以鏡像治療結合擴增實境於中風復健： 臨床與居家練習成效之初探對照研究

Abstract

背景：中風是全球第三大致死原因，且中風倖存者伴隨的後遺症往往造成龐大的社會經濟與照顧成本。為滿足中風患者多元的需求，複合療法被視為一種有遠景的途徑。鏡像治療（Mirror therapy, MT）目前已被廣泛運用中風病人的復健，尤其鏡像治療已被證實結合其他中風復健療法可觀察到對患者的復健發揮更大的優勢。此外，互動式體感運動遊戲（exergaming），如擴增實境（Augmented reality, AR），陸續被應用於中風復健，並有實證研究文獻支持其效益，例如可及性廣、有趣性、互動性，提升動機，誘導個案融入體感情境，主動練習等。鏡像治療與擴增實境在臨床中風復健治療的應用日益普遍，兩者相結合後具有互補可能。另外，過去中風復健練習多半限於醫院，居家練習雖為重要環節，但既有相關的實證研究有限。然中風患者在真實、自然情境的活動中依照個別需求設計療程可更滿足「以個案為中心」的理念。 目的：本研究旨在探討鏡像療法（MT）結合擴增實境（AR）在臨床與居家環境中對動作功能、平衡能力、日常功能及生活品質的影響，並於介入後即刻及三個月後進行追蹤評估。 方法：本研究為單盲、隨機分派臨床試驗，延攬並分析12位慢性中風患者隨機分派至上述兩組治療之一。治療劑量為每次 90 分鐘，每週 3到5 次，為期3週共。受試在治療前、治療後與3個月追蹤期結束後接受前測、後測與追蹤測評估，主要成效評估為傅格-梅爾評估量表(Fugl-Meyer Assessment)、與伯格平衡功能測驗(Berg Balance Scale, BBS)；次要成效評估包含動作活動日誌(Motor Activity Log)與中風衝擊量表第三版(Stroke Impact Scale 3.0)。 結果：後測結果顯示，兩組在各項指標上皆有顯著的組內進步。然而，兩組在不同的面相分別展現出優勢，醫院組在 FMA-UE 的表現上顯著優於居家組（p=.04），居家組在日常生活中對上肢功能的實際使用機會顯著提升（p=.03），兩組也都保持優勢傾向到追蹤測。 結論：在臨床環境中結合鏡像治療（MT）與擴增實境（AR）的介入方式，對改善動作功能障礙及平衡能力的效果較居家介入有優勢。居家情境中的介入則有利於上肢功能性使用的改善。這些發現提示在中風復健過程中考慮練習情境的重要性。

Background: Stroke is the third leading cause of death globally, often resulting in long-lasting effects that place great burdens on families, caregivers, and healthcare systems. To better satisfy the diverse needs of stroke survivors, hybrid therapeutic approaches have become popular. Mirror therapy (MT) is widely used in stroke rehabilitation, and there is growing evidence that it works even better when combined with other treatments. Exergaming technology, like augmented reality (AR), is also becoming popular because it is accessible, engaging, interactive, and helps motivate patients to participate in rehabilitation actively. As MT and AR are both being used more frequently in clinical settings, combining them could offer additional benefits. Home-based rehabilitation is important for stroke recovery, but there is limited research directly comparing home-based approaches to clinic-based treatments. Personalized rehabilitation in familiar, everyday settings might better align with patient-centered care. Objective: This study aimed to evaluate the effects of MT combined with AR on motor function, balance, daily functioning, and quality of life among individuals with chronic stroke, in both clinic- and home-based contexts. Assessments were conducted post-intervention and at a three-month follow-up. Methods: This single-blind, randomized controlled trial enrolled 12 individuals with chronic stroke, randomly assigned to either a clinic-based (CbMTAR) or home-based (HbMTAR) MT+AR intervention group. Both groups received training for 90 minutes per session, 3 to 5 times per week, over 3 weeks. Primary outcomes included the Fugl-Meyer Assessment of upper extremity motor function (FMA-UE) and the Berg Balance Scale (BBS). Secondary outcomes included the Motor Activity Log (MAL) and the Stroke Impact Scale 3.0 (SIS 3.0). Results: Both groups demonstrated significant improvements across outcome measures from pretest to posttest. However, each group demonstrated advantages in different aspects; the CbMTAR group significantly outperformed the HbMTAR group in terms of FMA-UE scores (p = .04), whereas the HbMTAR group exhibited a significant increase in MAL-AOU (p = .03). Both groups tended to maintain their respective advantages up to the follow-up assessment. Conclusions: The integration of MT and AR in a clinic-based setting demonstrated greater efficacy in enhancing motor recovery and balance, while home-based interventions were more conducive to improving functional upper limb use. These findings highlight the importance of contextual factors in optimizing stroke rehabilitation outcomes.