機器前誘式鏡像治療與雙側上肢練習結合居家轉移練習方案於中風復健療效:先導性研究

Abstract

研究背景和目的：中風在台灣仍是主要健康照護負擔之一。當代的復健療法包含鏡像療法、雙肢練習，和機器輔助療法。雙側上肢練習及鏡像治療，皆基於雙側練習引發雙腦耦合的密集練習概念，唯鏡像治療較雙側上肢練習增加了由鏡像產生的視覺回饋。本研究的目的為探討雙側機器誘導雙側上肢練習與雙側機器誘導鏡像治療對慢性中風患者的感覺運動功能，日常功能，自我效能和生活質量的療效。 研究設計：採用隨機分派、單盲試驗設計，進行前測，後測和追蹤測評估。慢性中風患者被隨機分派至雙側機器誘導雙側上肢練習組（RBAT）或雙側機器誘導鏡像治療組（RMT）。所有患者每次接受90分鐘的治療，每週3天，連續6週，共18次治療。 成效評量：結果測量包括：傅格梅爾動作量表 (Fugl-Meyer Assessment)、英國醫學研究顧問團體量表 (Medical research council scale)、修訂版諾丁漢感覺評估量表(Revised Nottingham Sensory Assessment)、沃夫動作功能測驗（Wolf Motor Function Test）、功能性獨立測驗（Functional independent measure）、動作活動記錄表（Motor Activity Log）、ABILHAND 問卷（ABILHAND Questionnaire）、中風影響量表(Stoke Impact Scale)、目標達成量表（goal attainment scale）、諾丁漢延伸性日常生活量表（Nottingham Extended Activities of Daily Living Scale）和腕動計測量活動度。所有參與者進行三次評估（治療前，治療後和三個月後）。 本研究使用Wilcoxon signed-rank test和Mann-Whitney U test分析組內和組別間差異。 結果：共有17名參與者隨機分配到兩組。各組之間沒有基線差異。兩組參與者在各評估量表有顯著進步並能維持至追蹤測。在主要指標中，RMT組在傅格梅爾動作量表和修訂版諾丁漢感覺評估量表上較有進步趨勢。在次要指標中，RMT組在諾丁漢延伸性日常生活量表和中風影響量表上較有進步趨勢。另一方面，RBAT組在目標達成量表上發現了較有進步趨勢。 結論：本研究的初步研究顯示雙側機器誘導鏡像治療在運動能力方面顯著比雙側機器誘導雙側上肢練習有更大進步, 在感覺功能、日常生活活動和生活質量較有進步趨勢。另外，雙側機器誘導雙側上肢練習則在實現自我復健目標上較有進步趨勢。本研究是前軀研究, 且樣本數不足, 未來需要招募更多受試者來進一步深入研究療效結果。 關鍵字: 雙側機器誘導，雙側上肢訓練，鏡像治療，中風

Background and Study Purpose: Stroke is one of the major medical conditions that leads to long-term disability and causes heavy health care. Current evidence indicates that robot-aided therapy, mirror therapy (MT), and bilateral arm training (BAT) are prominent approaches to improve upper extremity motor function and daily function in patients with stroke. These approaches are bilateral approaches to intensive practice based on theories of neuroplasticity. The purpose of this study is to examine the effects of bilateral robotic priming combined with BAT versus bilateral robotic priming combined with MT on sensorimotor function, daily function, self-efficacy, and quality of life in patients with chronic stroke. Methods: A randomized and single-blinded trial design with pretest, posttest and follow-up assessment was conducted. Participants with chronic stroke were randomly assigned to receive bilateral robotic priming combined with BAT (RBAT) or bilateral robotic priming combined with MT (RMT). All participants received a daily 90-minute therapy session, 3 days/week for 6 weeks, for a total of 18 sessions. Outcome Measures: The outcome measures were included: upper extremity Fugl-Meyer Assessment (FMA-UE), Revised Nottingham Sensory Assessment (rNSA), Medical Research Council (MRC), Motor Activity Log (MAL), Functional Independence Measure (FIM), Nottingham Extended Activities of Daily Living Scale Stroke (NEADL), Goal Attainment Scaling (GAS), Impact Scale Version 3.0 (SIS) and the wrist-worn accelerometers. All participants were assessed three times (before, immediately after intervention and follow-up test). The Wilcoxon signed-rank test and Mann-Whitney U test was used for statistical analysis. Results: A total of 17 participants were enrolled and randomly assigned to the two group. There were no baseline differences between groups. Both conditions demonstrated significant within-group improvements in outcome measures and retained the improvements to 3 months. In primary outcome measures, a positive trend was observed in the RMT group in the FMA-UE, rNSA. In the secondary outcome measures, a positive trend was found in RMT group on NEADL and SIS. On the other hand, a positive trend was found in RBAT group on GAS Conclusion: On the primary outcomes, the RMT group significantly gained greater benefit on motor ability than the RBAT and a positive trend on sensory function. On the secondary outcomes, the RMT group showed positive trends on IADL and quality of life. On the order hand, RBAT group show a positive trend on the achievement of self-expectation. More participants are needed to support this preliminary findings. Key words: bilateral robotic priming, bilateral arm training, mirror therapy, stroke rehabilitation