2013-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/650641摘要：腦性麻痺是一種永久性神經損傷疾患。腦性麻痺兒童除了有動作執行問題外也常伴隨動作計畫問題。傳統上，腦性麻痺兒童之上肢動作復健主要著重於動作執行能力的訓練。雖然動作執行訓練可能內隱訓練動作計畫能力，但因動作想像可外顯訓練動作計畫能力，使其成為上肢動作復健另一種有效之介入方式。根據文獻指出，動作想像訓練已成功應用於一般健康人或神經疾患病人，例如腦中風病人之動作訓練。但其在腦性麻痺兒童之介入成效如何仍未知。此外，如何確認個案是否執行動作想像為動作想像訓練的一大挑戰，故發展一套可確認是否執行想像的回饋系統，將可提升動作想像訓練的效果。因此，本研究之目的旨在發展一結合腦機介面與動作想像訓練之上肢動作復健模式，此模式將應用於單側偏癱腦性麻痺兒童之動作復健。此計畫為整合型計畫『多功能腦控復健機器人系統之發展』之子計畫三。腦機介面回饋系統將會由子計畫一發展，此將有助於確認個案是否執行動作想像。子計畫二將發展的『低阻抗乾式電極腦波量測模組』也將整合於腦機介面回饋系統中。本子計畫將分三年執行，每年均有其特定研究目的。第一年之研究目的為整合腦波系統與動作分析系統，建立正常發展兒童動作想像與動作執行之神經行為模型。藉由探究動作想像與動作執行時腦波模式之相似性，以建立神經行為模型。將探討不同年紀兒童在不同動作執行活動下動作模式及其神經控制機轉。此外，將探討動作想像模式對腦波之影響。第一年正常兒童之資料將作為第二年與第三年探討單側偏癱腦性麻痺兒童動作想像與動作執行表現之基準。第二年之研究目的為利用第一年發展之神經行為模型探討單側偏癱腦性麻痺兒童之動作想像與動作執行，並發展出適合此類兒童之動作想像訓練計畫。此年將探討單側偏癱腦性麻痺此一疾病對兒童動作想像與動作表現之影響。藉由探究動作想像模式對腦性麻痺兒童腦波之影響，企圖找出最適合腦性麻痺兒童執行動作想像訓練時最適合之動作想像模式，此將有助於此類兒童動作想像訓練計畫之擬定並提升其執行效果。第三年之研究目的為評估結合腦機介面回饋系統與動作想像訓練之動作訓練方案對單側偏癱腦性麻痺兒童之介入療效。我們將召納兩群單側偏癱腦性麻痺兒童並隨機分配於介入組或控制組。兩組的兒童均接受功能性動作之動作訓練，但介入組將額外施予結合腦機介面回饋系統之動作想像訓練。訓練前將評估受試者之動作想像與動作執行表現，作為訓練前的基準。經過一個月之訓練後將再次評估其動作想像與動作執行表現，以期瞭解結合腦機介面回饋系統之動作想像訓練對單側偏癱腦性麻痺兒童之介入療效。<br> Abstract: Children with cerebral palsy (CP), a broad definition of permanent neurological disorder,were proposed to have problems of not only motor execution but also motor planning.Traditionally, motor rehabilitation of upper extremity in children with CP focused mainly onmotor execution, with less emphasis on training motor planning. Although motor executionmay implicitly train motor planning ability, motor imagery training which explicitly trainsmotor planning ability, may provide another efficient intervention for motor rehabilitation ofupper limbs. It has been successfully used for improving motor performance in healthyindividuals and those who have neurological deficits, such as stroke. However, applicationof motor imagery training in children with CP has not been reported. It is unclear if childrenwith CP can obtain similar benefits from motor imagery training to improve their motorfunction. Moreover, one of the challenges in applying motor imagery training is to measurethe engagement of motor imagery. Development of a bio-feedback system that may providea solution to this problem will be useful for the facilitating the effects of motor imagerytraining.Therefore, the main purpose of the proposed study is to develop a useful therapeutic tool formotor rehabilitation, combining brain-machine-interface (BMI) and motor imagery training,for children with hemiplegic CP, which is within the framework of the subproject 3 of themain project, namely “Development of a Multi-functional Brain Controlled RehabilitationRobot System.” The BMI biofeedback system will be developed in subproject 1, which willbe helpful for confirming the engagement of motor imagery. Low-impedance dry EEGelectrode module developed in subproject 2 will also be integrated into the BMI biofeedbacksystem. This subproject will be carried out in three years with specific goals.The aim of the first year is to establish the neurobehavioral model of motor imagery andexecution in children with typical development by combining electroencephalography(EEG) and motion analysis systems. To develop the model, similarity of EEG patternsbetween motor imagery and execution will be investigated. Motor patterns and underlyingneural mechanism will be studied in different age bands of children during different motorexecution tasks. Moreover, effects of motor imagery types on EEG data during motorimagery and execution will be investigated. Data from children with typical children will beserved as the baseline data to investigate the performance of motor imagery and execution inchildren with hemiplegic CP.The aim of the second year is to investigate the performance of motor imagery andmotor execution in children with hemiplegic CP based on the neurobehavioral modeland to develop the protocol of motor imagery training in these children group. Effectsof the hemiplegic CP on motor imagery and execution will be investigated based on thedeveloped neurobehavioral model. Effects of motor imagery types on the motor imageryand execution will also be studied to identify the best type of motor imagery in children with hemiplegic CP which will help develop the protocol of motor imagery training for childrenwith hemiplegic CP.The aim of the third year is to evaluate the efficacy of motor imagery training combiningwith a BMI biofeedback system in children with hemiplegic CP. Two groups of childrenwith hemiplegic CP will be recruited. Each subject will be randomly assigned to theintervention or control groups. For all groups, physical practice of the functional tasks willbe enrolled. However, additional motor imagery training combining with a BMIbiofeedback system will be applied for the intervention group. Before training, performanceof motor imagery and execution will be collected as the baseline. After one month training,the same tasks will be performed to evaluate the efficacy of the motor imagery combiningwith a BMI biofeedback system on children with hemiplegic CP.腦機介面動作想像腦性麻痺復健Brain-machine-interfacemotor imagerycerebral palsyrehabilitation