2020-01-012024-05-17https://scholars.lib.ntu.edu.tw/handle/123456789/681288摘要：本研究計畫呼應國家衛生研究院個人計畫研究重點中第四點:神經疾患;我們團隊的研究結果,已被轉譯為中風照護與健康指引,本研究乃奠基於過去的研究成果,融合近年蓬勃發展的臨床精準醫療與轉譯神經科學,所應運而生的創新治療方案,本計畫將進行機器前誘式雙側上肢複合療法的對比試驗,並採用決策樹分析方法,探討有效治療的預測因素。中風不僅是世界各國生物醫藥研究重點,也是造成國人長期失能的重大疾病之一,若未能有效防治,可能導致沉重的照顧負擔及鉅額的資源消耗,提升中風患者的功能獨立及生活品質,為中風復健的首要之務。當代復健療法包含雙側機器輔助療法、鏡像治療、雙肢練習等,皆基於雙側練習,引發雙腦耦合的密集練習概念。雙側機器輔助療法可能具誘導之效,若銜接任務導向練習可望增強練習的既有成效。本專題研究計畫將檢驗:(1) 以雙側復健機器系統提供前段誘導(前誘),銜接鏡像治療(鏡像回饋)或雙肢練習(無鏡像回饋),對照於機器前誘損傷導向療法,以對比試驗探討感覺與動作功能、生活品質、日常功能、自我效能及動作控制等層面的療效;(2) 治療結束後三個月的成效與可能的延遲效應;(3) 療效的預測因子。本案預計延攬九十六位第一次中風發病個案,隨機分配至機器前誘鏡像治療組、機器前誘雙肢練習組、與機器前誘損傷導向療法組。此三組受試者將接受治療時數均等之劑量配對,進行每週三天、每天九十分鐘、持續六週的介入。受試將接受三次成效評量(治療前、治療後及三個月後追蹤)。本案將以共變數分析對比三種療法的成效,並將使用決策樹演算法來分析有效治療的預測因子。若能獲得貴院經費補助,預期本案可廓清復健機器系統前導銜接鏡像治療或雙肢練習之成效,以及成效預測因子。此案將有助於充實復健機器人系統輔助雙肢演練的實證基礎,瞭解復健機器人系統前誘功能訓練之優化模式,並透過資料探勘開掘成效預測因子。<br> Abstract: This proposed research fits in the NHRI Innovative Research Grant priority by addressing innovative treatment strategies for neurological disorders that is in desperate need of scientific scrutiny. Stroke is one of the major medical conditions that leads to long-term disability and causes heavy health care and financial burden. Our previous research funded by the NHRI has been published and translated to health literacy and stroke care. Extending our previous research, we will study robotic hybrid therapy by formulating different types of synergistic regimens; that is, bilateral robotic priming of mirror therapy and bilateral arm training.Current stroke rehabilitation programs such as robotic therapy, mirror therapy and bilateral arm training are bilateral approaches to intensive practice based on the tenet of coupling effect and practice-dependent neuroplasticity. Bilateral robotic therapy can potentially be a movement-based priming technique to promote rebalancing of cortical excitability and create an enriched neuroplastic environment by priming the brain to facilitate motor and functional recovery. This proposed research project will: (1) examine the effects of bilateral robotic priming combined with mirror therapy versus bilateral robotic priming combined with bilateral arm training approach, relative to the control intervention approach (bilateral robotic priming combined with impairment-oriented training) on sensorimotor function, quality of life, daily function, self-efficacy, and motor control strategy in patients with stroke, (2) investigate the 3-month retention effects of robotic priming combined with contemporary rehabilitation approaches (i.e.,bilateral arm training and mirror therapy) and the control intervention, and (3) identify the potential predictors of functionally relevant changes after therapy.We plan to recruit 96 stroke survivors who will be randomly allocated to the treatment group of robotic therapy and mirror therapy, robotic therapy and bilateral arm training, or robotic therapy and impairment-oriented training. All participants will receive interventions of equal duration and dose for 90 minutes/day, 3 days/week for 6 weeks. All participants will be assessed three times (before, after, and three months after the treatment). In addition to using the analysis of covariance to analyze the immediate and long-term effects of the treatments, we will use the method of decision tree analysis to examine the potential predictors of therapeutic improvements. This research will provide scientific evidence of the relative efficacy of robot-primed bilateral arm training vs. robot-primed mirror therapy in stroke care and will help to identify the potential predictors that may influence the treatment. The overall results will contribute to formulation of rationally based interventions formulated by hybridizing robotic therapy with bilateral task practice with and without mirror feedback. The findings will inform stroke rehabilitation research and practice by shedding light on the robotic priming effects in combinatory therapy. In addition, this research will demonstrate the relevance of decision tree analysis in stroke outcome prediction.中風復健複合療法Stroke rehabilitationhybrid therapy