| Abstract: | 背景與目的：為了瞭解姿勢控制與行走使用輔助器是否有注意力需求，常使用雙重任務來進行測試，兩個任務共享注意力資源可能表現變差。Fitts and Posner認為動作學習要經過認知期、連結期、自動化期，注意力在此過程需求也會從高到低。本研究欲了解剛學習拿柺學習行走的亞急性期中風患者動作控制、生活自理能力、雙重任務成本是否隨時間進步以及雙重任務成本與其他變項之相關性。
方法：12位住院中風患者，年齡平均60.4±10.8歲，性別(男性8人/女性4人)，中風發生天數平均73.1±31.0天，於第0、1、2、4及8週進行施測，第0週為治療師判斷病患拿拐杖（單或四腳拐）可獨立行走7.3公尺。單/雙重任務測試，個別執行及同時執行拿柺7.3公尺行走任務及算數任務，算術從1-100之間隨機選擇數字連續減1(簡單)和減3(困難)。計算行走速度的雙重任務成本[（簡單雙重任務表現-困難雙重任務表現）/簡單雙重任務表現]×100%。另外從斜率看雙重任務成本每天的變化量（最後一週雙重任務成本-第0週）/（最後一週天數-第0週天數）。
結果：重複測量前3週，福格邁爾-下肢分數（P=0.001）、巴氏量表（P=0.001）、計時起走測試時間（P=0.015）、簡單（P=0.012）及困難（P=0.004）雙重任務行走速度隨著時間顯著進步，雙重任務成本無顯著進步（P=0.459）。斜率看雙重任務成本每天的變化，有8位患者呈現進步的趨勢。雙重任務成本與中風發生天數呈現顯著中度負相關（r=-0.499，P<0.001）。
結論：亞急性中風患者隨著時間恢復與治療，下肢動作控制、行走速度及生活自理能力持續進步。剛學習拿拐杖行走所需的雙重任務成本從統計圖來看是呈現下降趨勢，而斜率有8位患者呈現進步的趨勢，與中風發生天數呈現中度負相關，表示隨著時間恢復與復健將可能會使的中風患者可以越來越有效率的分配並且同時執行任務。未來應該增加樣本數及追蹤時間才能看見更明顯的變化。
Objective：Dual task paradigm is often used to explore the attentional demand in posture control and walking using assistive devices, in which a share of attention resources may be evidenced by deteriorated performance of either task. Fitts and Posner proposed three stages of motor learning, that is cognitive, associative, and autonomous, which means that attentional demand of motor learning changes from high to low. This study aimed to explore the longitudinal changes of attentional demand of cane use in patients with subacute stroke who just learned to walk.
Methods：12 subjects, 8 males and 4 females with average age 60.4±10.8 years and average stroke onset days 73.1±31.0, were tested at the 0, 1, 2, 4, and 8st week. The 0 week was defined as when their physical therapists judged that they could walk with a single or quad cane by themselves for 7.3 meters. Participants were tested for single- and dual-task walking conditions; the latter involved simultaneous execution of continuous subtraction by one (low task) or three (high task) from a random number between one and a hundred. The index of dual-task cost of walking velocity was [（low dual task-high dual task）/low dual task] ×100%, and the slope of daily change of dual-task cost was（dual-task cost in the last week - dual-task cost in the first week）/(differences in days between the last and first week).
Results：In the first three weeks, the Fugl-Meyer lower extremity（P=0.001）, Barthel Index（P=0.001）, Timed Up and Go test（P=0.015）, and low（P=0.012）and high（P=0.004）dual task walking velocity significantly improved over time, but the dual-task cost of walking velocity did not（P=0.459）. Eight patients showed a trend of improvement in the slope of daily change of dual-task cost. There was negative correlation between the dual-task cost and stroke onset days（r=-0.499, P<0.001）.
Conclusions：In the initial learning phase of cane use in subacute stroke patients, improvements of motor control, self care, and functional mobility were evident. The dual-task cost of walking velocity showed a downward trend, which could be seen in 8 patients. With more stroke onset days, the dual-task cost decreased, showing a moderately negative relationship. In the future, the sample number should be increased to see more obvious changes. |
