
圖二十一、手持5公斤重物重複彎曲-伸直軀幹任務之下,左側腰束脊肌β頻帶的共調性訓練前後變化圖 61
圖二十二、手持5公斤重物重複彎曲-伸直軀幹任務之下,左側腰束脊肌γ頻帶的共調性訓練前後變化圖 61
圖二十三、手持5公斤重物重複彎曲-伸直軀幹任務之下,左側胸束脊肌β頻帶的共調性訓練前後變化圖 62
參考文獻
1. van Tulder, M., B. Koes, and C. Bombardier, Low back pain. Best Pract Res Clin Rheumatol, 2002. 16(5): p. 761-75.
2. Dillingham, T., Evaluation and management of low back pain: an overview. SPINE-PHILADELPHIA-HANLEY AND BELFUS-, 1995. 9: p. 559-596.
3. Strutton, P.H., et al., Corticospinal excitability in patients with chronic low back pain. J Spinal Disord Tech, 2005. 18(5): p. 420-4.
4. Hodges, P.W. and C.A. Richardson, Inefficient muscular stabilization of the lumbar spine associated with low back pain. A motor control evaluation of transversus abdominis. Spine (Phila Pa 1976), 1996. 21(22): p. 2640-50.
5. Hodges, P.W. and C.A. Richardson, Delayed postural contraction of transversus abdominis in low back pain associated with movement of the lower limb. J Spinal Disord, 1998. 11(1): p. 46-56.
6. Hodges, P.W. and C.A. Richardson, Contraction of the abdominal muscles associated with movement of the lower limb. Phys Ther, 1997. 77(2): p. 132-42; discussion 142-4.
7. Hodges, P.W. and C.A. Richardson, Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement. Exp Brain Res, 1997. 114(2): p. 362-70.
8. Hodges, P.W. and G.L. Moseley, Pain and motor control of the lumbopelvic region: effect and possible mechanisms. J Electromyogr Kinesiol, 2003. 13(4): p. 361-70.
9. Hayden, J.A., et al., Meta-analysis: exercise therapy for nonspecific low back pain. Ann Intern Med, 2005. 142(9): p. 765-75.
10. Bouter, L.M., M.W. van Tulder, and B.W. Koes, Methodologic issues in low back pain research in primary care. Spine (Phila Pa 1976), 1998. 23(18): p. 2014-20.
11. Woolf, A.D. and B. Pfleger, Burden of major musculoskeletal conditions. Bull World Health Organ, 2003. 81(9): p. 646-56.
12. Haldeman, S., Low back pain: current physiologic concepts. Neurol Clin, 1999. 17(1): p. 1-15.
13. Kinkade, S., Evaluation and treatment of acute low back pain. Am Fam Physician, 2007. 75(8): p. 1181-8.
14. Frank, J.W., et al., Disability resulting from occupational low back pain. Part I: What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine (Phila Pa 1976), 1996. 21(24): p. 2908-17.
15. Frank, J.W., et al., Disability resulting from occupational low back pain. Part II: What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins. Spine (Phila Pa 1976), 1996. 21(24): p. 2918-29.
16. Walker, B.F., The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord, 2000. 13(3): p. 205-17.
17. Valkenburg, H. and H. Haanen, The epidemiology of low back pain. Idiopathic Low Back Pain. Mosby. St. Louis, 1982.
18. Taylor, V.M., et al., Low back pain hospitalization. Recent United States trends and regional variations. Spine (Phila Pa 1976), 1994. 19(11): p. 1207-12; discussion 13.
19. Hart, L.G., R.A. Deyo, and D.C. Cherkin, Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine (Phila Pa 1976), 1995. 20(1): p. 11-9.
20. Frank, A., Low back pain. BMJ, 1993. 306(6882): p. 901-9.
21. 勞動部. 勞工保險-職業病給付人次-按成因分別. 勞動統計查詢網 2017 [cited 2017 04月24日]; Available from: https://statdb.mol.gov.tw/statis/jspProxy.aspx?sys=210&kind=21&type=1&funid=q08061&rdm=ahdlm79N.
