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題 名 | 雙手與單手伸手及物對中風患者饇動作影響之運動學分析=The Effects of Bilateral and Unilateral Reaching on Trunk Movement in Stroke Patients--A Kinematic Analysis |
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作 者 | 林婷瑩; 董玟伶; 郭藍遠; 張增瑩; 張志仲; | 書刊名 | 職能治療學會雜誌 |
卷 期 | 23 民94.10 |
頁 次 | 頁38-48 |
分類號 | 418.996 |
關鍵詞 | 中風; 運動學分析; 伸手及物; 軀幹動作; Stroke; Kinematic analysis; Reaching; Trunk movement; |
語 文 | 中文(Chinese) |
中文摘要 | 中風病人在亞急性期的軀幹控制能力是預測病人出院復日常生活功能恢復的重要因素之一,因此提升病人的軀幹控制能力以儲備病人的職能功能是職能治療的主要早期治療目標之一。本研究探討中風病患分別使用雙手交握與健側單手方式往健側及患側伸手及物時的軀幹動作軌跡,並以運動學方式分析四種不同伸手及物情境是否會產生不同的軀幹動作改變,以期能將研究結果應用於治療活動分級。研究共收集15位單側中風患者(平均年齡為57.00±11.83歲;男性7位,女性8位),個案以隨機順序方式執行下列四種伸手及物運動情境:(1)健側單手伸及患側的目標物(2)健側單手伸及健側的目標物(3)雙手交握同時伸及患側的目標(4)雙手交握同時伸及健側的目標物。利用三度空間動作分析儀記錄分析個案在各情境中的軀幹運動軌跡變化並計算出軀幹的運動學參數而加以分析,最後資料統計則採用重複性變異數分析。結果顯示,統計學上有顯著差別的變項包括最大速度、軀幹向前移動路徑長、軀幹旋轉角度及標準化急動值等(P<0.05)。經事後比較分析發現,雙手較單手伸手及物的情境可得到較大的最大速度、較長的軀幹移動路徑。健側單手向患側碰觸目標物的情境較雙手操作的兩情境得到軀幹旋轉角度較大。單手往健側碰觸目標物較雙手操作的情境得到的平順度較佳。在雙手伸手及物的兩個情境中,各項動作參數並未達統計上的顯著性。本研究結果支持雙手同時及物的操作情境會比單手及物產生較大的活動需求,同時也會誘發較大的軀幹往前移動動作,本研究結果可提供給職能治療師在臨床上的活動分級參考依據,並提供擬訂適切治療性活動的參考。 |
英文摘要 | Trunk control ability, in sub-acute stage, is a significant predictor of discharged activities of daily living function in stroke patients. One of the early treatment goals in occupational therapy for stroke patients is to improve the ability of trunk control for the preparation of independence in occupational performance. This study, by using kinematic analysis method, investigated the changes of trunk movement trajectories during four experimental reaching tasks in order to analyze the gradation level of trunk movement during unilateral and bilateral reaching for patients with unilateral stroke. Fifteen unilateral stroke patients (mean age=57.00±11.83 y/o; 7 males, 8 females) were recruited in this study. Subjects were asked to perform the following four experimental reaching tasks in sitting position with random order: (1) unaffected upper limb reaching to the cone located in the ipsilateral workspace; (2) unaffected upper limb reaching to the cone located in the contralateral workspace; (3) both hands clasped and bilateral upper limbs reaching to the cone located in the ipsilateral workspace; (4) both hands clasped and bilateral upper limbs reaching to the cone located in the contralateral workspace. The trajectories of the subject's trunk movement were recorded with a three-dimensional motion analysis system (Visualeyez(superscript TM) Hardware, Canada) during reaching. The trunk trajectories were computed and final data were analyzed with repeated measures ANOVAs. The results showed that significant differences in trunk movement kinematics, among the four experimental reaching tasks, were maximal reaching velocity, trunk curve line value, trunk rotational angle, and normalized jerk score of the trunk movements (p<0.05). Post hoc analysis revealed that subjects showed significantly greater maximal velocity, trunk curve line value and normalized jerk score of the trunk movement in bilateral reaching tasks than in unilateral reaching tasks. Subjects showed the greatest trunk rotational angle while using unaffected upper limb reaching to the cone located in the contralateral workspace. There were no significant differences in kinematics of trunk movement between contralateral and ipsilateral bilateral reaching tasks. Our study suggested that bilateral reaching tasks would add higher task-demands to stroke patients and might induce more trunk forward movements when comparing to unilateral reaching tasks. Findings from this study provide guideline on activity gradation for occupational therapists to set a challengeable therapeutic activity for stroke patients. |
本系統中英文摘要資訊取自各篇刊載內容。