行政院國家科學委員會專題研究計畫期中進度報告: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
Date Issued
2004
Date
2004
Author(s)
胡名霞
DOI
922314B002187
Abstract
The purposes of this second-year part of the three-year research project were two-fold: first,
to examine the influence of regular cane use on the movement performance, neuromuscular
control mechanisms of dynamic balance, and the attentional demands associated with performing
a voluntary forward stepping movement in patients with stroke and in age-matched healthy adults;
second, to further understand the biomechanical role of a regular cane when being used in the
above-mentioned task by investigating the kinetics recorded from the cane. Nine stroke patients
and 11 healthy adults participated in the study to date. All subjects were tested in 3 task
conditions: single primary task (stepping alone), single secondary task (verbal reaction time
alone), and dual task (stepping plus verbal reaction tasks) conditions. All three conditions were
further stratified into cane-use and cane-free sub-conditions. Performance of stepping movements
(step reaction time, step movement time, center of pressure measures, and EMG of bilateral
tibialis anterior and gastrocnemius and unilateral triceps brachii) and verbal responses (verbal
reaction time and accuracy of verbal response), as well as the kinetics of cane were recorded and
analyzed. Preliminary results of the 3-way (group x cane x task) repeated measures of ANOVA on
6 healthy and 5 stroke patients revealed only the task main effect (p<.05) on verbal response, with
both groups showing increased verbal reaction time (929.4ms) in the dual-task condition
compared with the single-task condition (685.2ms). There was a significant group x cane
interaction effect on step reaction time (p<.05). With the use of a cane, patients with stroke
significantly (p<.016) reduced the step reaction time when stepping with the unaffected leg
(reduced from 775.9ms to 692.1ms) and with the affected leg (reduced to from 740.3ms 699.0ms),
whereas healthy adults showed no significant changes in step reaction time (no cane: 545.7ms;
with cane: 540.0ms). The kinetics of the cane showed anticipatory adjustments of the forces
applied on the cane before initiating the stepping movements in patients with stroke, but not in
healthy controls. The results suggest that both healthy adults and patients with stroke require
substantial attentional demands when performing a volitional stepping task. Although the use of a
cane does not significantly change such attentional demands, the shortened step reaction times
under the cane use condition in patients with stroke indicate that using a cane may provide better
anticipatory postural adjustments in preparation for making a volitional stepping movement for
these patients, as revealed from our kinetic data of the cane.
Subjects
hemiplegia
assistive device
stepping
dynamic equilibrium
attention
dual task
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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