林克忠臺灣大學：職能治療研究所魏慈慧Wei, Tzu-HuiTzu-HuiWei2007-11-272018-07-092007-11-272018-07-092005http://ntur.lib.ntu.edu.tw//handle/246246/55384目標物距離於中風後伸手及物動作之情境效應 摘要 目標：探討中風病人伸手及物動作的距離效應，以及軀幹、手臂的協調情形。 方法：25位中風病人使用健側手分別在手長範圍內、手長及手長範圍外執行按鈴任務，使用運動學分析來探討動作表現。 結果：距離影響軀幹、手臂以及兩者之間的協調；距離增加，軀幹及手臂的速度、位移量及角度變化量都增加。軀幹及手臂的協調有固定模式，在時間上，軀幹比手臂先開始動作；在空間上，不論目標物的距離遠近，動作後段的位移主要由軀幹貢獻。 結論：目標物距離對健側手和軀幹動作的影響很大，特別在時間及空間的協調上；軀幹不只做為姿勢穩定之用，負責在動作後半部將手帶到目標物上。研究結果顯示左腦傷者在手臂及軀幹動作控制的障礙包括動作軌跡及時間協調兩部分。 目標物距離與軀幹侷限於中風後伸手及物動作之情境效應 摘要 目標：研究目標物距離與軀幹侷限對中風病人伸手及物動作的影響。 方法：25位中風病人使用健側手在四種實驗情境下執行伸手及物動作，實驗情境由目標物距離（遠、近）以及軀幹侷限與否共同決定：近距離及軀幹侷限、遠距離及軀幹侷限、近距離及不侷限軀幹、遠距離及不侷限軀幹。 結果：目標物距離及軀幹侷限對增加手臂關節角度變化量有顯著且高度的效應，在軀幹侷限而且目標物在近距離的情況下，可以改善動作流暢度。 結論：本研究結果顯示內在侷限及外在侷限都會影響動作表現。左腦傷及失用症患者在手臂動作流暢度的控制出現明顯的障礙，臨床評估及治療時應該納入考量，另外軀幹控制能力對伸手及物動作有很大的影響，尤其是反應時間及動作時間。Task context and reaching performance after stroke: Effects of target distance Abstract Purposes: To examine the effect of target distance on reaching performance in persons after stroke and the influence of voluntary trunk movement on the arm endpoint trajectory during reaching. Methods: Twenty-five persons after stroke using ipsilesional arm performed reaching task. Kinematics of reaching movements to targets placed within arm length, arm length and beyond arm length were analyzed. Results: As reaching distance increased, the velocity, displacement and active joint ranges of trunk and arm increased. Whenever the trunk was involved, there was a stereotyped sequential recruitment of the arm and trunk in that the trunk began moving before the hand. The trunk played an important role in positioning the hand close to the target during the terminal stage of the reaching movement. Conclusions: Reaching distance affected the spatio-temporal aspects of coordination between the trunk and arm. The trunk not only acts as a postural stabilizer during reaching, but also becomes an integral component in positioning the hand close to the target. Persons with left brain damage showed deficits in trunk and arm movement trajectory control and in temporal coordination of trunk and arm. Task context and reaching performance after stroke: Effects of target distance and trunk restraint Abstract Purpose: To examine the effects of context on reaching performance in persons with stroke. Methods: Twenty-five persons with stroke used ipsilesional arm to perform an upper-extremity reaching task under four experimental conditions, formed by the crossing of target distance and trunk restraint. Results: Significant and large effects of target distance and trunk restraint were found on increasing elbow and shoulder joint ranges. Movement smoothness was improved under condition of trunk restraint and target placed in near distance. Conclusions: The results of this study showed that the influence of internal and external constraints on reaching performance. Participants with left brain damage and apraxia showed deficits in movement trajectory control. The ability of trunk control affected reaching performance in the variables of movement time and reaction time.摘要 ii 第1部 目標物距離於中風後伸手及物動作之情境效應 表目錄 viii 圖目錄 ix 1. 文獻回顧 1.1 目標物距離對伸手及物動作的影響 1-1 1.2 中風後健側手的動作表現 1-2 1.3 影響伸手及物動作的因素 1-3 1.4 研究目的及假設 1-3 2. 方法 1-5 2.1 參與者 1-5 2.2 評估工具 1-7 2.3 實驗設計 1-7 2.4 實驗流程 1-8 2.5 資料處理 1-8 2.6 資料分析 1-9 3. 