慢性中風患者身體補償與協同動作之動作分析與評估

Abstract

本研究的目的為評估慢性中風患者上肢動作之協調性與身體代償動作。慢性中風受試者與健康受試者各九位，以自選之速度執行順時鐘追跡圓形軌跡的功能性動作。我們發展了一套客觀的評估系統，用以評量受試者執行此功能運動時上肢動作之功能，並與臨床習用之量表作比較。中風患者依賴軀幹的代償來完成目標的動作；若沒有軀幹之代償，中風受試者其端點運動呈現了較小的軌跡內面積。此外，端點運動軌跡圓之傾斜角度與身體代償有著相關性。在肩、肘關節之協調運動上，健康受試者族群依著規律的肩肘關節運動方向的變化以完成動作，而中風患者族群中則未見規律之變化，運動方向變化的頻率較健康族群顯著地多，並與臨床之評量有相關。

Background and purpose. Following brain lesions, stroke patients suffered limited arm movements. Our study aimed to investigate the trunk compensation and inter-joint coordination of unilateral upper limb movements in able-bodied and hemiparetic groups on a circle tracing task. Methods. Nine able-bodied subjects and nine hemiparetic subjects were recruited in the study. Participants were asked to trace a circle on a table, at a self-selected pace. An evaluation framework was established to investigate features of trunk recruitments and inter-joint coordination. Correlation among features and clinical assessment scores were then investigated. Results. Hemiparetic participants accomplished the circle tracing task with more trunk recruitments, accompanied with abnormal movement pattern of shoulder and elbow. More switch times of movements directions in the hemiparetic group was also quantified in the study. The axis ratio of the tracing trajectory without trunk compensation was correlated with the amount of executing shoulder adduction and elbow extension on hemiparetic subjects. The orientation of the tracing trajectory was correlated with the degrees of trunk compensation. Conclusions. A framework to evaluate trunk compensation and inter-joint coordination was suggested. The effect of trunk involvement on the tracing trajectory was quantified. Among the hemiparetic group, trunk compensation might be relevant to the orientation angles of the trajectory. In addition, the outcomes of shoulder adduction and elbow extension combination might be relevant to the axis ratio of the tracing trajectory without trunk compensation.