中風患者虛擬實境電刺激踩車系統之研發與臨床評估(I)

中山醫學大學機構典藏 CSMUIR > 醫學科技學院 > 物理治療學系暨碩士班 > 研究計劃 > Item 310902500/2274

Please use this identifier to cite or link to this item: https://ir.csmu.edu.tw:8080/ir/handle/310902500/2274

Title:	中風患者虛擬實境電刺激踩車系統之研發與臨床評估(I) Development Amd Clinical Evaluation of FES Cycling System with Virtual Reality for Stroke Patients(I)
Authors:	葉純妤;薛雅馨;陳家進;王淳厚;蔡昆宏
Contributors:	中山醫學大學：物理治療學系
Date:	2007
Issue Date:	2010-08-12T02:54:38Z (UTC)
Abstract:	中風是指突發性上運動神經元損傷的腦血管疾病。造成中風的病因是腦部組織因為得不到足夠的血液灌流以提供腦部營養而導致腦部機能缺失或者壞死，造成患者半邊癱瘓，無法產生適當的肌肉動作型態。而出現肌肉張力異常是上運動神經元損傷患者臨床上常見的表徵，如腦中風患者的肌肉痙攣。影響肌肉張力的因素包括有牽張反射過強，會有過多的神經肌肉反應及不正常的阻力增加，因為肌肉痙攣或是關節活動度會導致不正常的肌肉活動，無法產生適當的肌肉動作型態，導致患者產生不對稱的動作型態，因此，如何抑制不正常的肌張力是患者回復功能性活動很重要的一部分。踩車運動是一種多關節且有協調交替性、對稱性的兩側下肢運動，並且可以對於下肢關節提供被動拉張的運動以降低不正常張力，在踩車運動中，可以提供與動作表現相關的功能性測試，產生兩側下肢連續交替且對稱之多關節協調性動作。在這樣的活動中，不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。利用功能性電刺激使脊髓損傷者或中風者的肌肉收縮來帶動下肢動作已發展一段時間，之前有學者結合踩車運動及功能性電刺激，陸續發展出各式的功能性電刺激踩車系統，而本團隊在這方面之研發也已有相當的成果，但目前之功能性電刺激踩車系統均適用於脊髓損傷患者，因此，本研究團隊基於之前之研發能量，希望以四年的研究時間，成功的開發出一部「虛擬實境電刺激踩車系統」以造福廣大之中風患者。 For poststroke patients, increasing muscle tone and associated reaction in the paretic limbs sometimes disturb the activities of daily living. Patients with asymmetrical lower limb functions are difficult to perform continuous and smooth reciprocal movements in the lower limb, such as walking. For this reason, decay in cardiopulmonary function and muscle atrophy will also cause them much physical restrictions in the daily life. To enhance residual functions of patients with partial motor disorders, electrical stimulation (ES) combined with cycling exercise has been utilized as a rehabilitation technology recently. Mazzocchio and colleagues were the first investigators who reported on the ability to establish a target speed increased and H-reflex size decreased more after cycling training involving frequent changes in pedal resistance that required calibrated locomotor compensatory action than with training involving constant pedal resistances and lesser compensation. The degree of performance improvement correlated with the reduction in the amplitude of the H-reflex. But there were no detailed report in documents about the effects of muscle tone and functional standing balance with neural plastic changes after the pedaling exercise. Therefore, the purpose of this study was to investigate whether (1) a single bout cycling training with stroke can improve abnormal tone and functional standing balance of paretic leg; (2) ES to the paretic leg during cycling has more effects than cycling without ES. Material and Method: Eighteen stroke patients were recruited, 15 male and 3 female, all subjects gave informed consent as approved by the internal review board of the Chung Shan Medical University School of Medicine and were randomly devided into 2 groups. The experimental group (ES-LCE) performed leg cycling exercise with tolerable ES that evoked muscle contractions during a lower resistance and constant speed cycling training; to evaluate muscle tone and standing balance before and after the training period (20 min). The control group (LCE) received the same study protocol except the ES. In this study, we used the paired sample t-test to assess the changes between the baseline and post-test, and on the other hand the repeated measures ANCOVA was used to analysis the differences between groups. Results: The H/Mmax ratio was significantly decreased in ES-LCE (p= 0.027) and LCE (p= 0.004). The RI was significantly increased in the ES-LCE (p= 0.012), but not in the LCE (p= 0.078). Muscle strength was not significantly changed after training. Scores on the forward limits of stability (LOS) control improved (ie, the MXE increased in the ES-LCE (p= 0.012), and furthermore the significant improvements of RT (p= 0.044), MVL (p= 0.009) and EPE (p= 0.044) were in the LCE). On the other hand scores on the EPE, MXE, and DCL in the affected-ward trial were significantly improved in 2 groups. Training-induced temporal changes of H/Mmax , RI and LOS were no significant difference between the 2 groups. Discussion and Conclusion: This present study showed that a short cycling training program is an useful therapeutic intervention to reduce the muscle tone and to improve the standing balance control of lower paretic limb in patients with stroke. But the use of ES had no additional effects in this specific group of subjects with stroke.
URI:	https://ir.csmu.edu.tw:8080/handle/310902500/2274
Appears in Collections:	[物理治療學系暨碩士班] 研究計劃

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