2015-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646657摘要：忽略症是腦中風後常見的神經心理學缺損，此症對生活功能、活動參與、及生活品質均有不良影響且具重要的預後意義。雖然部分忽略症疾患可於急性期之後取得部分自發性復原，但多數個案之忽略徵兆仍持續至慢性階段且影響生活功能甚鉅，並帶來沈重照護負擔。先前忽略症研究曾使用主動動作演練及被動感覺輸入等單一復健方案來提升中風復健成效，但所得證據多支持立即性的治療成效，欠缺追蹤期的功能改善證據；此外過去的療效成果多側重於神經學與神經心理學評量，缺乏與生活情境相關之功能表現及生活品質量測。為提升忽略症矯治的功能成效，後續研究值得探討深具發展潛力的複合療法（如結合密集動作演練與感覺輸入），並對照混合療法、單一療法、及常規復健的長、短期成效。此研究可望提供忽略症治療更完整的實證基礎，並提升忽略症治療對功能表現及生活品質的長、短期綜效，充實現有中風後忽略症的實證基礎。侷限誘發治療與體感覺輸入療法均呼應目前忽略症神經復健的重要理論建構：激活右大腦半球的神經活性以改善對側空間的忽略。侷限誘發治療促用主動性患肢演練來提供豐沛的動作練習經驗，繼而提升患側肢體的功能使用；提供感覺刺激的治療策略，則能經由增加患側肢體的感覺輸入，來降低兩側大腦半球間的失衡。侷限誘發治療與體感覺輸入療法於近年腦中風復健的個別療效研究裡已呈現顯著的立即成效，但結合此兩者之複合療法於改善中風後忽略症的成效仍不明朗，亟需療效對比試驗。此三年期專題研究計畫將採用創新性合併療法，結合迫用患肢動作演練的侷限誘發治療與患側手部感覺輸入方案，檢測複合療法的綜效。本研究計畫的主要目的如下：(一) 對比複合療法（侷限誘發治療合併手部體感覺輸入）與單一療法（侷限誘發治療、常規復健治療）於急性後忽略症疾患之短期與長期成效，並藉以探討誘發改變的可能機制；（二）提供全面性且具客觀的量化評量，以建立複合與單一療法的適合指標；（三）分析治療成效的預測因子，以探求適用上述治療的個案特質，並引導後續研究。本計劃案預計延攬七十二位發病三個月內之腦中風忽略症個案，並將隨機分配於侷限誘發治療合併體感覺輸入組（實驗組）、侷限誘發治療組（對照組）、與常規復健治療組（控制組）。此三組受試個案將接受治療時數均等之劑量配對介入方案，進行每週五天、每天九十分鐘、持續四週之治療。所有受試將接受三次成效評量（治療前、治療後、及治療後六個月之追蹤），治療成效指標涵蓋感覺與動作功能、動作控制分析、功能性活動與生活品質等多重面向。本研究計畫完成後可望提供更客觀的忽略症神經復健成效證據，藉此長、短期療效對比試驗來呈現複合型與單一型療法，在不同成效指標的差異，並探討治療成效之影響因子與預測模型。此計畫將延展我國中風神經復健的成果，提升忽略症治療的實證基礎與實務應用，並帶動接續神經行為領域的研發與譯介。<br> Abstract: Unilateral neglect (UN) is one of the most disabling neurological deficits after stroke. People with UN show significant difficulties in functional activities and participation in life situations, leading to reduced life quality and increased caregiver burden. Although UN may recover naturally in some patients at an early stage, it remains severe in many patients and may persist into the chronic stage. Various interventions for UN have been used over clinical settings and appear to be promising, but the effects are often transient and cannot be transferred to daily functions and life quality. Moreover, comparative efficacy research that compares the benefits of monotherapy and combination treatment for UN remains scant. Further research based on a larger sample is needed to investigate the possible synergistic effects of the combined therapy not only in neuropsychological test performance but also in patients’ functional independence in order to inform poststroke UN rehabilitation.Motivated by the research that reported the effects of constraint-induced therapy (CIT) and mesh glove (MG) afferent stimulation for neurorehabilitation and the relevance of their combined use, we will hybridize CIT and afferent stimulation to exam the short- and long-term effects in postacute stroke with UN. In the combinatory regimen, the CIT will be the active component based on mass practice of the affected upper limb and passive afferent stimulation to the affected hand will be used to augment CIT intervention. Based on our power analysis, we expect to recruit 72 patients with neglect within 3 months after stroke. All participants will be randomized into one of three groups: (1) CIT combined with MG afferent stimulation (CIT + MG); (2) CIT alone; or (3) dose-matched control intervention (DMCI), along with functional tasks practice. The participants in each group will receive equivalent amounts of treatment (5 days/week for 1.5 hours/day for 4 weeks).We propose herein a 3-year research project to: (1) determine the efficacy of the CIT + MG compared with CIT alone, and DMCI in participants with poststroke neglect; (2) provide a comprehensive evaluations to formulate effective regimens for UN rehabilitation; and (3) explore the demographic and clinical characteristics of the participants that may be relevant for predicting changes in the treatment outcomes. Outcome measures will range from neurological functions, to activity limitations, and to participation restrictions which will be assessed over 28 weeks at pretreatment, the end of treatment, and 6 months after cessation of treatment. This research project will be the first to investigate the potential synergistic effects of combining the CIT with afferent stimulation for UN after stroke. We will adopt a randomized, controlled study to investigate the short- and long-term benefits of the hybrid intervention, relative to monotherapy and regular rehabilitation. These findings will help us to recognize the changes over time after treatment, identify the clinical relevance of the hybrid regimen, as well as motivate theoretical innovation of neurorehabilitation for UN following stroke.中風單側忽略侷限療法感覺輸入複合療法神經復健strokeunilateral neglectrestraint therapyafferent stimulationcombined therapyneurorehabilitation