請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/80916完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 黃正雅(Cheng-Ya Huang) | |
| dc.contributor.author | Yueh-Hsia Chen | en |
| dc.contributor.author | 陳月霞 | zh_TW |
| dc.date.accessioned | 2022-11-24T03:21:49Z | - |
| dc.date.available | 2022-02-15 | |
| dc.date.available | 2022-11-24T03:21:49Z | - |
| dc.date.copyright | 2022-02-15 | |
| dc.date.issued | 2022 | |
| dc.date.submitted | 2022-02-08 | |
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Motor control : theory and practical applications. 2nd ed. Lippincott Williams Wilkins; 2001. 128. Chan JY, Wong ST, Chan RC, Wei WI. Shoulder Dysfunction after Selective Neck Dissection in Recurrent Nasopharyngeal Carcinoma. Otolaryngol Head Neck Surg. Sep 2015;153(3):379-84. doi:10.1177/0194599815590589 129. Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016. 130. Beretta-Piccoli M, Cescon C, Barbero M, D'Antona G. Reliability of surface electromyography in estimating muscle fiber conduction velocity: A systematic review. J Electromyogr Kinesiol. Oct 2019;48:53-68. doi:10.1016/j.jelekin.2019.06.005 131. McIntosh KC, Gabriel DA. Reliability of a simple method for determining muscle fiber conduction velocity. Muscle Nerve. Feb 2012;45(2):257-65. doi:10.1002/mus.22268 132. Hermens HJ, Freriks B, Disselhorst-Klug C, Rau G. Development of recommendations for SEMG sensors and sensor placement procedures. J Electromyogr Kinesiol. Oct 2000;10(5):361-74. doi:10.1016/s1050-6411(00)00027-4 133. Ekstrom RA, Soderberg GL, Donatelli RA. Normalization procedures using maximum voluntary isometric contractions for the serratus anterior and trapezius muscles during surface EMG analysis. J Electromyogr Kinesiol. Aug 2005;15(4):418-28. doi:10.1016/j.jelekin.2004.09.006 134. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. Mar 1986;42(1):121-30. 135. Birhanu T, Molenberghs G, Sotto C, Kenward MG. Doubly robust and multiple-imputation-based generalized estimating equations. J Biopharm Stat. Mar 2011;21(2):202-25. doi:10.1080/10543406.2011.550096 136. Paik M. The generalized estimating equation approach when data are not missing completely at random. Journal of the American Statistical Association. 1997;92:1320-1329. 137. Ma Y, Mazumdar M, Memtsoudis SG. Beyond repeated-measures analysis of variance: advanced statistical methods for the analysis of longitudinal data in anesthesia research. Reg Anesth Pain Med. Jan-Feb 2012;37(1):99-105. doi:10.1097/AAP.0b013e31823ebc74 138. Struyf F, Nijs J, Mollekens S, et al. Scapular-focused treatment in patients with shoulder impingement syndrome: a randomized clinical trial. Clin Rheumatol. 2013;32(1):73‐85. doi:10.1007/s10067-012-2093-2 139. Muir SW, Corea CL, Beaupre L. Evaluating change in clinical status: reliability and measures of agreement for the assessment of glenohumeral range of motion. N Am J Sports Phys Ther. Sep 2010;5(3):98-110. 