行政院國家科學委員會補助專題研究計畫成果報告:坐/站功能性肌力訓練對腦性麻痺兒童粗動作功能之效果

Abstract

治療腦性麻痺（ cerebral palsy， 簡稱 CP）兒童近年來肌力訓練逐漸受重視。研究 指出肌力訓練可增進肌力，但是否增進其動 作功能仍無定論。主要原因可能是傳統肌力 訓練皆以單關節、開放式動力鏈（ open kinetic chain）動作方式，不符合日常生活下 肢肌肉動作方式;與現今以任務取向（task oriented）之治療趨勢不符。因此本研究室發 展出，結合肌力及多關節/閉鎖式動力鍊動作 之功能性肌力坐/站荷重測試（STSLT）/訓 練方法（STSLE）。本研究室已證實，CP 兒 童與一般兒童之STSLT 之測試信度良好，然 要驗證STSLE 對CP 兒童之功效，需先釐清 STSLT 測試結果與粗動作功能之關係。故本 研究目的為：(1)探討CP 兒童之STSLT 結果 與粗動作功能之關係； (2)探討CP 兒童 STSLT 結果與其個別肌肉肌力之關係。 本研究採取方便取樣（sample of convenience）方式，就近在台灣的北部徵召 20 名6-12 歲痙攣型CP 兒童參與本實驗（平 均年齡88±24 月），在2-7 天內，分別測量 其粗動作功能量表(Gross Motor Function Measure, GMFM)，坐/站1 次最大荷重阻 與以徒手肌力測試儀(Hand-held dynamometer)，測量下肢個別肌肉之最大等 長肌力(包括髖關節、膝關節、踝關節之伸直 及屈曲肌、髖關節外展及內收肌)及腰部脊旁 肌肌力。以坐到站1 次所能負荷之最大重量 除以體重，稱為標準化坐/站1 次最大荷重阻 力(STSN1RM)來代表其功能性肌力。 本研究結果顯示CP 兒童之標準化坐/站 1 次最大荷重阻力與其粗動作功能量表之總 分分數及訓練領域目標分數呈現高度相關 (r=0.76~0.80,p<0.01)。CP 兒童之STSNIRM 與下肢各個別肌力也都有顯著相關。 STSN1RM 在控制平衡能力之控制因子後， 其與膝伸直肌力及髖外展肌力之相關 （r=0.61~0.62，P<0.01）。膝伸直肌肌力及 髖外展肌肌力為預測坐/站最大荷重能力之最 佳複迴歸公式之獨立變項，其判定係數為 0.72（p<0.01）。結論：CP 兒童之坐/站最大 荷重能力與其粗動作功能有高度相關，與膝 伸直肌及髖外展肌個別肌力相關最高。因此 結合肌力與功能性動作之坐/站功能性肌力訓 練方式，應可適用於增進下肢伸直肌無力之 CP 兒童的粗動作功能，但成效如何，尚待研 究。

Recently, strengthening program for children with cerebral palsy (CP) is paid great attention to. Studies have indicated that muscle strengthening can increase muscle strength; however, the effectiveness of strengthening for motor function is still controversial. The movement pattern of isolated and open kinetic chain under traditional strengthening program does not similar to the functional movement used in activity of daily living. A functional sitto- stand loading testing (STSLT) and exercise (STSLE) method was developed in our laboratory before. That STSLT method is a multi-joint, closed kinetic chain activity with strength and movement control dimensions. Our previous study found that STSLT was a reliable test for children with CP and non-disabled children. The purpose of this study was to investigate the relations between (1) functional strength and gross motor; and (2) STSN1RM and the individual muscle strength in children with CP. Methods: A convenience sample of 20 children with spastic diplegia in Northern Taiwan was recruited. Their age ranged from 892314B002454.doc2001/10/29 72 – 122 months (88 ± 14 mo). Gross Motor Function Measure (GMFM), normalized 1 repetitive maximum of STSLT (STSN1RM), speed of sit-to-stand 5 times and maximum isometric contraction in lower extremities with Nicholas hand-held dynamometer were measured. STSN1RM represents the functional strength of lower extremities. Results: There was significant correlation between STSN1RM and the scores of 3 dimensions of GMFM (r = 0.76~ 0.80, p <0.01), and between STSN1RM and muscle strength of 12 muscles of lower extremities(r = 0.4~ 0.78, p <0.05). The stepwise regression test found that the muscle strengths of knee extensor and hip abductor were the best predicting factors for STSN1RM ( r2 = 0.72, p <0.01). Conclusion: STSN1RM is highly correlated with the gross motor function and the muscle strength of lower extremities in children with CP. However the effects of STSLE need further studies.