頸椎脊髓神經病變患者於頸椎減壓手術後接受干擾式平衡訓練之效果

Abstract

背景: 頸椎脊髓神經病變患者於頸椎減壓手術後，有些患者仍存在平衡與功能損傷。干擾式平衡訓練能有益於老年人與神經性疾患患者的平衡與功能性表現。然而，目前未有臨床研究應用干擾式平衡訓練，於頸椎減壓手術後之頸椎脊髓神經病變患者。 目的：探討干擾式平衡訓練對頸椎減壓手術後之頸椎脊髓神經病變患者，於平衡與功能性表現之效果。 實驗設計：兩組設計的前瞻性控制臨床試驗。 實驗方法： 本實驗招募十五名頸椎減壓手術後之頸椎脊髓神經病變患者 (DCM組)與十四名年齡相符的健康成年人 (健康控制組)。DCM組接受為期四週的干擾式平衡訓練。靜態姿勢控制是以平地張眼與閉眼站立之足底壓力中心搖晃速度進行評估。動態姿勢控制是以靜止站立加上平衡干擾的質心變異度與反應時間進行評估。功能性表現以平地行走的行走速度與質心－重心傾斜角度，以及計時坐站起走測試與肌力測試進行評估。功能性問卷則包含視覺類比量表、頸部失能量表，以及日本骨科學會頸椎脊髓神經病變評估問卷之下肢功能。DCM組在前測與後測進行兩次評估，健康控制組則只進行一次評估。 實驗結果： DCM組於訓練後，閉眼時足底壓力中心的搖晃速度、質心變異度、反應時間、行走速度及計時坐站起走測試皆有顯著進步，張眼時足底壓力中心的搖晃速度、質心－重心傾斜角度、肌力與功能性問卷則無顯著變化。DCM組與健康控制組之組間比較，兩組於前測的顯著差異，在後測皆未達統計顯著水準，除了張眼時足底壓力中心的搖晃速度、冠狀面的質心－重心傾斜角度與肌力以外。 結論：四周的干擾式平衡訓練，為頸椎減壓手術後之頸椎脊髓神經病變患者可行的平衡復健介入，以改善其平衡與功能損傷。此外，本實驗可提供未來欲探討其他平衡失調患者之研究，一個可行的參考訓練計畫。然而，針對步寬大的行走策略仍須進一步的調整介入，以達到更有效率行走方式。

Background: Patients with degenerative cervical myelopathy (DCM) may still present with balance and functional impairments after surgery. Perturbation-based balance training had positive effects on balance and functional performance in elderly population and patients with neurological disorders. However, no study so far had conducted perturbation-based balance training in postoperative patients with DCM. Purpose: To evaluate the effects of perturbation-based balance training on balance and functional performance in postoperative patients with DCM. Design: A two-arm prospective controlled clinical trial. Methods: Fifteen postoperative patients with DCM (DCM group) and 14 age-matched healthy adults (healthy control group) were recruited in the study. The DCM group received a 4-week perturbation-based balance training using a perturbation treadmill. The static postural control was assessed by mean velocity of center of pressure (COP) during quiet standing with eyes open and eyes closed. The dynamic postural control was assessed by center of mass (COM) variance and reaction time during standing with perturbation. The functional performance was assessed by gait speed and COM-COP inclination angle during level-ground walking, as well as the Timed Up and Go Test (TUG) performance and the muscle strength. The disability questionnaires included Visual Analog Scale, Neck Disability Index, and Lower Extremity Function of Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire. The assessments were conducted pre-test and post-test for DCM group but only once for the healthy control group. Results: In the DCM group, significant improvements after training were observed in the mean velocity of COP in eyes closed condition, COM variance, reaction time, gait speed, and TUG performance. The mean velocity of COP in eyes open condition, COM-COP inclination angles, muscle strength, and the disability questionnaires did not change significantly. For between-group comparisons, significant differences that were observed pre-test were not observed post-test, except for the mean velocity of COP in eyes open condition, COM-COP inclination angle in the frontal plane, and muscle strength. Conclusion: The 4-week perturbation-based balance training is a potential rehabilitation strategy for addressing balance and functional impairments in postoperative patients with DCM. In addition, the training regimens offer a practical reference for future studies on populations with balance disorders. However, further intervention for the wide-based gait is needed to enhance the ambulation efficiency in postoperative patients with DCM