140. Frikha M, Chaari N, Elghoul Y, Mohamed-Ali HH, Zinkovsky AV. Effects of Combined Versus Singular Verbal or Haptic Feedback on Acquisition, Retention, Difficulty, and Competence Perceptions in Motor Learning. Percept Mot Skills. Aug 2019;126(4):713-732. doi:10.1177/0031512519842759 141. Ludewig PM, Cook TM, Nawoczenski DA. Three-dimensional scapular orientation and muscle activity at selected positions of humeral elevation. J Orthop Sports Phys Ther. Aug 1996;24(2):57-65. doi:10.2519/jospt.1996.24.2.57 142. Del Balso C, Cafarelli E. Adaptations in the activation of human skeletal muscle induced by short-term isometric resistance training. J Appl Physiol (1985). Jul 2007;103(1):402-11. doi:10.1152/japplphysiol.00477.2006 143. Gabriel DA, Kamen G, Frost G. Neural adaptations to resistive exercise: mechanisms and recommendations for training practices. Sports Med. 2006;36(2):133-49. doi:10.2165/00007256-200636020-00004 144. Camargo PR, Alburquerque-Sendin F, Avila MA, Haik MN, Vieira A, Salvini TF. Effects of Stretching and Strengthening Exercises, With and Without Manual Therapy, on Scapular Kinematics, Function, and Pain in Individuals With Shoulder Impingement: A Randomized Controlled Trial. J Orthop Sports Phys Ther. Dec 2015;45(12):984-97. doi:10.2519/jospt.2015.5939 145. Sale DG. Neural adaptation to resistance training. Med Sci Sports Exerc. Oct 1988;20(5 Suppl):S135-45. doi:10.1249/00005768-198810001-00009 146. Kibler WB, Sciascia AD. Disorders of the Scapula and their role in shoulder injury. Spring……… | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/80916 | - |
| dc.description.abstract | "背景：近幾年，我國口腔癌發生率佔世界之冠，且為頭頸癌中最常見之部位。脊副神經肩功能障礙是口腔癌患者接受頸部廓清術後最常見的併發症，會引發肩胛運動障礙並影響生活品質。過去研究指出肩胛訓練運動可改善肩部夾擠症候群患者的肩關節活動度、肩胛肌肉力量、肩胛骨位置。此外，肩胛訓練運動結合動作控制訓練除了提升肩關節活動度與肩胛肌肉力量之外，還可改善肩胛肌肉徵召方式，減輕肩痛和失能。由於脊副神經損傷會造成斜方肌功能障礙，無法正常穩定肩胛骨，有別於肩部夾擠症候群因為上斜方肌與其他肩胛肌肉力量間不平衡所造成的肩胛運動障礙，目前尚無研究將肩胛訓練運動結合動作控制之治療模式應用於口腔癌患者頸部廓清術後，因脊副神經肩功能障礙所造成之肩胛運動障礙。本論文目的在探討肩胛訓練運動結合不同動作控制訓練之技巧，對脊副神經功能障礙之口腔癌患者肩胛功能之訓練效果。本論文包含三個實驗：實驗一目的為探討肩胛訓練運動中給予治療師回饋對肩胛動作控制的短期訓練成效；實驗二目的為探討肩胛訓練運動中患者使用內在意識控制的長期訓練成效；實驗三目的為探討肩胛訓練運動合併表面肌電圖之視覺回饋的長期訓練成效。 方法：實驗一招募38位口腔癌患者，隨機分配至動作控制組與一般運動組，二組皆在頸部廓清術後平均12天，開始為期一個月的治療介入。治療內容包含肩關節一般性物理治療介入(止痛電刺激、肩關節活動)和肩胛訓練運動，而動作控制組於肩胛訓練運動中，治療師會給予肩胛動作控制之回饋。於介入前和介入後，記錄受試者的肩關節疼痛度、肩關節外展活動度、肩胛肌肉最大自主等長收縮與執行肩胛動作時之肌電訊號。實驗二招募36位口腔癌患者，隨機分配至動作控制組與一般運動組，二組在經過頸部廓清術後，立即進行三個月的治療介入。動作控制組於肩胛訓練運動中強調患者本身對肩胛骨的意識控制。於介入前、介入後一個月與介入後三個月進行評估，評估參數包含：肩關節疼痛度、肩關節外展活動度、上肢功能自陳量表、肩胛關節肌肉最大等長收縮肌力與肌電訊號、執行肩胛動作時之肌電訊號。實驗三共徵招24位口腔癌患者，隨機分配至動作控制肌電回饋組與動作控制組，介入時間為三個月。二組都給予肩關節一般性物理治療介入(止痛電刺激、肩關節活動)、肩胛訓練運動和肩胛動作控制訓練，而動作控制肌電回饋組在動作控制訓練時給予斜方肌肌電反應之視覺回饋，而動作控制組則無給予肌電回饋。於介入前、介入後三個月進行評估，評估參數包含：肩關節疼痛度、肩關節外展活動度、肩胛位置、上肢功能自陳量表，以及上斜方肌、中斜方肌和下斜方肌最大等長收縮肌力和肌電訊號，以及肩關節外展向心和離心收縮之肌電訊號。 結果：實驗一，介入一個月後，二組肩關節疼痛皆降低，肩胛肌肉於最大自主等長收縮時，肌電訊號強度皆增加。然肩關節外展活動度僅有動作控制組增加(95% CI 3.80 ~ 20.51, p=0.004)，且在執行負重聳肩動作時(拿1公斤啞鈴)，動作控制組的上斜方肌肌電強度下降(95% CI: -33.06 ~ -1.29, p=0.034)，一般運動組則無改變。此外，執行肩部平行內收與屈曲動作時，動作控制組的前鋸肌肌電強度降低(95% CI: -29.73~ -27.68, p<0.001)，而一般運動組反而增加(95% CI: 28.16 ~ 30.05, p<0.001)。實驗二，介入三個月後，二組除了肩關節疼痛度和上肢功能外，其餘結果皆呈顯著進步。然而，動作控制組的進步程度較一般運動組多，於三個月時，動作控制組之肩關節外展活動度較一般運動組多19度(95% CI: 10 ~ 29, p<0.001)、上斜方肌肌力介入前後共進步11牛頓(95% CI: 2 ~ 20, p=0.021)，生活品質也在介入後有明顯進步(95% CI: 4 ~ 33, p=0.011)。另外，執行肩部平行內收與屈曲動作時，一般運動組之前鋸肌肌電強度較動作控制組高(95% CI 7 to 205, p＝0.037)。實驗三，介入3個月後，動作控制肌電回饋組顯著改善雙側肩胛對稱性，在雙手下垂、插腰及肩外展下，二側對稱性分別比動作控制組增加1.0公分(95% CI：-1.6 ~ -0.4, p=0.001)、0.5公分(95 % CI：-0.9 ~ 0, p=0.040)和1.1公分(95% CI：-1.8 ~ -0.3, p=0.004)。二組肩關節疼痛皆無顯著改變，動作控制肌電回饋組肩關節外展活動度進步23度(95% CI: 14 ~ 31, p<0.001)，而動作控制組進步15度(95 % CI：6 ~ 24, p<0.001)。二組皆增加上斜方肌和中斜方肌之最大等長收縮肌力，然只有動作控制肌電回饋組在介入後顯著增加下斜方肌肌力和上肢功能，且於手臂抬高和放下過程中，上斜方肌和中斜方肌肌電強度降低。 結論：整合實驗一、二、三之結果，於臨床上，建議口腔癌病人在頸部廓清術後，以動作控制加上肩胛訓練運動進行早期動作介入，可有效促進肩關節活動度和減少肩胛肌肉代償之效果。此外，在肩胛訓練運動訓練中，肌電回饋訓練動作控制比單純只有動作控制更能提升雙側肩胛骨對稱性以增加肩胛控制穩定程度，提升肩胛肌肉效能與上肢功能。" | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-24T03:21:49Z (GMT). No. of bitstreams: 1 U0001-0502202215245700.pdf: 13574605 bytes, checksum: cc431d30ebd96c50f6cad48f9ee48e79 (MD5) Previous issue date: 2022 | en |
