Effects of weight bearing at different locations on reach-to-grasp kinematics in patients with intentional tremor. on performance of stroke patients: clinical analysis.

意向性震顫的治療方式大致分為藥物療法、外科手術與復健介入，而復健治療上多以重量套治療來改善其動作表現。過去研究對重量套治療未曾進行量化分析與運動學特性之探討。因此，本研究的目的在透過運動學分析探討穿戴不同重量之重量套於不同位置對意向性震顫患者執行伸臂抓握任務過程中上肢功能的表現。受試對象為15名有意向性震顫的病患，並以三度空間動作分析系統擷取其坐姿伸臂抓握動作過程，情境組合為重量套重量（480克與720克）與重量套位置(手腕與上臂)交叉比對與一控制情境（無重量套）共5種。統計分析採用單因子重複量數變異數分析，事後分析則採用對比分析檢定。結果顯示小腦腦幹病變者穿戴重量套能減少伸臂動作時的動作時間、動作路徑和動作單元(p<0.05)、及增加速度高峰值之時間百分比(p<0.05)，顯示重量套治療能有效改善意向性震顫患者的動作效率及動作流暢度。本研究建議穿戴重量套治療時，若選擇手腕位置則重量儘可能不要過重，相對地，選擇上臂位置時則儘可能不要太輕，如此治療的效果可能會更有效。 Intention tremor has been treated with a variety of procedures including medications, use of weights on the affected limbs or supportive devices. Efficacy study of limb weighting treatment is, however, sparse. This investigation was designed to examine how patients with intention tremor responded to various weights and locations of weighted cuff when performing prehensile movements. Fifteen patients with intention tremor were instructed to reach forward to open the jar with a 6 cm diameter under five experimental conditions. One condition was the control one (i.e., no weight). The other four conditions were formed by the crossing of the cuff weights (480g vs. 720g) and locations (upper arm vs. wrist). Reaching movement was recorded using a 6-camera three-dimensional motion analysis system. ANOVA with repeated measures were performed for each kinematic variable. In patients with cerebellar or brain stem lesions, the conditions of adding various weights on the upper arm and wrist significantly improved movement kinematics in comparison with the control condition, as represented by decreasing movement time, total displacement and movement unit (p<0.05), and increasing the percentage of time to peak velocity (p<0.05). The results demonstrated wearing the weight cuffs would facilitate more efficient and smoother movements than wearing nothing. The findings of this study suggested beneficial effects be established when the cuff with lighter weight was placed on the wrist or that with heavier weight on the upper arm.