行政院國家科學委員會專題研究計畫成果報告:使用輔具對腦中風病患站立與步行時之動態平衡及維持動態平衡所需注意力之影響(3/3)
Date Issued
2005
Date
2005
Author(s)
胡名霞
DOI
932314B002029
Abstract
Restoration of the ability to independently stand and walk is one of the primary goals of
stroke rehabilitation. The regular cane is one of the most commonly used assistive devices in
standing and ambulation training for patients with stroke. Although the use of a regular cane does
present some biomechanical advantages, the use of can may, on the other hand, inevitably
introduce some negative influences on patients. For instance, the use of a regular cane may
increase standing and walking asymmetry, decreased weight bearing or force generation demands
on the affected lower extremity, and increased psychological dependence on the device.
Furthermore, these patients need to operate the devices with certain degree of temporal and
spatial accuracy during movements. It remains unanswered as to whether the use of such devices
would increase the demands on patients’ attention, which in turn, may reduce patients’ level of
control over the mobility tasks at hand or degree of vigilance to attend to the changing
environment, and consequently leads to more falls among these patients.
There three specific aims for this three-year research project were: first, to investigate the
influence of using a regular cane on the movement performance and kinetics during voluntary
forward stepping task in standing for patients with stroke and healthy adults; second, to
investigate the influence of using a regular cane on the attentional demands associated with
performing a voluntary forward stepping task in standing for patients with stroke and healthy
adults; and third, to investigate the influence of using a regular cane on the gait performance and
attentional demands while performing comfortable-speed walking in patients with stroke and
healthy adults.
Results of the first-year project showed that while performing a volitional forward stepping
task, patients with stroke demonstrated similar ground reaction force patterns, but of smaller
magnitudes and with poorer smoothness, compared to age-matched healthy adults. This was
especially true when these patients stepped with the affected lower extremity. When the patients
stepped with the affected lower extremity and with the use of a regular cane held on the
unaffected hand, their step length (SL) increased compared to the stepping without a cane
condition. When the patients stepped with the unaffected lower extremity and with the use of a
regular cane, the movement time (MT) duration, during which the affected lower extremity
supported the majority of the body weight, and the center of pressure speed (COPsp) in the
reaction time (RT) phase were significantly increased, the patterns of the vertical ground reaction
forces became smoother, whereas the magnitude of the vertical ground reaction forces decreased,
compared to the stepping with the unaffected lower extremity and without a cane condition.
Therefore, it is evidence that the regular cane played a role of assisting the forward propulsion
and weight support especially when these patients stepped with the unaffected lower extremity.
Although the use of a cane indeed improved the movement performance and dynamic balance
associated with the stepping task for these patients, the use of a cane inevitably reduced the need
for them to generate active vertical ground reaction forces by the affected lower extremity of
these patients.
The major findings of the second-year project were that the patients with stroke showed a
significantly greater increase in the verbal reaction time (VRT) from the single task (verbal
choice reaction time (VCRT) task) condition to the dual task (stepping plus VCRT tasks)
condition than the age-matched healthy adults (p < .001). Such increase was the greatest when the
patients were stepping with the affected lower extremity, indicating that patients with stroke
required a much greater amount of attention while performing the stepping with the affected
lower extremity task than age-matched healthy adults. The use of a regular cane did not
significantly change the needed amount of attention associated with performing the stepping task
for both groups of subjects.
In the third-year project, we found that the use of a regular cane did not significantly affect
the VRT performed in a single task VCRT condition for both patients with stroke and healthy
adults. The use of a regular cane, however, increased the VRT from a mean of 858.3 msec in the
single task (VCRT task only) condition to an average of 969.1 mses in the dual task (VCRT task
was performed simultaneously with a comfortable-speed walking task) condition for both groups
of subjects (p < .05). These findings suggest that the use of a regular cane to walk required a
greater amount of attention than not using a cane for both patients with stroke and healthy adults.
Together, our results suggest that the benefits of using a regular cane to perform a voluntary
forward stepping task or a walking task primarily include the effectiveness in improving the
movement performance and dynamic stability. The negative influences of using a cane to perform
these tasks are the reduced need to generate active forces with the affected lower extremity for
patients with stroke and increased attention demands for walking for both patients with stroke and
healthy controls. Therefore, the decision as to whether a regular cane ought be used as an
assistive device for mobility and ambulation training for patients with stroke or not has to be
based upon case-specific relative weighting between the positive and negative influences of cane
use.
Subjects
stroke patients
ambulation assistive device
attention
stepping during standing
walking
dynamic equilibrium
Publisher
臺北市：國立臺灣大學醫學院物理治療學系暨研究所
Type
journal article
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