| Abstract: | 肌肉張常是上運動經元損傷患者床上常的表徵，如腦中風患者的肌肉痙攣。影響肌肉張的因素包括有牽張反射過強，會有過多的經肌肉反應及正常的阻增加，因為肌肉痙攣或是關節活動會導致正常的肌肉活動，無法產生適當的肌肉動作型態，導致患者產生對稱的動作型態，因此，如何抑制正常的肌張是患者回功能性活動很重要的一部分。踩運動是一種多關節且有協調交替性、對稱性的側下肢運動，並且可以對於下肢關節提供被動張的運動以低正常張，在踩運動中，可以提供與動作表現相關的功能性測試，產生側下肢續交替且對稱之多關節協調性動作。在這樣的活動中，僅可以提供被動的關節伸張活動，也能增加下肢肌肉的自主收縮的活動。用功能性電激使脊髓損傷者或中風者的肌肉收縮帶動下肢動作已發展一段時間，之前有學者結合踩運動及功能性電激，續發展出各式的功能性電激踩系統，而本研究團隊在這方面之研發也已有相當的成果，但目前之功能性電激踩系統均適用於脊髓損傷患者，今本計畫主持人已將其應用於中風患者，並有初步成果，因此，本研究團隊基於之前之研發能，希望以三的研究時間，成功的開發出一部「虛擬實境電激踩系統」以造廣大之中風患者。
neuron lesion, such as stroke, traumatic brain injury, cerebral palsy etc. Conventionally, spasticity is defined as “a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex.” In addition to the increased motoneuron excitability, researchers have also reported the alternation in mechanical properties of the spastic limb that should be one of the major considerations for clinical interventions. In the course of physical rehabilitation, Functional Electrical Stimulation-cycling exercise has been widely used to improve the cardiopulmonary condition, increase the muscle volume and suppress the hyperreflexia. Literature has documented that while performing passive cycling movement, the soleus H-reflex of both normal people and patients who suffer from spinal cord injury is suppressed in initial phase. Institute of Biomedical Engineering, NCKU had developed a series of FES-cycling systems. The system had achieved stable on controller of functional Electro-stimulation after test, such as electric current output, stimulating frequency, type of stimulation and cycling resistance. But the part of Man-Machine Interface still needs to be improved. Besides, those systems were suitable for spinal cord injury subjects not for the stroke subjects. As the motivation of specific for stroke subjects, Man-Machine Interface, we will mainly aim at stroke to have a Virtual Reality FES-cycling (VR-FES cycling) system during this study. In this year (2007), we evaluate the clinical effects of the FES-cycling system for CVA subjects and the satisfaction for subjects and therapists. The preliminary results present that the hypertonia is suppressed and the balance improves after cycling for 20 minutes. The grades of satisfaction for subjects and therapists are high but the items of mode of FES and the fixation of subject’s lower extremity. In our study, the aim of the first year is the setup of the CVA-cycling system. The aims of the second year are to evaluate the clinical effects of the CVA-cycling system for stroke and the setup of the Virtual Reality system. Finally, the aims of the third year are the integration of the CVA-cycling system and the Virtual Reality system, the completion of the pilot study about the clinical effects of the VR-FES cycling system. |