| dc.description.tableofcontents | 口試委員會審定書 i 誌謝 ii 中文摘要 iii Abstract v Table of Contents viii List of Tables x List of Figures xi List of Appendix xii CHAPTER 1 Introduction 1 1.1 Background 1 1.2 Study purposes 3 1.3 Hypotheses 5 CHAPTER 2 Review of the Literature 6 2.1 Scapular kinematics and scapular dyskinesis 6 2.2 Evaluations of scapular dyskinesis 14 2.3 Interventions for scapular dyskinesis 16 CHAPTER 3 Experiment 1: Short-term training effects (1 month) of motor-control training integrating into scapular-focused exercises with extrinsic feedback from a physical therapist 23 3.1 Introduction 23 3.2 Methods 25 3.3 Results 30 3.4 Discussion 32 3.5 Conclusions 37 CHAPTER 4 Experiment 2: Long-term training effects (3 months) of motor-control training integrating into scapular-focused exercises with inherent feedback through conscious correction of scapular orientation by patients themselves 39 4.1 Introduction 39 4.2 Methods 41 4.3 Results 46 4.4 Discussion 49 4.5 Conclusions 53 CHAPTER 5 Experiment 3: Long-term training effects (3 months) of motor-control training integrating into scapular-focused exercises with EMG biofeedback 54 5.1 Introduction 54 5.2 Methods 55 5.3 Results 60 5.4 Discussion 62 5.5 Conclusions 65 CHAPTER 6 General discussion and conclusions 67 6.1 General discussion 67 6.2 Conclusions 70 References 72 | |
| dc.language.iso | en | |
| dc.subject | 口腔癌 | zh_TW |
| dc.subject | 頸部廓清術 | zh_TW |
| dc.subject | 動作控制 | zh_TW |
| dc.subject | 脊副神經 | zh_TW |
| dc.subject | 肩胛骨運動異常 | zh_TW |
| dc.subject | 肩胛訓練運動 | zh_TW |
| dc.subject | 肌電回饋 | zh_TW |
| dc.subject | scapular-focused exercises | en |
| dc.subject | EMG biofeedback | en |
| dc.subject | scapular dyskinesis | en |
| dc.subject | accessory nerve | en |
| dc.subject | neck dissection | en |
| dc.subject | motor control | en |
| dc.subject | oral cancer | en |
| dc.title | 動作控制訓練對頸部廓清術後之肩胛運動障礙治療效果 | zh_TW |
| dc.title | Motor-Control Training on Scapular Dyskinesis in Patients with Neck Dissection | en |
| dc.date.schoolyear | 110-1 | |
| dc.description.degree | 博士 | |
| dc.contributor.author-orcid | 0000-0002-5363-4600 | |
| dc.contributor.oralexamcommittee | 林有德(Chien-Yu Chen),林居正(Ping-Lang Yen),周立偉(Pei-Li Sun),陳譽仁(Mei-Chun Lo) | |
| dc.subject.keyword | 動作控制,肩胛訓練運動,口腔癌,頸部廓清術,脊副神經,肩胛骨運動異常,肌電回饋, | zh_TW |
| dc.subject.keyword | motor control,scapular-focused exercises,oral cancer,neck dissection,accessory nerve,scapular dyskinesis,EMG biofeedback, | en |
| dc.relation.page | 160 | |
| dc.identifier.doi | 10.6342/NTU202200287 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2022-02-09 | |
| dc.contributor.author-college | 醫學院 | zh_TW |
| dc.contributor.author-dept | 物理治療學研究所 | zh_TW |
| 顯示於系所單位： | 物理治療學系所 | |
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