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請使用永久網址來引用或連結此文件:
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| 題名: | 探討中風患者足踝關節本體感覺缺損表現對下肢動作與功能之影響
Investigating The Deficits Of Ankle Proprioception And Motor Control On Functional Performances Of Lower Extremity In Persons With Stroke |
| 作者: | 劉皖茹
Liu, Wan-Ju |
| 貢獻者: | 長期照護碩士學位學程
林玨赫 |
| 關鍵詞: | 中風;本體感覺;足踝;下肢
Stroke;Proprioceptive;Ankle;Lower Extremity |
| 日期: | 2018-12-10 |
| 上傳時間: | 2020-01-21 11:41:08 (UTC+8) |
| 摘要: | 背景：慢性中風患者的偏癱踝關節活動與本體感覺表現對於下肢的動作控制與功能表現扮演相當重要角色。目前鮮少有研究探討中風患者足踝關節在承重下且多平面本體感覺表現，進而反映出踝關節在日常生活活動的功能表現。
目的：探討慢性中風患者足踝本體感覺缺損表現並分析本體感缺損變化與下肢動作功能、日常生活動作功能的相關性。
方法：研究招募25位健康受試者(21.04±0.33歲)和16位慢性中風患者(59.5±8.31歲)，評估雙側踝關節於承重狀態下的雙軸本體感覺表現及臨床動作功能評估。為了驗證本體覺表現，本研究計算及分析本體感覺方向誤(Joint Position Sense Direction Error, JPS-DE)、本體感覺絕對誤(Joint Position Sense Absolute Error, JPS-AE)以及本體感覺變異誤(Joint Position Sense Variable Error, JPS-VE)數值變化；臨床動作評估包括巴氏量表(BI)、傅格-梅爾下肢評估量表(FMA-LE)、伯格氏平衡量表(BBS)、起身行走測試(TUG)、中風病患姿勢控制評估量表(PASS)、十公尺行走測試(10MWT)、緹氏步態評估量表(TGS)。統計方法為使用Paired Samples t-tests分析中風患者兩側踝關節的本體感覺差異，使用Independent Sample t-test分析健康受試者和中風患者之間本體感覺的差異。此外，研究也以Spearman's Correlation Coefficients了解踝關節本體感覺變化與下肢動作與功能表現之間的關係。研究使用的統計軟體為SPSS 19.0版本，統計上顯著差異的α值設為0.05。
結果：相較於健康側足踝，研究結果發現偏癱足踝的本體感覺絕對誤在足踝處於蹠屈、內翻以及蹠屈、外翻之本體感覺表現比健側差1.48 ～2.9 (p<.05)之間，變異誤則是0.94～1.33 (p<.05)。此外，偏癱足踝於內翻和蹠屈的本體感覺方向誤與傅格-梅爾、堤氏步態為中度負相關，至於偏癱足踝於外翻及蹠屈的本體感覺絕對誤、變異誤以及內翻和背屈的本體感覺方向誤，分別與十公尺行走測試以及傅格梅爾、巴氏量表為中度正相關，另外背屈和內翻的本體感覺絕對誤則和巴氏量表有中度負相關。
結論：本研究結果發現在中風患者偏癱足踝本體感覺表現確實比健側足踝較差，並且偏癱足踝本體感覺缺損與下肢動作與功能恢復有中等程度相關。
Background: Range of motion and proprioception performances of ankle play important roles in movement control and functional activities in the lower extremities in post-stroke patients. However, few studies have investigated ankle proprioception performance in multiple planes and under weight bearing conditions, which reflects the real functional activities of the ankle joints for people with stroke in daily living.
Objective: The purpose of this study was to investigate the impact of stroke on the ankle proprioception deficits in multiple axis movements under weight bearing conditions and to analyze the relationship between proprioception performances and motor and functional performance of the ankle joint in chronic stroke patients.
Methods: Twenty-five adults healthy (21.04±0.33 y/o) and sixteen chronic stroke adults (59.5±8.31 y/o) were recruited into this study. The proprioceptive performances in multiple planes in both ankles were evaluated under weight bearing conditions. In order to evaluate the proprioception, scores of Joint Position Sense Direction Error (JPS-DE), Joint Position Sense Absolute Error (JPS-AE) and Joint Position Sense Variable Error (JPS-VE) were calculated and analyzed in this study. Clinical motor and functional assessments for paretic lower limb included Barth Index (BI), Fugl-Meyer Assessment Lower Extremity (FMA-LE), Berg Balance Test (BBS), Time Up and Go (TUG), Postural Assessment Scale for Stroke Patients (PASS), Timed 10-Meter Walk Test (10MWT) and Tinetti Gait Scale (TGS). Paired samples t-tests was used to analyze the difference in the proprioception of two ankle joints after stroke patients, then the Independent Sample t-test was also used to analyze the difference in proprioception between the healthy and stroke subjects. Furthermore, Spearman correlation test was performed to determine the relationships between paretic ankle proprioception and motor and functional performances. The α level was set at 0.05(SPSS version 19.0).
Results: Compare with the non-paretic ankle, results showed that the scores of JPS-AE and JPS-VE of paretic ankle was significantly poorer in planar flexion with inversion and planar flexion with eversion by 1.48°~2.9° (p<0.05) and 0.94°~1.33° (p<.05) respectively in the patients. Additionally, we found that the JPS-DE score for the paretic ankles in plantar flexion with inversion has moderately and there were significantly negative correlations with the FMA-LE and TGS (p<0.05). The JPS-AE and JPS-VE scores in plantar flexion with eversion and dorsiflexion with inversion indicated moderately and positive significant correlations with the 10 MWT, FMA-LE and BI and TGS. The JPS-AE score for paretic ankle in dorsiflexion with inversion also showed moderately negative with the BI (p<0.05).
Conclusion: This study found that proprioceptive performance in paretic ankle joint was significant poorer than that in the new-paretic ankle and showed the proprioceptive deficits of paretic ankle reflected moderate correlations with the motor and functional performance for paretic lower limbs in stroke patients. |
| 描述: | 碩士
指導教授：林玨赫
委員：蔣尚霖
委員：賴建宏 |
| 資料類型: | thesis |
| 顯示於類別: | [長期照護碩士學位學程] 博碩士論文
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