2013-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645945摘要：背景：大多數的肩關節損傷患者有肩胛骨運動學異常的情形，肩胛骨運動異常為可觀察之肩胛骨位置與動作模式上之改變。文獻指出，過去有許多測試肩胛骨運動異常之評估方法，但並不完備，因此針對肩胛骨運動異常以臨床觀察為評估方法是有需要的。此異常和許多肩關節疾患中常發現肩關節之動作學參數、肩胛骨周圍之肌肉活動的改變有關。除此之外，有許多學者認為不正常的姿勢及軟組織的攣縮及緊繃與肩胛骨運動學不正常有關，但其關係為何仍需進一步研究驗證。目前，臨床上常使用貼紮方式來減緩肩關節的不適感，在功能性動作中，貼紮可提供保護及支撐關節，然而，貼紮對於肩胛骨運動學的動作控制的影響及貼紮是否能改變肩胛骨動作還未有一定論。目的：因此本研究第一年希望發展新整合之肩胛骨運動異常之臨床評估方法，並探討其信效度。第二年則探討有肩胛骨運動異常之受試者的肩部緊縮程度、肩膀前傾姿勢、肩關節角度、肩胛骨運動學、肩胛骨肌肉活動特性以及功能性失能之間的關係：及上述因素是否能預測此類受試者與症狀相關之功能性失能。第三年將探討肩胛骨貼紮對於有肩胛骨運動異常之受試者的肩胛骨運動學及肩胛骨肌肉活動特性的影響及其療效。設計：第一年以60 位肩關節單側疼痛患者為研究對象，請受試者在肩胛骨平面上作負重手臂上抬、放下動作，觀察上抬與放下過程中肩胛骨之動作型態加以分類，計算兩位評估者之測試者間信度，並同時以三度空間動作分析儀做效度分析。第二年則利用第一年的評估方法，將70 位肩關節單側疼痛患者作分類，結合肩胛關節三維動作與肌電圖表現，並評估肩部緊縮程度、肩部前傾姿勢、肩關節角度、肩胛骨運動學及相關肩胛骨肌肉活動特性。第三年則欲收取48 位單側肩膀疼痛及肩胛骨運動學異常之受試者。將進行四次維持8 天貼紮療程，於首次貼紮前後量測肩胛骨運動學及相關肩胛骨肌肉活動特性，並於第四次療程結束後，做最後測量。將分析肩胛骨運動學及肩胛骨肌肉活動特性，並比較治療前後之差異。<br> Abstract: Background: Scapular dyskinesis is common in patients with shoulder injuries. Scapulardyskinesis is defined as observable alternations in scapular position and/or patterns ofmotion. In previous studies, there are several evaluation methods to assess scapulardyskinesis. However, reliability and validity of these methods are limited for its clinicalusage. Therefore, development of visual-based clinical assessment to identify scapulardyskinesis is valuable in the rehabilitation for the patients. Shoulder kinematics and scapularmuscular activities alternations have been reported to be correlated with many shoulderdisorders. Further, several mechanisms are proposed to explain shoulder injuries in terms ofscapular dyskinesis. Abnormal shoulder posture, contracture, and/or tightness of shouldersoft tissue are/is the possible reason(s) for contributing to scapular dyskinesis. Identificationof the relationships among these factors is helpful for planning treatment strategy. On theother hand, application of tape is widely used in the rehabilitation and in the prevention ofthese shoulder complaints. Although taping is proposed to afford protection and support forscapula during functional movement, evidence to support that control of the scapula can bealtered by taping is limited. Objective: The purpose of the first year study is to investigatethe reliability and validity of the novel scapular dyskinesis classification test. In the secondyear, the purposes of the experiment are (1) to investigate the relationships between shouldertightness, forward shoulder posture, joint range of motion, scapular kinematics andassociated muscular activity, and functional disability in subjects with scapular dyskinesis;(2) to determine whether these factors can predict the degree of symptoms-related functionaldisability in subjects with scapular dyskinesis. The purpose of the third year study is toinvestigate the effect of scapular taping in terms of kinematics and associated muscle activityin subjects with scapular dyskinesis. Methods: For the first year, sixty subjects withunilateral shoulder pain will be recruited into our study. We will observe dynamic movementpatterns of scapula during weighted arm elevation and lowering in scapular plane andclassify the movement pattern of scapula, and then calculate the inter-rater reliability of 2evaluators. In validity part, we will use 3-D motion analysis system to validate thealterations of the scapular kinematics with different types of scapular dyskinesis. For thesecond year, seventy subjects with unilateral shoulder pain will be recruited into our study.The similar procedure used in the first study will be applied in the second year study.Additionally, shoulder tightness, forward shoulder posture, joint range of motion, scapularkinematics and associated muscular activity will be assessed in this investigation. For thethird year, forty-eight subjects with unilateral shoulder pain will be recruited into our study.We will measure the kinematics and associated muscle activity before and after the tapingapplication. Discriminating the treatment effect between the two conditions with and withouttaping application will be investigated.childhood acute lymphoblastic leukemiasingle-nucleotide polymorphism arrayCREBBP deletionsABD