鏡像治療與等量傳統復健於慢性中風個案之對比試驗

Abstract

背景: 中風後的半側偏癱以及感覺缺失常造成中風病患上肢動作缺失及生活失能的常見原因。半側偏癱外，習得廢用現象常出現於中風病患，呈現了日常生活中患側手的功能使用頻率與品質低落，並對中風後的復原帶來不利影響。臨床上常規使用的復健療法外，近年有諸多新興的神經復健療法，其中鏡像治療對中風患者的上肢動作再學習感覺復原的成效漸受重視且極需驗證。本研究使用隨機試驗探討鏡像治療方法對中風患者在各種功能面向的成效差異，以建立有效的動作復健方案。 方法: 本研究採取隨機對照試驗之方法，由北部醫院之復健部門募集24位同意參與實驗之慢性中風參與者，並隨機分派至鏡像治療 (n=12)以及等量傳統復健組 (n=12)。兩組受試者皆接受職能治療師所提供的等量治療介入，每天1.5小時，每週五天，共四週。在治療前後，利用臨床評估工具以及運動學分析評估受試之上肢感覺動作表現、生活功能及中風相關生活品質。 結果: 鏡像治療組相較於等量配對傳統復健組於治療後有較佳的感覺動作復原。在執行單手伸臂按鈴動作時，鏡像治療組表現出較流暢及準確的動作控制策略。劑量配對控制組相較於鏡像治療組於治療後則表現較佳的功能性能力。 討論: 鏡像治療法可改善慢性中風病患側上肢感覺動作復原能力及動作控制策略，使個案表現出流暢及準確的動作，並同時減少上肢代償動作。

Background: The loss of upper extremity control and sensory deficits are common impairment after stroke. As a consequence of paresis, poor motor control and sensory dysfunction of affected upper extremity, “learned nonuse phenomenon” is often seen in stroke patients. Most of the traditional rehabilitations lack of evidences to exam the efficacy of motor recovery and sensory deficits on stroke patients. To date, an alternative intervention, mirror therapy (MT), which might have activation changes in the primary motor cortex with somatosensory input has been getting much attention in stroke rehabilitation recently. The study investigated the effects of MT on sensorimotor recovery, functional abilities and motor strategy compared with dose-match control intervention (CI). Methods: The design of this study was randomized pretest and posttest control trial. Participants were individually randomized to MT (n=12) or CI group (n=12).The clinical measures at pre-treatment and post-treatment were evaluated by a certified rater who was trained before performed the evaluation of clinical measures. The 24 participants were recruited, screened, enrolled and randomized from the rehabilitation department of participating hospitals in Taiwan. Both group received intensive training for 1.5 hours/day, 5 days/week, for 4 weeks. The clinical and kinematic measures were administered before and after the 4-weeks intervention immediately. Results: The MT group showed better improvement in sensorimotor recovery compared with CI. Additionally, MT group also showed the smoother and accuracy movement with less compensatory pattern during unilateral task rather than bilateral task. However, the patents in the CI group showed the better improvement on bimanual function and manual dexterity. Conclusions: The study provides the evidence that MT could lead to better sensorimotor recovery and motor control of affected upper extremity in chronic stroke patients rather than functional abilities.