2010-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/658854摘要：中風是導致成人失能的主要原因之一，其中以動作的問題最為常見。約有三分之二的中風患者因為患側上肢無法進行功能動作而失去活動的獨立性。目前任務導向模式已成為治療方法的主流，但以往臨床應用(如限制誘發動作治療)多只強調單側。然而受到近十年雙手動作研究在動作行為與神經生理學的啟發，物理治療專家開始嘗試各種基於雙側同步動作的治療方式，並於機能損傷、動作策略、功能層面的得到初步的成效。儘管如此，過去研究仍存有一些為解決之問題，包括設計與訓練內容的變異大，需要使用特製治療器材，而且訓練內容多為機械化地重複動作，並非目標導向的任務。近年亦有部份研究者將功能電刺激訓練模式整合入雙側同步動作的治療方式而得到部份成功。然而這些研究所進行的方法亦為機械化地重複動作而非功能性動作。此外，由於臨床上物理治療師評估中風患者上肢功能往往只能依賴一些量表進行評估，而可以提供客觀的上肢運動學參數之動作分析系統又十分昂貴且不易操作。因此有必要建構一個成本低廉、操作方便之中風患者往前伸展功能分析之系統，提供給臨床治療師做為參考的依據。綜上所述，本研究之目的為利用加速規ADXL330和電子尺SP1-50發展一套有效的臨床評估中風病患上肢動作功能之系統。本研究亦將利用本系統與功能性電刺激及肌電訊號量測系統整合，嘗試探索整合肌電訊號啟動功能性電刺激(EMG triggered FES)之任務取向雙側上肢運動訓練效果。本計畫第一年已初步完成評估系統之設計、測試。而信效度分析正在進行中；預叶第二年將利用已完成之動作分析系進行任務取向雙側上肢運動訓練效果評估；第三年則利用已完成之動作分析系進行整合肌電訊號啟動功能性電刺激之任務取向雙側上肢運動訓練效果評估。<br> Abstract: Stroke is one of the major causes of adult disabilities, among which motor problems are the most commonly seen. About two-third of stroke patients are unable to use their upper extremity functionally and lost their independence of activities of daily living. Task-oriented approach became the main stream of physical therapy for stroke patients. In previous clinical application such as Constraint-Induced Movement Therapy (CIMT) focused on affect arm training only without using the unaffected arm. However, inspired by the behavior and neurophysiological findings of research about bilateral arm movement in the past decade, physical therapy experts began trying several of treatment protocols based on bilateral arm movement. The effect of this approaches showed preliminary success. However, some unsolved problems including large treatment variability and special design therapeutic device requirement might impede the clinical application of bilateral arm training. Besides, most researches regarding bilateral arm training were only performing mechanically repetitive movements, not a goal-directed task. In recent years, researchers found some success to improve the upper extremity function via combining functional electrical stimulation (FES) with bilateral arm training. In these study, they only asked patients to perform mechanically repetitive movements, not a goal-directed task.On the other side, only some clinical evaluation instruments were available to evaluate the upper extremity functions of stroke for a physical therapist. Motion analysis systems could provide objective kinematic data of stroke patients. However, these system remained expensive and hard to operate in clinical situations. Therefore it is necessary to develop a low-cost and convenient device for physical therapists to evaluate reaching functions of stroke patients.According as mention above, the goal of this study is try to design a effective upper extremity function evaluation system for stroke patients by accelerometers (ADXL330) and linear potentiometer. This system will be integrated with a myoelectric signal (EMG) measurement system and the functional electrical stimulator which provide by subproject one to explore the effects of combined a task-oriented bilateral arm training with EMG triggered FES on the stroke patients with upper extremity impairment. In the first year, the evaluation system was designed and tested. The clinical evaluated of this system\s reliability and validity was continue smoothly. In the second year, we try to evaluate the effects of bilateral arm training via the system designed in the first year. The clinical effects of bilateral arm training with EMG triggered FES will be evaluate in the third year.inflammationCBPT cell development