| Summary: | 碩士 === 長庚大學 === 臨床行為科學研究所 === 96 === Chapter 1
No abstract
Chapter 2
Trunk Study of Distributed Constraint-Induced Therapy
in Patients with Chronic Stroke
Objective：
Patients showed impairments of arm trunk coordination after stroke. Previous studies didn’t investigate the interventions’ effects on arm-trunk coordination after constraint-induced therapy (CIT). However, the trunk compensation often used by stroke patients may limit the improvement of the affected arm. Therefore, we tried to discuss the influence on arm trunk coordination and trunk compensation strategy after the intervention of distributed CIT.
Methods：
A total of 16 participants (at least 6 months post-onset) after stroke were randomly assigned to either distributed CIT group (practiced 2 hours every workday for 3 weeks and restrained the unaffected arm 6 hours per day) or control group (received traditional rehabilitation for equivalent intensity and duration). We used kinematics analysis (unilateral and bilateral tasks) to investigate the arm-trunk coordination and two clinical measures (Functional Independent Measure, FIM and Stroke Specific Quality of Life Scale, SSQOL) to assess functional ability and quality of life of the participants. All the outcomes were measured at the beginning and end of the 3-week intervention.
Results：
There were no differences between the groups at baseline (p > 0.05). The results showed that there were statistically different between the groups during the unilateral tasks on elbow extension angular change (p = 0.030), trunk flexion angular change (p = 0.045), elbow extension & trunk flexion correlation (p = 0.020), and early part, terminal part, and total of the trunk contribution slope (p < 0.05). There were also statistically different on elbow extension angular change (p = 0.017), trunk-arm delay (p = 0.030), and the total trunk contribution slope (p = 0.033) during the bilateral tasks. Statistically different on transfer domains of FIM (p = 0.046) and family role domain of SSQOL (p = 0.013) were noted as well.
Conclusion：
After 3-week distributed CIT, the participants reduced trunk compensation and performed normally as a result of gained better elbow joint control during both the unilateral or bilateral tasks. It showed that distributed CIT elicited better arm trunk coordination and improved greater motor control. Participants also had better performances in functional ability and quality of life after distributed CIT.
Chapter 3
Effects of Bilateral Arm Training in Patients
with Chronic Stroke
Objective：
To examine the effectiveness of bilateral arm training (BAT) on chronic stroke patients by measuring the performance of kinematics analysis, motor capacity and functional ability.
Methods：
A total of 33 patients (at least 6 months post-onset) after stroke were randomly assigned to either BAT or placebo-controlled traditional rehabilitation. All patients practiced 2 hours every workday for 3 weeks. The outcome measures were the performance of kinematics analysis (unilateral & bilateral tasks), motor capacity (the Fugl-Meyer Assessment, FMA) and functional ability (Functional Independent Measure, FIM), assessed at the beginning and end of treatment.
Results：
There were no significant differences between the groups at baseline (p > 0.05). We observed better performance in reaching kinematics of the affected arm after BAT as compared with the traditional rehabilitation by less nMT and nTD (p = 0.034; p = 0.039) during both unilateral and bilateral tasks. But a non-significant and small effect was found on PPV during the unilateral task (p = 0.396), rather than bilateral task (p = 0.001). Also, BAT showed a significant greater improvement in FMA than traditional rehabilitation (p = 0.041), but there were no differences in FIM (p > 0.05).
Conclusion：
BAT was associated with higher efficiency in the temporal and spatial aspects during the unilateral and bilateral tasks, also a greater preplanning control strategy during the bilateral tasks. Greater motor improvements were also observed by FMA. These findings provide some insight about the mechanisms that may be responsible for improved motor function of the affected arm after BAT. But we suggested that more studies were needed to examine the effect of BAT on functional ability.
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