中風為單邊偏癱的主要原因之一，由此造成的不對稱動作是神經復健的主要目標。電刺激輔助踩車已被證實可以立即與長期改善中風患者不對稱性動作。除了透過電刺激產生功能性肢體動作，其他研究提出給從本體感覺及神經生物回饋方面給中風病人低電量電刺激。所以本研究目的在於藉由近紅外光譜儀發展電刺激輔助中風患者踩車神經復健。因此本研究探討使用近紅外光譜儀了解不同電量在被動踩車對於大腦活化的影響，量測範圍包括前運動區、運動輔助區、感覺運動區、次級感覺區。首先招募正常受試者以發展死點與電刺激範圍的自動偵測。理論上死點是由量測髖關節與腳踏車轉軸中心的距離與高度而得；實驗上的死點是藉由量測被動踩車10秒鐘並計算力矩值而獲得。研究結果發現兩種死點偵測的方法並沒有差異，代表被動踩車10秒鐘可以決定死點的位置與電刺激的範圍。未來需要再加上主動踩車時的肌電圖來驗證肌肉用力與電刺激的範圍是否一致。然後十六個受試者包括九個中風病人與七個正常受試者被要求進行由踩車系統帶動的被動踩車，速度為每分鐘50圈，分別給予沒有電刺激、10毫安培的低電量電刺激、30毫安培的高電量電刺激。量測大腦不同區域的帶氧血紅素濃度變化來觀察大腦活化以及代表兩腦對稱反應的大腦半球間相關係數來看腦血流自動調控。我們結果顯示正常人的大腦活化顯示在高電量的情況下出現全面性的去活化反應。中風病人兩側的次級感覺區在低電量的情況下顯著活化。正常人的大腦半球間相關係數在感覺動作區比中風病人顯著較高。我們的研究使用非侵入式近紅外光譜儀觀察血液動力變化與大腦兩側自主調控對稱建議相較於沒有電或高電量，低電量電刺激輔助被動踩車可以更能促進大腦活化。本研究的結果可以提供一般性指引提供簡化臨床設定電刺激輔助被動踩車。本研究的結果未來可以運用在給中風患者的神經復健上以及整合至電刺激輔助踩車的醫療儀器設計與發展。

Stroke is a leading cause for hemiparesis and such asymmetrical movement is the main goal of neurorehabilitation. Electrical stimulation assisted cycling has been proved to improve the symmetrical movement for stroke patients for immediate and long term effect. In addition to generate functional limb movement via electrical stimulation, other research proposed lower intensity stimulation for stroke patients from proprioceptive and neuro-biofeedback aspects. Thus the aim of the study is to develop neurorehabilitation program for stroke patients during electrical stimulation assisted cycling by using near infrared spectroscopy (NIRS). Therefore this study investigates the effects of different intensity levels of electrical stimulation during passive cycling on cortical activation using multichannel NIRS covering premotor cortex (PMC), supplementary motor area (SMA), sensorimotor cortex (SMC), and secondary sensory cortex (S2) regions. Normal subjects were first recruited to develop a autodetermination of dead spots and electrical stimulation ranges. Theoretical dead spots were measured by horizontal and vertical distances of hip joint and crank center. Experimental dead spots were obtained from torque value during passive cycling for 10 seconds. The result showed that there is no significant differences between the two methods. It indicated that the use of passive cycling for 10 s is capable of determining dead spots and electrical stimulation ranges. Electromyography measurement is needed to verify muscle activation pattern and hypothesized electrical stimulation ranges. Then, sixteen subjects, including nine stroke patients and seven normal subjects, were instructed to perform passive cycling driven by an ergometer at a pace of 50 rpm under conditions without (NES) and with low-intensity electrical stimulation (LES) at 10 mA and high-intensity electrical stimulation (HES) at 30 mA. Changes in oxyhemoglobin in different brain regions and the derived interhemispheric correlation coefficient (IHCC) representing the symmetry in response of two hemispheres were evaluated to observe cortical activation and cerebral autoregulation. Our results showed that cortical activation of normal subjects exhibited overall deactivations in HES compared with that under LES and NES. In stroke patients, bilateral S2 activated significantly greater under LES compared with those under NES and HES. The IHCC of the normal group displayed a significant higher value in SMC compared to that of the stroke group. Our study utilized noninvasive NIRS to observe hemodynamic changes and bilateral autoregulation symmetry from IHCC suggesting that passive cycling with low-intensity electrical stimulation could better facilitate cortical activation compared with that obtained with no or high-intensity electrical stimulation. The results of this study could provide general guidelines to simplify the settings of electrical stimulation-assisted-passive cycling in clinical use. The findings of our study can be adopted in neurorehabilitation program in the future and implanted into the brain-based neurorehabilitation medical device using electrical stimulation assisted cycling for stroke patients.

摘要 IV
Abstract VI
致謝 IX
Table of Contents X
List of Figure XIIII
List of Table XV
Chapter 1 Introduction 1
1.1 Stroke 1
1.2 Passive cycling 2
1.3 Electrical stimulation-assisted cycling 3
1.4 Timing for electrical stimulation 4
1.5 Electrical stimulation intensity 6
1.6 Non-invasive measurement for brain information 8
1.7 Near infrared spectroscopy (NIRS) 9
1.8 Cortical activation during cycling 11
1.9 Symmetrical Evaluation of stroke 12
Chapter 2 Methods 15
2.1 Determination of dead spots 15
2.1.1 Theoretical dead spots 15
2.1.2 Experimental dead spots 17
2.1.3 Subjects and experimental procedure 18
2.1.4 Data analysis 18
2.2. Electrical stimulation-assisted cycling 19
2.2.1 System setup 19
2.2.2 NIRS recording 21
2.2.3 Subjects 23
2.2.4 Experimental procedure 23
2.2.5 Data analysis and statistical analysis 26
Chapter 3 Results 30
3.1 Comparison of the theoretical and experimental dead spots 30
3.2 Electrical stimulation assisted cycling 32
3.2.1 Subjects 32
3.2.3 IHCC for cerebral organization 38
Chapter 4. Discussion 42
4.1 Auto-determination of electrical stimulation ranges 42
4.2 Cortical activation during ES-assisted cycling 43
4.3 IHCC for cerebral organization 47
4.4 Study limitation 49
Chapter 5. Conclusion 50
References 53

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