22. 郭浩然, 職業性下背痛. 中華公共衛生雜誌, 2000. 19(5): p. 332-339.
23. Waddell, G., 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain. Spine (Phila Pa 1976), 1987. 12(7): p. 632-44.
24. Borkan, J., et al., Advances in the field of low back pain in primary care: a report from the fourth international forum. Spine (Phila Pa 1976), 2002. 27(5): p. E128-32.
25. Panjabi, M.M., The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. J Spinal Disord, 1992. 5(4): p. 390-6; discussion 397.
26. Hides, J.A., G.A. Jull, and C.A. Richardson, Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine (Phila Pa 1976), 2001. 26(11): p. E243-8.
27. Richardson, C.A. and G.A. Jull, Muscle control-pain control. What exercises would you prescribe? Man Ther, 1995. 1(1): p. 2-10.
28. O'Sullivan, P.B., Lumbar segmental 'instability': clinical presentation and specific stabilizing exercise management. Man Ther, 2000. 5(1): p. 2-12.
29. van Dieen, J.H., L.P. Selen, and J. Cholewicki, Trunk muscle activation in low-back pain patients, an analysis of the literature. J Electromyogr Kinesiol, 2003. 13(4): p. 333-51.
30. Apkarian, A.V., M.N. Baliki, and P.Y. Geha, Towards a theory of chronic pain. Prog Neurobiol, 2009. 87(2): p. 81-97.
31. Tracey, I. and M.C. Bushnell, How neuroimaging studies have challenged us to rethink: is chronic pain a disease? J Pain, 2009. 10(11): p. 1113-20.
32. Flor, H. and D.C. Turk, Etiological theories and treatments for chronic back pain. I. Somatic models and interventions. Pain, 1984. 19(2): p. 105-21.
33. Flor, H., et al., Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neurosci Lett, 1997. 224(1): p. 5-8.
34. Moseley, G.L., A pain neuromatrix approach to patients with chronic pain. Man Ther, 2003. 8(3): p. 130-40.
35. Zusman, M., Forebrain-mediated sensitization of central pain pathways: 'non-specific' pain and a new image for MT. Man Ther, 2002. 7(2): p. 80-8.
36. Giesecke, T., et al., [Central pain processing in chronic low back pain. Evidence for reduced pain inhibition]. Schmerz, 2006. 20(5): p. 411-4, 416-7.
37. Wang, X.Q., et al., A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One, 2012. 7(12): p. e52082.
38. Mok, N.W., et al., Core muscle activity during suspension exercises. journal of Science and Medicine in Sport, 2015. 18(2): p. 189-194.
39. Carpes, F.P., F.B. Reinehr, and C.B. Mota, Effects of a program for trunk strength and stability on pain, low back and pelvis kinematics, and body balance: a pilot study. Journal of bodywork and movement therapies, 2008. 12(1): p. 22-30.
40. Kim, J.H., et al., The effect of the neurac sling exercise on postural balance adjustment and muscular response patterns in chronic low back pain patients. J Phys Ther Sci, 2013. 25(8): p. 1015-9.
41. Kilner, J.M., et al., Human cortical muscle coherence is directly related to specific motor parameters. Journal of Neuroscience, 2000. 20(23): p. 8838-8845.
42. Pfurtscheller, G. and F.L. Da Silva, Event-related EEG/MEG synchronization and desynchronization: basic principles. Clinical neurophysiology, 1999. 110(11): p. 1842-1857.
43. Conway, B.A., et al., Synchronization between motor cortex and spinal motoneuronal pool during the performance of a maintained motor task in man. J Physiol, 1995. 489 ( Pt 3): p. 917-24.
44. Salenius, S., et al., Human cortical 40 Hz rhythm is closely related to EMG rhythmicity. Neurosci Lett, 1996. 213(2): p. 75-8.
45. Salenius, S., et al., Cortical control of human motoneuron firing during isometric contraction. J Neurophysiol, 1997. 77(6): p. 3401-5.
46. Baker, S.N., E. Olivier, and R.N. Lemon, Coherent oscillations in monkey motor cortex and hand muscle EMG show task-dependent modulation. J Physiol, 1997. 501 ( Pt 1): p. 225-41.
