臺灣博碩士論文加值系統

中風後造成上肢自主動作控制受損會影響病患之日常生活的獨立程度，所以上肢的運動及功能之重建一直是復健治療的重點。傳統的中風患者上肢的治療介入缺乏上肢遠端之手部肌肉的特殊主動活動的運動訓練，因此加入肌電回饋引發功能性電刺激訓練可使患者主動參與動作，加速運動學習的效果。另外，選取適當的評估工具來評估患者單手代償動作與雙手在功能上的差異，可減少對研究結果的誤判。因此，本研究使用較適合的上肢運動及功能評估量表來評估肌電回饋引發功能性電刺激治療對發病超過半年之中風病人偏癱上肢運動與功能恢復之療效。
本研究共有十位中風患者參與，每位患者均接受每週二至三次、每次半小時，為期兩個月，平均每位受試者接受19.8次之肌電回饋引發功能性電刺激治療，於實驗前、後以手臂動作探討測試(Action Research Arm Test, 簡稱ARAT) 評估上肢功能、費格-麥爾評估工具(Fugl-Meyer Assessment, 簡稱FM)評估上肢運動、以及巴氏量表(Barthel Index)評估日常生活獨立情況。所有參與患者之例行物理治療、職能治療仍持續。
以配對-t檢定結果顯示： FM評估量表、ARAT評估量表中之 “抓”、 ”握”、 “捏” 細項、及ARAT上肢功能評估量表之總分之p值均小於 0.05，有顯著差異。而ARAT上肢功能評估量表中之 ”粗動作” 細項及巴氏量表前後無顯著差異。另外，每位受試者治療前後三次主動翹腕或伸直手指之最大肌電活動能力之前後差異平均值以配對-t檢定P值均小於 0.05，有顯著差異。
此結果支持肌電回饋引發功能性電刺激治療對於慢性中風患者能促進手部抓、握、捏等功能及運動能力改善。

The impairment of upper extremity voluntary movement control cause by stroke will have great influence on the independency of daily activity. Therefore, the rehabilitation of upper extremity motor and functional recovery is one of the most important aspect of treatment. Lack of the specific voluntary movement control interventions of distal part hand muscle in stroke patients. Therefore, present study tried of electromyography triggered functional electrical stimulation (EMG-FES) make patient performing wrist and finger extension voluntary movement and have improvement of the motor learning. Furthermore, this study used appropicate assessment tool to evaluate the difference function of both hand, so as to could reduce the mistake of judement. Therefore, this study will evaluate the upper extremity motor and functional recovery by using suitable assessment scale for EMG-FES treated patients who suffered from stroke for more than 6 months.
There were 10 patients participated in this study. All of the patients received half an hour per section EMG-FES treatment and total average 19.8 sections for 2 months . Before and after EMG-FES treatment the motor and function of upper extremity of the patients were evaluated by Action Research Arm test (ARAT) and Fugl-Meyer assessment, and the independency of ADL were evaluated by Barthel index . The routine treatment, such as physical and occupational therapy were continued.
The paired-t statistics test result showed significant differences in all of the assessment scales, such as Fugl-Meyer assessment and the grasp, grip, pinch subscale of ARAT assessment (p <0.05). The gross motor subscale of ARAT assessment and the Barthel index showed no significant difference (p>0.05). Before and after EMG-FES treatment, all of the subjects performed three maximal voluntary wrist or finger extension, and the difference of average EMG activity was tested by paired-t statistics test showed significant difference (p <0.05).
The results support that EMG-FES treatment will benefit chronic stroke patients and will improve the hand motor ability and function such as grasp, grip and pinch .

第壹章 緒論……………………………………………………………01
第一節 研究動機……………………………………………….01
第二節 研究目的……………………………………………….03
第三節 研究假設……………………………………………….03
第貳章 文獻回顧………………………………………………………05
第一節 中風後上肢功能之缺損……………………………….05
第二節 偏癱上肢之治療……………………………………….06
第三節 肌電回饋引發功能性電刺激之神經機轉…………….09
第四節 評估工具……………………………………………….11
第參章 材料與方法……………………………………………………14
第一節 研究對象……………………………………………….14
第二節 儀器設備……………………………………………….14
第三節 測量參數與評估工具………………………………….15
第四節 治療介入……………………………………………….19
第五節 操作行定義…………………………………………….22
第六節 統計分析……………………………………………….22
第四章 結果……………………………………………………………23
第一節 上肢功能狀況之評估結果……………………………...23
第二節 上肢運動能力之評估結果……………………………...24
第五章 討論…………………………………………………………..25
第六章 結論與臨床應用……………………………………………..30
參考文獻………………………………………………………………..31
表………………………………………………………………………..36
圖………………………………………………………………………..41
附錄
附錄一：實驗同意書……………………………………………………43
附錄二：巴氏量表………………………………………………………44
附錄三：F M評估量表…………………………………………………45
附錄四：ARAT評估量表………………………………………………48
附錄五：病患基本資料調查表…………………………………………50
附錄六：肌電回饋引發功能性電刺激儀器Automove AM800………52

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