痙攣型雙邊麻痺兒童在有無荷重兩種狀況下進行坐到站動作之生物力學特徵

Abstract

研究背景與目的:肌肉無力以及動作控制能力缺損是痙攣型雙邊麻痺兒童常見的問題。研究顯示荷重坐站阻力訓練對這些兒童在肌肉力量以及粗大動作能力方面有促進的效果，但是其機轉未知。探究荷重坐站阻力訓練效果的可能機轉之前，應當先檢驗雙邊麻痺兒童對於外加荷重的立即反應。本研究的目的便是透過運動學和動力學分析來探討痙攣型雙邊麻痺兒童荷重的立即反應。受試者:13位痙攣型雙邊麻痺兒童(106.5±26.8月，6男7女)和10位一般兒童(104.3±18.9月，7男3女)參與此研究。研究流程:本研究使用Vicon 250動作分析系統以及3塊AMTI力板進行資料蒐集。實驗分為兩天進行：第一天的實驗決定各個兒童的坐站一次最大荷重重量；第二天則進行在自然狀態以及荷重狀態（負荷50%坐站一次最大荷重重量）下的坐到站動作的運動學和動力學資料蒐集。之後進行動作策略、平順度、髖以及膝關節之最大伸直力矩和功率的計算，並比較之。結果：於運動學方面，腦性麻痺兒童所使用之動作策略和一般兒童無顯著差別，且外加荷重並不影響腦性麻痺兒童的動作策略。在自然狀況下，腦性麻痺兒童之動作平順度較一般兒童差；在荷重狀態下，部分腦性麻痺兒童在前後方向的動作平順度有改善。於動力學方面，腦性麻痺兒童的膝關節最大伸直力矩和功率皆較一般兒童低；在荷重狀態下，腦性麻痺兒童的髖關節和膝關節之最大伸直力矩都有增加，其中膝關節的伸直力矩提升到與一般兒童相當的程度。結論:在坐到站動作過程當中，中度荷重可以有效增加膝關節之伸直力矩，並改善部分腦性麻痺兒童在前後方向的動作控制，故中度荷重坐站可以作為臨床肌力訓練和促進坐站動作控制的方式。

Background and Purposes: Children with spastic diplegia are characterized with muscle weakness and poor movement control ability. The loaded sit-to-stand (STS) training has demonstrated its effects in improving these children’s knee extensor strength and gross motor ability. However, mechanisms underlying the training are still unclear. Prior to probe into possible mechanisms, immediate responses of these children to externally imposed load should be examined first. The purpose of this study is to explore the immediate effects of load on children with spastic diplegia, with kinematic and kinetic analysis. Subjects: Thirteen children with spastic diplegia (106.5±26.8 months, 6 males and 7 females) and ten age-matched typical children (104.3±18.9 months, 7 males and 3 females) participated in this study. Methods: The Vicon 250 motion analysis system and 3 AMTI force platforms were used to collect data of STS movements. The experiment took two separate days to accomplish. On the first day, the STS1RM of individual children was determined. On the second day, kinematic and kinetic data of STS movements in natural and loaded (applying load of 50% STS1RM during STS movements) conditions were collected. Data of strategies, smoothness, maximal extension moment and power around hip and knee joints were then calculated. Results: In the kinematic aspect, strategies used in children with spastic diplegia and in typical children did not differ statistically. External load did not influence strategies used in children with spastic diplegia. Children with spastic diplegia demonstrated less smooth STS movements than did typical children in the natural condition and some of the former group demonstrated smoother movements alone the anterior-posterior direction in the loaded condition. In the kinetic aspect, children with spastic diplegia demonstrated smaller maximal extension moment and power of knee joints than did typical children in the natural condition. In the loaded condition, both the maximal hip and knee extension moment increased and the maximal knee extension moment increased to the level of typical children. Conclusion: Applying the load of 50% STS1RM during STS movements increased knee moment and also improve anterior-posterior movement control in some children with spastic diplegia. The loaded STS training may be clinically used for strengthening and movement proficiency enhancement.