使用第二代自控式電動步行矯具進行任務導向行走訓練對於慢性不完全脊髓損傷患者平衡與行走功能的影響：個案研究

Abstract

背景：脊髓損傷是造成下肢癱瘓主要的原因之一，隨著醫療科技與健康照護的進步，脊髓損傷個案的壽命也跟著延長，然而因後遺症的問題，這樣個案的生活品質下降不少，動力步行矯具(Powered Gait Orthosis，又稱Exoskeleton、外骨骼 )在1970年代被發展出來，目的以馬達動力協助大關節去完成跨步動作，以提升個案的行走功能，近期的電動步行矯具發展著重於：有效率的能量使用、輕量、實惠的價格。第二代患者自控式電動步行矯具(User-controlled Powered Gait Orthosis Second Edition，簡稱UPGO II)以一對髖關節馬達作為驅動力，搭配站立控制膝關節(Stance-controlled knee)、長腿支架……等機構設計，欲以馬達減量的方式去減輕整體重量，讓馬達的使用作最有效率的運用，並同時達到價格控制的目的，欲成為一個具有足夠功能且有效率的電動步行矯具。本文中將UPGO II運用在慢性脊髓損傷個案的任務導向行走訓練上，欲觀察使用UPGO II進行行走訓練過後，個案在行走功能上所有的改變。 方法：一名可以使用前臂拐行走的57歲慢性脊髓損傷個案，穿著UPGO II進行12次的任務導向行走訓練，在第6次的訓練過後以及第12次的訓練過後執行10公尺行走測試，並在訓練全部結束過後完成伯格氏平衡量表與肌力再評量。 結果：6次的訓練過後，使用前臂拐的行走速度增加、HRR比例下降、RPE分數下降，甚至能改以平衡難度更高的兩支單拐作為行走輔具輔助行走。完成12次訓練過後，個案使用前臂拐的行走速度從0.292 m/s增加至0.503 m/s，能用兩支單拐進行行走，甚至能嘗試使用單拐完成10公尺的行走，伯格氏平衡量表分數從27分進步至31分，左腳肌力有些微提升。 結論：12次任務導向行走訓練結合UPGO II 改善了個案的行走速度、平衡、肌力以及行走功能，也許UPGO II對於治療師來說會是個協助執行訓練的新利器，而且也許任務導向行走訓練結合UPGO II 對於那些原先就具有平地行走功能、但平衡能力尚不足的慢性不完全脊髓損傷個案來說會是個新的訓練方式，然而仍需要更多的研究來證實。

BACKGROUND: Powered gait orthoses (PGOs), or called exoskeletons, were initially developed in the 1970s. Powered gait orthoses make use of some actuators positioned adjacent to the anatomical hips, knees or ankles for the SCI patients to walk more efficiently. User-Intent Powered Gait Orthosis II (UPGO II) is a powered gait orthosis which uses stance-controlled knee-ankle-foot orthoses to replace knee and ankle powers, and only 2 actuators on the hips. The purpose was to observe the effect on walking function of a person with the chronic SCI after task-oriented gait training with UPGO II. METHODS: A 57-year-old male with chronic spinal cord injury who could walk with forearm crutches and canes but no need of UPGO was involved in the study. The subject had a 12-session task-oriented gait training with UPGO II. 10-meter walking tests were tested after 6th-session and 12th-session. The Berg Balance Scale manual muscle test was re-tested after 12-session training. RESULTS: The walking velocity, HRR% and RPE scores of walking with forearm crutches improved after 6 sessions of training. The participant even can walk with walking aids which are more difficult to maintain balance than using forearm crutches. After 12 sessions of training, walking velocity improved from 0.292 m/s to 0.503 m/s, and Berg Balance Scale improved from 27 scores to 31 scores. He can walk with 2 canes and even try to finish a 10-meter walking with a cane after 12 sessions of training. Furthermore, slight improvement in muscle power was found on left lower extremity. No adverse events occurred during the case study. CONCLUSION: 12 sessions of task-oriented walking training with UPGO II improves the participant’s walking velocity, balance, walking function and muscle power. UPGO II may be a new option for helping therapists to carry out their program. Task-oriented walking training combined with UPGO II may be another new training method for chronic incomplete SCI patients who are able to walk on level-ground with aids, but poor at balance. However, the further researches are required in the future.