機器輔助療法合併功能性電刺激於慢性中風病人動作控制及移行能力之療效

Abstract

目的：比較機器輔助治療合併功能性電刺激、機器輔助治療合併安慰性電刺激及劑量配對之控制介入對慢性中風病人上肢動作功能與移行能力之療效。 方法：本研究為隨機控制試驗，29名受試者接受每天90-100分鐘、每週5天、共20次之治療。療效評量包含－梅爾評估量表上肢次量表（Upper Extremities of Fugl-Meyer Assessment, FMA-UE）、運動學分析及十公尺行走測驗（10-Meter Walking Test, 10MWT）。 結果：與其他兩組相比，機器輔助治療合併功能性電刺激可減少及物動作中肩關節（partial η2=.080）及軀幹（partial η2=.074）之代償動作，並改善行走時患側上肢與健側下肢的協調（partial η2=.077）。機器輔助治療合併安慰性電刺激亦可減少及物時軀幹（partial η2=.087）之代償動作，並減少健側上肢與患側下肢於行走時擺動的時間差（partial η2=.182）。機器輔助治療合併功能性電刺激或安慰性電刺激皆可改善及物時肩關節與肘關節之協調性（partial η2=.147）、行走速度（partial η2=.086）及步距（partial η2=.188）。控制介入組較其他兩組可改善上肢動作功能（P<.05）、較可使用前饋機制（partial η2=.105）及伸直肘關節（partial η2=.100）執行及物動作。控制介入亦可改善行走時健側上肢與對側下肢擺動之時間差（partial η2=.076）。 結論：機器輔助治療合併功能性電刺激或安慰性電刺激可提升及物時肩肘關節之協調並減少代償動作，亦可改善中風病人之移行能力。控制介入可改善動作功能損傷，但無法減少肩關節或軀幹之代償動作。

Objectives: To compare the effects of robot-assisted therapy combined with functional electrical stimulation (RTES), robot-assisted therapy combined with placebo stimulation (RTPS) and control intervention (CI) on upper-limb motor functions and mobility in patients with chronic stroke. Methods: This research was a randomized controlled trial. 29 participants received one of the three treatment program for 90-100 minutes per day, 5 days per week, for four weeks. Fugl-Meyer Assessment of Upper Extremity (FMA-UE), movement kinematics and 10-meter Walk Test (10MWT) were outcome measures. FMA-UE and goal-directed reaching kinematics were used for upper-limb motor function assessment. 10MWT and waking kinematics were used to assess mobility. Adverse effects were measured with Visual Analogue Scale (VAS) in pain and fatigue rating. Results: The RTES group showed less compensatory movement of shoulder (partial η2=.080), less trunk compensation in the middle part of reaching (partial η2=.074) and the better arm-leg coordination of the affected shoulder and the contralateral hip (partial η2=.077) than the two other groups. The RTPS group showed partially similar outcomes to the RTES. The RTPS could reduce the trunk compensation during the end part of reaching (partial η2=.087) and reduce the time lag between the unaffected shoulder and the affected hip swing (partial η2=.182). Both RTES and RTPS could enhance the coordination of the joint angle of shoulder flexion and the elbow extension in reaching (partial η2=.147), walking speed (partial η2=.086) and stride length (partial η2=.188). The CI could significantly improve the scores of FMA-UE (P<.05) and had large effect on the proximal part of FMA-UE (partial η2=.183). The CI group also showed preplanned motor strategy (partial η2=.105), improvement in elbow extension (partial η2=.100) during reaching, and less time lag between the affected shoulder and the unaffected hip (partial η2=.076). Conclusions: Compared with the CI group, the RTES and the RTPS group performed less compensatory movement during reaching, better coordination of the shoulder and the elbow joint and better walking performance. CI could reduce motor impairment but could not prevent compensatory movement during reaching task.