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題名 | 結合軀幹侷限與分散式侷限誘發療法於中風後上肢復健之先驅研究=Effects of Combined Trunk Restraint with Distributed Constraint-Induced Therapy on Upper Limb Motor Performance in Patients with Stroke: A Pilot Study |
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作者 | 葉怡伶; 趙靜平; 吳菁宜; 林克忠; 蔡沛潔; 黃佩珍; 張雅棻; 游振弘; | 書刊名 | 臺灣職能治療研究與實務雜誌 |
卷期 | 6:2 2010.12[民99.12] |
頁次 | 頁90-99 |
分類號 | 418.996 |
關鍵詞 | 中風復健; 軀幹侷限; 侷限誘發療法; Stroke; Rehabilitation; Trunk restraint; Constraint-induced therapy; |
語文 | 中文(Chinese) |
中文摘要 | 目的:中風患者常使用代償方法,如使用影響較少的肢體或是軀幹來代償動作缺損,執行功能性活動。代償策略的過度依賴可能阻礙中風後之復原,為矯治中風後的上肢動作缺損,本研究合併軀幹侷限與分散式侷限誘發療法,來限制代償性軀幹動作,促進患側手的功能使用,並探討合併療法較之等治療量的傳統復健,是否帶來較佳之上肢動作與軀幹動作表現。方法:本研究募集14位慢性中風患者,隨機分派至合併療法組以及控制組,接受3週、每週5天、每天2小時之治療,以運動學分析以及渥夫動作功能測驗、動作活動日誌比較兩組治療之療效。運動學分析包括伸臂抓握位於125%手臂長之物體,肢段間協調度、軀幹代償度、以及關節活動度。結果:合併療法組在肩部前屈與手肘伸直之相關性、軀幹前屈與肩前屈之相關性、軀幹代償程度較控制組明顯的改善,其效應值達中至高度。臨床評估上,合併療法組在渥夫動作功能測驗平均品質分數、動作活動日誌優於控制組,呈現接近高度或高度效應。結論:相較於控制組,合併療法改善了中風患者上肢肢段間協調性,減少軀幹代償性動作,提升患肢使用量和使用品質。此研究顯示合併療法後,個案較能採行趨於正常上肢動作模式的控制策略。 |
英文摘要 | Objective: Stroke patients often use compensatory strategies to perform daily routines. Compensatory strategies include the use of the less affected side or excessive trunk movements to accomplish functional tasks. Research is needed to examine the effects of trunk restraint during practicing functional tasks on trunk compensation and on functional use of the affected upper limb (UL). This study was designed to investigate the effects of trunk restraint combined with constraint- induced therapy, relative to conventional rehabilitation, on UL motor function and trunk control in patients with stroke. Methods: Fourteen chronic stroke patients were randomly assigned to receive trunk restraint combined with distributed constraint-induced therapy (the combined therapy group) or traditional rehabilitation (the control group). Both groups received 3-week intensive therapy and evaluation was performed before and after intervention. Outcome measures included kinematic analysis of reaching-to-grasp task with target located at 125% of arm length,, the Motor Activity Log (MAL), and the Wolf Motor Function Test (WMFT). Kinematic measures include inter-segment coordination, trunk involvement, and range of motion during a reach-to-grasp task. Results: The results showed moderate to large effects on the correlation of shoulder and elbow, the correlation of shoulder and trunk, trunk compensation in favor of the combined therapy. The results showed large effects on clinical measures. Patients in the combined group had higher WMFT quality scores and MAL scores after training than the control group. Conclusion: This research showed the benefits of constraint-induced therapy combined with trunk restraint on facilitating typical motor patterns and improving movement quality in patients with chronic stroke. The findings indicate that the combined therapy may produce treatment effects by reducing motor impairment, rather than improving functional outcomes by means of the use of compensatory strategies. |
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