結果 1-10 3.1 線性運動學變項 1-10 3.2 角度運動學變項 1-10 3.3 軀幹-手臂協調性 1-11 3.4 腦傷側對動作表現的影響 1-12 3.5 臨床評估與運動學分析 1-12 4. 討論 1-13 4.1 距離效應 1-13 4.2 腦傷側對動作表現的影響 1-14 4.3 研究的優點及限制 1-16 4.4 對未來研究的建議 1-16 4.5 臨床意義及應用 1-17 4.6 結論 1-17 5. 參考文獻 1-18 6. 圖表 1-23 表目錄 Table 1 Characteristics of participants with right brain damage 1-23 Table 2 Characteristics of participants with left brain damage 1-24 Table 3 Linear parameters of reaching movements to three distances 1-25 Table 4 Angular parameters of reaching movements to three distances 1-26 Table 5 Trunk-arm time coordination of reaching movements to three distances 1-27 Table 6 Slopes of arm versus trunk displacement in the forward direction in the sagittal plane 1-28 Table 7 Correlations between clinical scores and kinematic variables 1-29 圖目錄 Figure 1 The mean angular changes of shoulder flexion and elbow flexion for three reaching distance conditions 1-30 Figure 2 The mean shoulder-elbow correlation of three reaching distance conditions 1-31 Figure 3 The mean trunk-arm time coordination related to the start and end of movement as a function of reaching distance 1-32 Figure 4 The mean trunk contribution slope related to the first, middle and last part of movement as a function of reaching distance 1-33 Figure 5 The mean trunk NTD and arm NTD with SD bars is displayed separately for the LCVA and RCVA groups 1-34 Figure 6 The mean arm PPV with SD bars is displayed separately for the LCVA and RCVA groups 1-35 Figure 7 The mean trunk-arm time coordination related to the end of movement with SD bars is displayed separately for the LCVA and RCVA groups 1-36 第２部　　目標物距離與軀幹侷限於中風後伸手及物動作之情境效應 表目錄 xii 圖目錄 xiii 1. 文獻回顧 2-1 1.1 平衡能力對伸手及物動作的影響 2-1 1.2 中風後患側手的動作表現 2-1 1.3 中風後健側手的動作表現 2-2 1.4 影響伸手及物動作的因素 2-3 1.5 研究目的及假設 2-4 2. 方法 2-5 2.1 參與者 2-5 2.2 評估工具 2-7 2.3 實驗設計 2-7 2.4 實驗流程 2-8 2.5 資料處理 2-8 2.6 資料分析 2-9 3. 結果 2-10 3.1 軀幹侷限效應 2-10 3.2 次分析 2-11 4. 討論 2-12 4.1 軀幹侷限效應 2-12 4.2動作表現的影響因子 2-12 4.3 研究的優點及限制 2-13 4.4 對未來研究的建議 2-14 4.5 臨床意義及應用 2-14 5. 參考文獻 2-15 6. 圖表 2-21 表目錄 Table 1 Experimental conditions 2-21 Table 2 A priori hypotheses for experimental conditions 2-22 Table 3 Characteristics of participants with right brain damage 2-23 Table 4 Characteristics of participants with left brain damage 2-24 Table 5 Kinematic parameters of reaching movements associated with testing conditions 2-25 Table 6 Contrast analyses for kinematic parameters of stroke patients 2-26 Table 7 Results of post hoc contrast analyses 2-27 圖目錄 Figure 1 The mean arm NTD with SD bars is displayed for the CVA between different laterality, neurological severity and apraxia sverity. 2-28 Figure 2 The mean shoulder-elbow correlation with SD bar is displayed for the CVA with mild and severe apraxia severity 2-29 Figure 3 The mean arm MT & RT with SD bars is displayed for the CVA with more impaired and less impaired trunk control ability 2-30 Figure 4 The mean arm PV with SD bars is displayed for the CVA with and without extinction. 2-31352873 bytesapplication/pdfen-US伸手及物動作運動學分析距離軀幹及手臂協調軀幹侷限距離效應健側手reachingkinematicsdistancetrunk-armcoordinationtrunk restraintDestance effectipsilesional armtexthttp://ntur.lib.ntu.edu.tw/bitstream/246246/55384/1/ntu-94-R92429010-1.pdf