輕度脊髓損傷患者使用第二代自控式電動步行矯具在移行訓練造成心肺適能和生活品質改善的影響

Abstract

隨著科技日新月異，慢性脊髓損傷患者的壽命越來越長，也導致更多的慢性併發症被發現，像是骨質疏鬆、肥胖、冠狀動脈心臟病、疲乏、心肺適能衰退、久坐不動的生活習慣，這些都起因於患者生理儲備功能的下降。這情況會導致患者累積性的惡性循環，讓生理及心理造成損傷，最後直到死亡或長期住院。根據國際健康功能與身心障礙分類系統數據顯示，對於慢性脊髓損傷患者而言，除了在神經肌肉骨骼相關的功能顯示衰退，其次為在心肺及代謝的相關功能，而心肺功能的衰退往往是造成患者死亡的主要原因。 近年來外骨骼復健機器蓬勃發展，越來越多的文獻開始探討外骨骼機器所帶來的成效，外骨骼機器可以協助患者長時間行走，增進患者行走的動作表現及心肺功能。研究顯示出心律儲備的百分比可以顯示出患者是否有達到符合的訓練強度，當患者達到一定的訓練強度時，心肺適能的表現及生活品質也會提升。 本文利用實驗室自行設計的外骨骼系統(UPGO II)，只利用兩個馬達去帶動患者的髖關節動作，由治療師安排訓練計劃，逐步增強訓練強度，提高心肺耐力，打破併發症所帶來的惡性循環。結果顯示，在密集的12次45分鐘的行走訓練後，心律儲備百分比、6分鐘行走測試、平衡評估、生活品質和疲勞問卷都有部分改善。訓練過程中，患者都沒有發生皮膚壓傷及跌倒。研究認為UPGO II在脊髓損傷患者上是可行且可用，但依舊需要改良UPGO II及收集更多的患者數據。

With the rapid advancement of science and technology, the longevity of chronic spinal cord injury (SCI) patients is increasing, and more secondary medical complications have been found, such as osteoporosis, obesity, coronary heart disease, fatigue, weakness, and sedentary lifestyle. The main result from a decline in the patient's physiological reserve function. This situation will allow SCI patients to accumulate a vicious cycle, causing physical and psychological disability, and finally death or long-term hospitalization. According to the International Classification of Functioning, Disability, and Health System (ICF), chronic SCI patient’s main problem were neuromuscular and skeletal related functional decline, second problem were cardiopulmonary and metabolic related functions. The decline of cardiopulmonary function is often caused death. In recent years, exoskeleton rehabilitation have developed vigorously, and more literature has begun to explore the effects of exoskeleton system. Exoskeleton system can help SCI patients to walk for a long time and improve their walking performance and cardiopulmonary function. Recent studies have shown that the percentage of heart rate reserves can indicate that the SCI patient has achieved an appropriate training intensity. When the SCI patient reaches a certain training intensity, the performance of cardiopulmonary fitness, metabolic functions and quality of life will increase. This study uses the newly exoskeleton system (UPGO II) to use only two motors to drive the patient's hip joint. Training program will gradually increase the training intensity and improve the cardiopulmonary and endurance. To break the vicious circle of patient’s secondary medical complications. The results showed that after 12 intensive (45 mins) walking sessions, the percentage of heart rate reserve, 6-mins walking test, berg balance assessment, quality of life and fatigue questionnaire has improved. During the training, no skin injury and fall occurred. The study found that UPGO II is feasible and available in patients with mild SCI, but it is still necessary to improve UPGO II system and collect more data.