2016-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646089摘要：背景臺灣已邁入老年化的社會，而頸椎脊髓神經病變又是中老年人常見之脊椎退化性疾病，常造成患者失能進而影響生活品質，增加家人社會及醫療成本的負擔。故本研究將利用動作分析技術，從生物力學的角度評估頸椎脊髓神經病變患者之動作控制能力，以發展個別化的動態平衡復健評估及訓練系統，並長期追蹤其訓練療效與機制。本研究為四年期計畫，分年描述如下:方法第一年： 招募將接受脊椎減壓手術之頸椎脊髓神經病變患者，以及無症狀之老年人接受臨床測試評估，包括：三D 動作分析之生物力學測試、醫學影像診斷、問卷評估、動作表現測試、脊椎曲度及肌肉力量評估。評估頸椎脊髓神經病變患者，於接受脊椎減壓手術治療前後，其動作控制能力之關節肌肉協調度於功能性動作之變化。第二年： 開發人機互動式之平衡干擾雙帶跑步機，發展互動式復健訓練計畫。持續增加收案個數，並根據動作分析數據結果，發展以平衡干擾雙帶跑步機為主之個別化動態平衡訓練。第三年： 病患組將於術後三個月隨機分配至兩組，一組進行互動式之個別化平衡及行走訓練，並於術前、術後三個月、六個月、及一年評估；另一組則是接受一般物理治療復健訓練。病患將依照脊髓壓迫程度被分級，建立與動作控制能力與壓迫程度之相關性，並比較接受互動式動態平衡復健訓練療效。第四年： 持續追蹤病患至術後一年，並定期電訪記錄其跌倒次數，並探究個別化動態平衡訓練之短期與長期療效機制。預期結果與貢獻本研究結果將提供頸椎脊髓神經病變手術後的實證復健指引，藉由生物力學之動作分析，對脊椎減壓手術後之動作控制能力與脊椎穩定度將有全面的瞭解，有助於日後治療及增進頸椎疾病患者的生活品質，減輕家人社會及醫療成本的負擔。本研究所開發之互動式平衡干擾雙帶跑步機可商品化，並應用於動態平衡復健訓練臨床復健計畫中，除可造福頸椎脊髓神經病變患者，更可運用於任何有平衡或步態缺失的老人或病人族群，增進其平衡能力，預防跌倒。<br> Abstract: Taiwan is quickly becoming a nation of aging population with radiculomyelopathy reporting to be one ofthe most common spinal cord disorderes associated with spinal degeneration. Given the high prevalencerate of the condition, current project aims to investigate the impact of radiculomyelopathy on motorcontrol from a biomechanical perspective with the overall aim to develop a interactive balanceperturbation rehabilitation program targeting individual patients and identified deficiency. Theefficacy of the individual rehabilitation program will be assessed and determined utilizing a prospectivelongitudinal study design. A break down of the proposed three year project are as follows:Year 1: Radiculomyelopathy patients undergoing cervical decompression surgery as well asage-matched asymptomatic controls will be recruited and subjected to the following clinicalevaluations: 3-dimensional biomechanical motion analysis, diagnostic Magnetic Resonance Imaging,pain and disability questionnaires, motor performance assessment, spinal curvature as well as musclestrength assessment. Motor control and coordination during functional movements will beevlautaed.Year 2: Continue to recruit potential participants and further develop the use of the interactivesplit-belt balance perturbation treadmill as modalities for gait and balance therapy.Year 3: Physical Therapy rehabilitation programs at 3 month post surgery, one group will participatein a specific and personalized interactive balance perturbation training program targetingbalance and gait retraining, while the other group receive the routine Physical Therapy program.Both treatment groups will be assessed pre-operatively, at 3, 6 and 12 month post-operatively.Patients will be classified based on their severity and grade of the spinal cord compression beforebeing compared for any difference in treatment responses.Year 4: Follow-up monitoring and documenting the number of falls experienced by patients at oneyear postoperatively as an outcome of effectiveness.Expected outcome and significanceThe findings from the current project will provide important empirical evidence to guide postoperativerehabilitation of radiculomyelopathy patients. Through detailed biomechanical motion analysis, it isanticipated that this project will provide an in-depth understanding of the influence of decompressionsurgery on motor control and spinal stability. The tailored and innovative rehabilitation program will alsoimprove patients’ long term quality of life.