47. Halliday, D.M., et al., Using electroencephalography to study functional coupling between cortical activity and electromyograms during voluntary contractions in humans. Neurosci Lett, 1998. 241(1): p. 5-8.
48. Mima, T. and M. Hallett, Electroencephalographic analysis of cortico-muscular coherence: reference effect, volume conduction and generator mechanism. Clin Neurophysiol, 1999. 110(11): p. 1892-9.
49. Kristeva, R., L. Patino, and W. Omlor, Beta-range cortical motor spectral power and corticomuscular coherence as a mechanism for effective corticospinal interaction during steady-state motor output. Neuroimage, 2007. 36(3): p. 785-792.
50. Witte, M., et al., Modulation of human corticomuscular beta‐range coherence with low‐level static forces. European Journal of Neuroscience, 2007. 26(12): p. 3564-3570.
51. Schoffelen, J.-M., R. Oostenveld, and P. Fries, Neuronal coherence as a mechanism of effective corticospinal interaction. Science, 2005. 308(5718): p. 111-113.
52. Omlor, W., et al., Gamma-range corticomuscular coherence during dynamic force output. Neuroimage, 2007. 34(3): p. 1191-1198.
53. Gilbertson, T., et al., Existing motor state is favored at the expense of new movement during 13-35 Hz oscillatory synchrony in the human corticospinal system. The Journal of neuroscience, 2005. 25(34): p. 7771-7779.
54. Hoogenboom, N., et al., Localizing human visual gamma-band activity in frequency, time and space. Neuroimage, 2006. 29(3): p. 764-773.
55. Murayama, N., et al., Oscillatory interaction between human motor cortex and trunk muscles during isometric contraction. Neuroimage, 2001. 14(5): p. 1206-1213.
56. Childs, J.D., S.R. Piva, and J.M. Fritz, Responsiveness of the numeric pain rating scale in patients with low back pain. Spine, 2005. 30(11): p. 1331-1334.
57. Pengel, L.H., K.M. Refshauge, and C.G. Maher, Responsiveness of pain, disability, and physical impairment outcomes in patients with low back pain. Spine, 2004. 29(8): p. 879-883.
58. Chow, J.H. and C.C. Chan, Validation of the Chinese version of the Oswestry Disability Index. Work, 2005. 25(4): p. 307-314.
59. Ng, J.K., V. Kippers, and C.A. Richardson, Muscle fibre orientation of abdominal muscles and suggested surface EMG electrode positions. Electromyogr Clin Neurophysiol, 1998. 38(1): p. 51-8.
60. Danneels, L.A., et al., Intra-operator and inter-operator reliability of surface electromyography in the clinical evaluation of back muscles. Man Ther, 2001. 6(3): p. 145-53.
61. Kavcic, N., S. Grenier, and S.M. McGill, Determining the stabilizing role of individual torso muscles during rehabilitation exercises. Spine (Phila Pa 1976), 2004. 29(11): p. 1254-65.
62. Rosenberg, J., et al., The Fourier approach to the identification of functional coupling between neuronal spike trains. Progress in biophysics and molecular biology, 1989. 53(1): p. 1-31.
63. Gallet, C. and C. Julien, The significance threshold for coherence when using the Welch's periodogram method: effect of overlapping segments. Biomedical Signal Processing and Control, 2011. 6(4): p. 405-409.
64. van Middelkoop, M., et al., Exercise therapy for chronic nonspecific low-back pain. Best practice & research Clinical rheumatology, 2010. 24(2): p. 193-204.
65. Searle, A., et al., Exercise interventions for the treatment of chronic low back pain: A systematic review and meta-analysis of randomised controlled trials. Clinical rehabilitation, 2015. 29(12): p. 1155-1167.
66. Kirkesola, G., Neurac-a new treatment method for long-term musculoskeletal pain. J Fysioterapeuten, 2009. 76: p. 16-25.
67. Aruin, A.S. and M.L. Latash, Directional specificity of postural muscles in feed-forward postural reactions during fast voluntary arm movements. Experimental Brain Research, 1995. 103(2): p. 323-332.
連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top