鏡像治療併用刺激輸入對慢性中風病患感覺動作復原與生活功能之成效

Abstract

目的：比較鏡像治療併用刺激輸入、鏡像治療及一般動作復健對慢性中風病患感覺動作復原與日常生活功能之效應。 設計：隨機分派，前測後測比較，安慰劑控制組試驗。 環境：醫院之復健科部。 受試者：23名慢性中風個案(平均年齡50.84年，平均中風時間27個月)隨機分派至鏡像治療併用刺激輸入、鏡像治療或一般動作復健當中一組，接受每週五天、每天90分鐘，為期四週之療程。 成效評量：主要評估工具包含有傅格-梅爾動作評估量表(Fugl-Meyer Assessment)、沃夫動作功能測驗(Wolf Motor Function Test)；次要評估工具有修訂版艾許沃斯量表(Modified Ashworth Scale)、功能獨立量表之動作項目(motor items of Functional Independence Measure)、動作活動日誌(Motor Activity Log)、十公尺步行測驗(10-Meter Walking Test)、傅格-梅爾感覺評估量表(sensory section of the Fugl-Meyer Assessment)、修訂版諾丁漢感覺評估量表(Revised Nottingham Sensory Assessment)以及運動學分析。 結果：個案接受四週治療後動作復原皆有改善，然而鏡像治療併用刺激輸入和鏡像治療在遠端動作損傷和遠端肌肉張力之改善程度優於一般復健；相較其他組別，鏡像治療合併刺激輸入可促進患側手之日常使用，並且增進行走的獨立程度。運動學分析結果，一般復健組在肩膀外展角度顯著增加，表示使用代償動作完成伸手及物任務。另外，鏡像治療合併刺激輸入在感覺功能呈現正向效應的趨勢；其餘參數則無顯著差異。 結論：鏡像治療併用刺激輸入和鏡像治療對於改善遠端動作損傷之成效優於一般復健組，且相較於一般復健組，不會過度使用近端做代償。此外，鏡像治療加上刺激輸入可有效促進患側手於日常生活之使用，以及行走獨立能力。以上發現值得後續研究驗證。

Objective: To compare the effects of mirror therapy combined with mesh-glove stimulation (MGS), mirror therapy with placebo stimulation (MTP), and conventional upper-limb rehabilitation (CR) on sensorimotor functions and daily functions for patients with chronic stoke. Design: A randomized, pretest-posttest, placebo-controlled design was used. Settings: Outpatient rehabilitation clinics Subjects: Twenty-three patients (mean age = 50.84 year; mean time after stroke = 27 month) were randomized to MGS, MTP, or CR groups. Each group received treatment for 90 minutes/day and 5 days/week over 4 consecutive weeks. Main measures: Primary outcomes were Fugl-Meyer Assessment (FMA) and Wolf Motor Function Test. Secondary outcomes were Modified Ashworth Scale (MAS), motor items of Functional Independence Measure (FIM), Motor Activity Log (MAL), 10-Meter Walking Test, sensory section of the Fugl-Meyer Assessment, Revised Nottingham Sensory Assessment, and kinematic analysis. Results: After four week treatment, all participants had better motor recovery. Compared with CR group, patients received MGS or MTP significantly reduced motor impairment in distal part of FMA, decreased muscle tone in distal part of MAS and less shoulder abduction in reaching movement. Enhanced functional performance was found for MGS group in the MAL and locomotion subcomponent of the FIM. No significant difference but a positive trend for MGS was showed in sensory outcomes. Conclusions: Compared with CR group, MGS and MTP may improve motor impairment of the distal upper extremity and prevent compensatory pattern at shoulder joint. MGS group may enhance the effect of activity level on functional arm-use and locomotion than other groups. These positive results on sensorimotor functions and daily functions encourage enrolling larger sample size to confirm the findings for similar participants.