2014-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/658785摘要：動作障礙(Movement Disorders)是屬於神經學專門領域，其中尤以巴金森氏病最為人熟知。巴金森氏症(Parkinson’s disease, PD)是一種進行性的退化性中樞疾病，患者之動作功能會受影響，患者通常表現於動作起始困難，進行節律性動作以及執行順序性動作皆受影響，學習動作技巧的能力亦下降。針對巴金森氏病，目前已有多種藥物或手術方法可供使用，然而都只能做到改善症狀，無法抑止巴金森氏病的病程進展。因此動作障礙是患者終其一生必須處理的問題，臨床人員必須針對患者在行動障礙所產生的日常生活困難加以處理，因此物理治療在此扮演相當重要的角色。 另一方面，遠距醫療(telemedicine)利用資通科技帶來了新的醫療服務模式。目前也有學者將遠距醫療應用在動作障礙患者身上，尤其是利用可穿戴之感測器進行患者的行動與功能的監測是近幾年研究的重點。然而這類系統主要的目的是在於對患者的行動加以監測，並對已發生跌倒事件的患者提供警訊及求救服務。對患者而言，發生跌倒事件時傷害已然造成，這類系統的需求雖然存在，但只能達成事後告知的效果，並無助與患者的傷害減少。因此，如何在事先有效的評估患者之功能，並針對高危險的族群加以評估並提早介入就成為一個臨床上重要的問題。 就目前常用的臨床評估方面，除了常見的功能性量表外，手指輕敲測驗(finger tapping test)亦是目前認為一種量化的動作功能評評測驗。手指輕敲測驗常用來評估精細的動作及腦傷的嚴重程度，亦可用於評估神經肌肉系統的功能，並檢查動作控制能力。目前已有研究開始利用手指輕敲測驗作為評估巴金森氏症患者的嚴重程度，亦有研究指上肢的起始困難與下肢的起始困難呈相關，因此似可以利用手指輕敲測驗作為患者上肢功能以及下肢行走功能之指標。此一指標在遠距監測上易於評估，且在安全上較行走或其他需要轉位的測試更佳。然而是否具有足夠的代表性，則有待進一步探討。 外在提示(external cue)為臨床上常用於訓練巴金森氏症患者的一種技巧，尤其常常用於行走訓練以及改善步態，而聽覺提示(auditory cue)相對地對節律性的動作的效果尤其顯著。有關聽覺提示的臨床應用，包括用於下肢步態及上肢活動，其臨床表現的進步已有相當多文獻佐證，但大部分只集中於同步給予提示時的情況，只有少數文獻探討訓練(或視為學習)的效果，且文獻的樣本數較少。 綜上所述，本研究主要的目標在於第一年發展一套臨床可用的動作障礙患者之功能評估系統。系統應包括由三軸加速規、力感測器、微感測器及資料擷取分析等元件所組成。以提供動作參數供復健時之參考；同時針對患者之手指動作時，以同步化的聽覺提示對照沒有同步化聽覺提示時，其動作表現、學習效果及其大腦皮質興奮性，以做為第二年遠距介入效果之基礎。而在第二年之目標為利用第一年所研發之系統進行臨床實驗，並同時進行上肢訓練介入與行走功能之間的相關性分析，以評估臨床效果。 <br> Abstract: Movement disorders is a special field in clinical neurology, especially Parkinson's disease is the most well-known disease in this field. Parkinson's disease (PD) is a progressive degenerative disease which affected in patients’ motor function. Patients suffered from PD are usually expressed in difficulties along the whole course of the movement process, from planning to initiation and finally execution of a movement, perform rhythmic or sequential movement are also affected, and ability to learn motor skills also declined. Medication and surgery are available for PD, however, current treatment methods can only delay the progress of the symptoms of PD but not cure. Therefore, movement disorders is an issue that must be managed and the clinician must deal with the difficulties of activities in daily living. Physical therapy play an important role in maintaining and improving mobility, flexibility, strength, gait speed, and quality of life. On the other hand, telemedicine use of information and communication technology brings a new health care model. Currently there are some researches in telemedicine for movement disorders patients, especially using wearable sensors to monitor the patients’ daily activities and fall events and provide alerts and distress that have occurred in patients with a fall event. The demand for such systems still exist, but none of these system can reduce patients’ injuries caused by falls. An effective evaluation methods to screen out the high-risk patients and early intervention has become a significant clinical problem. Beside the clinical instruments, the finger tapping test is also now considered a quantitative assessment of motor function. Finger tapping test commonly used to assess the severity of brain injuries and also function of fine motor control of the neuromuscular system. Some research used a finger tapping test for evaluating patients with Parkinson's disease severity. Because some studies suggested the movement initiation of upper limbs and lower limbs were related. It seems to be reasonable to use the finger tapping test in patients with upper extremity features to predict the ambulation functions of a PD patient. This test is easy to perform on remote monitoring, and more safe than other motor skill test such as transfer and ambulation. However, this hypothesis need to be validated. External cue is a clinical technique commonly used in the ambulation training of patients with Parkinson's disease, and auditory cues relative to the rhythmic movements of the effect is especially significantly. The clinical application of the auditory cues, including for lower limb gait and upper limb activities, showed the auditory cue is an effective modality. However, these researches most focused only on synchronous cue prompt during acidities. There are only few studies to use auditory cues as a training modality. In summary, this two-year project aims to develop an evaluation tools for the patients suffered from movement disorders in the first year. The system includes a three-axis accelerometer, a force sensor, and data acquisition analysis system. It will provide the finger tapping signals as the reference for rehabilitation. We also evaluate the motor performance, motor learning and cortical excitability when the patient perform finger movement with or without auditory cue as the basis of telerehabilitation in the second year. The goal of the second year in research and development carried out for the use of the system in the first year of clinical trials, while the upper limb training correlation analysis between the intervention and walking function to evaluate the clinical effect.巴金森氏症外在提示遠距醫療Parkinson’s DiseaseExternal CueTelemedicine