胡名霞2006-07-262018-07-082006-07-262018-07-082004http://ntur.lib.ntu.edu.tw//handle/246246/25641此第二年期研究計畫的目的有二：（一）探討使用單拐對中風病患及健康成人執行自主 性前跨動作時之動作表現、動態平衡之神經肌肉控制機制、以及注意力需求之影響；（二） 由分析單拐下之力學變化進一步瞭解單拐之生物力學角色。至今本研究已收集9 位中風與 11 位健康受試者之資料。每位受試者皆接受三種情境之測試：主要單項任務（跨步）情境、 次要單項任務（口語反應）情境、及雙項任務（跨步加口語）情境。以上三種情境之測試 又再細分為在持拐與不持拐下各執行六次。實驗記錄受試者之跨步表現（含跨步反應時間、 跨步動作時間、壓力中心相關參數、及兩下肢腓腸肌與脛前肌之肌電反應）、口語反應表現 （含口語反應時間、反應正確率）、及單拐下之力學變化。以6 位健康及5 位中風受試者所 作之三維重複變異數統計分析之初步結果顯示：對口語反應時間只有任務之主要效應（p ＜.05），兩組人在雙項任務情境下之口與反應時間（929.4ms）皆較單項任務情境下的 （685.2ms）長。而對跨步反應時間則有組別與持拐情境之交互作用效應（p＜.05）。持拐下， 中風病患用健側下肢跨步之跨步反應時間由不持拐下之775.9ms 降至692.1ms，其用患側下 肢跨步時間則為由740.3ms 降至669.0ms；然而健康受試者在持拐下（545.7ms）與不持拐 下（540.0ms）之跨步反應時間則無顯著差異。單拐下之施力分析則顯示中風病患在持拐下 跨步前，其拐下施力出現預期性之調節，而健康受試者則無此現象。這些初步結果顯示健 康與中風受試者在跨步時都有顯著之注意力需求。雖然持拐下跨步未降低中風病患這種注 意力需求，然而由持拐能減少其跨步反應時間來看，持單拐跨步可能提供較佳之預期性姿 勢調節，使患者對跨步作較佳之準備。此研究之拐下力學結果亦支持這種推測。The purposes of this second-year part of the three-year research project were two-fold: first, to examine the influence of regular cane use on the movement performance, neuromuscular control mechanisms of dynamic balance, and the attentional demands associated with performing a voluntary forward stepping movement in patients with stroke and in age-matched healthy adults; second, to further understand the biomechanical role of a regular cane when being used in the above-mentioned task by investigating the kinetics recorded from the cane. Nine stroke patients and 11 healthy adults participated in the study to date. All subjects were tested in 3 task conditions: single primary task (stepping alone), single secondary task (verbal reaction time alone), and dual task (stepping plus verbal reaction tasks) conditions. All three conditions were further stratified into cane-use and cane-free sub-conditions. Performance of stepping movements (step reaction time, step movement time, center of pressure measures, and EMG of bilateral tibialis anterior and gastrocnemius and unilateral triceps brachii) and verbal responses (verbal reaction time and accuracy of verbal response), as well as the kinetics of cane were recorded and analyzed. Preliminary results of the 3-way (group x cane x task) repeated measures of ANOVA on 6 healthy and 5 stroke patients revealed only the task main effect (p<.05) on verbal response, with both groups showing increased verbal reaction time (929.4ms) in the dual-task condition compared with the single-task condition (685.2ms). There was a significant group x cane interaction effect on step reaction time (p<.05). With the use of a cane, patients with stroke significantly (p<.016) reduced the step reaction time when stepping with the unaffected leg (reduced from 775.9ms to 692.1ms) and with the affected leg (reduced to from 740.3ms 699.0ms), whereas healthy adults showed no significant changes in step reaction time (no cane: 545.7ms; with cane: 540.0ms). The kinetics of the cane showed anticipatory adjustments of the forces applied on the cane before initiating the stepping movements in patients with stroke, but not in healthy controls. The results suggest that both healthy adults and patients with stroke require substantial attentional demands when performing a volitional stepping task. Although the use of a cane does not significantly change such attentional demands, the shortened step reaction times under the cane use condition in patients with stroke indicate that using a cane may provide better anticipatory postural adjustments in preparation for making a volitional stepping movement for these patients, as revealed from our kinetic data of the cane.application/pdf72584 bytesapplication/pdfzh-TW國立臺灣大學醫學院物理治療學系暨研究所hemiplegiaassistive devicesteppingdynamic equilibriumattentiondual taskjournal articlehttp://ntur.lib.ntu.edu.tw/bitstream/246246/25641/1/922314B002187.pdf