| Abstract: | 已經有數篇研究針對中風病人使用本體感覺刺激（somatosensory stimulation, SSS）的治療，證實在平衡、動作表現、及日常生活上均有一定的效果。但因研究設計不一，還沒辦法提供明確的證據來證明如經皮神經電刺激（transcutaneous electrical nerve stimulation, TENS）或針灸（acupuncture）等治療對中風患者的平衡表現有改善的情形。而近年來針對中風患者的SSS新趨勢為使用全身振動模式（wholebody vibration, WBV）於中風復健上。考量使用WBV的原因有下列幾點：（1）WBV為較深層的感覺刺激方法，相較於TENS或針灸等較表淺的刺激更能刺激到Ia及II控制的較大肌群。（2）WBV提供兩側的刺激，可能引起中風患者兩側大腦的塑性變化（plastic changes）。（3）WBV提供的感覺刺激由足底傳入，此種刺激輸入在姿勢控制上扮演重要的角色。（4）WBV研究也被廣泛的運用於運動、老人醫學領域上或的一些療效證實。 WBV的設備已經設計的相當簡便使用，可以站姿、坐姿或甚至直接分別使用於上下肢均可，因此本研究希望能將WBV加入常規復健治療計畫中，針對亞急性期及慢性期中風患者的平衡控制、動作恢復、日常生活功能之表現來探討，WBV對中風患者復健治療上是否提供助益。國內尚無相關研究發表，本三年期研究計畫預計將分別探討WBV對亞急性、慢性期中風患者的平衡表現、上下肢動作恢復、行走能力表現、上下肢α運動神經元的興奮程度、日常生活功能表現等成果評量的影響做一系列研究。將可作為WBV於臨床使用的療效驗證，並提出完整之報告供臨床醫師、治療師做一選擇WBV訓練的依據。
Several studies have claimed beneficial effects of somatosensory stimulation (SSS) in patients with
stroke in terms of balance, motor performance, and activities of daily living. These studies described both
short-term (< 1 hour) and long-term (> 6 weeks) results of SSS in different phases post-stroke. However,
well-controlled randomized, controlled trials and reviews did not show clear evidence of beneficial effects
of transcutaneous electrical nerve stimulation or acupuncture on balance in patients with stroke. Yet, these
recent insights do not preclude beneficial effects of other forms of SSS in (post) acute stroke
rehabilitation.
A relatively novel form of SSS that shows considerable promises for the rehabilitation of stroke
patients is whole body vibration (WBV). To underscore this notion, four important considerations can be
given. First, WBV is a deeper way of sensory stimulation compared with the more superficial modes such
as acupuncture and transcutaneous electrical nerve stimulation, targeting the Ia and II afferents of (large)
muscle groups. Second, WBV provides bilateral stimulation, which may induce plastic changes in both
hemispheres after stroke. Third, WBV induces sensory stimulation of foot-sole afferents as well, which
afferents are well known to play an important role in postural control. Lastly, WBV research in general
has shown promising results in various domains of sports and geriatric medicine. In addition, there is
preliminary evidence for short-term effects (< 1 hour) of WBV on postural stability in patients with
chronic stroke.
Therefore, the purpose of this study was to investigate whether WBV, added to regular rehabilitation,
has beneficial effects on balance control and activities of daily living in patients with subacute and chronic
stroke. We also tested whether such functional benefits coincide with improvements of strength, motor
recovery, H/M ratio, mobility and motor function of upper extremity. |
