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系統識別號 U0026-1908201415180300
論文名稱(中文) 彈性貼紮對垂足中風病患跨越障礙物效益評估
論文名稱(英文) Effect of elastic taping on obstacle crossing for the stroke patients with foot drop
校院名稱 成功大學
系所名稱(中) 物理治療學系
系所名稱(英) Department of Physical Therapy
學年度 102
學期 2
出版年 103
研究生(中文) 忻昱廷
研究生(英文) Yu-Ting Hsin
學號 T66001011
學位類別 碩士
語文別 英文
論文頁數 47頁
口試委員 指導教授-楊政峯
指導教授-黃英修
口試委員-卓瓊鈺
中文關鍵字 垂足  彈性貼紮  跨越障礙物  中風 
英文關鍵字 foot drop  elastic taping  obstacle crossing  stroke 
學科別分類
中文摘要 背景及目的: 垂足是中風病人常見的症狀之一,有此症狀的中風病人在步態行走週期中的擺盪期無法主動做出足踝關節背屈的動作。缺乏踝關節背屈角度會導致不正常的走路方式,像是足步拖曳(foot drap)、髖關節過度地抬高(hip hiking)以及出現環繞式步態(circumduction)…等異常動作。這些異常的步態使得中風病人面臨跌倒的風險隨之增加。矯正垂足最常見的方法為穿戴足踝副木(ankle-foot orthosis)。然而,足踝副木會限制踝關節的活動度,使得病人無法自我調整踝關節角度位置。用來替代足踝副木的功能性電刺激(functional electrical stimulation),因其價格過高,並非所有病人所能負擔。彈性貼布(elastic tape)既不會限制踝關節活動度,價格也相對較低,或許可作為矯正中風病人垂足的新方法。因此,本研究目的為探討彈性貼布對於垂足症狀的中風病人是否有立即性效益。

研究方法:本研究收集16位有垂足症狀,且平常穿戴足踝副木的中風病人,受試者必須在三種不同實驗狀況下跨過4公分高障礙物,此三種實驗狀況分別為:(1) 使用彈性貼紮(KTP)、(2) 穿戴足踝副木(AFO)、(3) 沒有彈性貼紮也沒有穿戴足踝副木(NON)。這三種實驗狀況會隨機排序,受試者須於每個實驗狀況下跨越8次障礙物。共有兩條彈性貼布會貼在中風病人的患側腳上,一條在小腿前側為促進脛前肌收縮,另一條在小腿後側為抑制小腿肌肉收縮。於試驗完成後,針對跨越障礙物的成功率、肌肉痙攣程度(Modified Ashworth scale)、末端動作控制的相關變數(end-point control variables)做分析。

研究結果:本研究結果顯示不論在哪種實驗狀況下,跨越障礙物的成功率、步幅時間、步幅長度、腳跟障礙物距離與步長比,都是沒有顯著差異的。然而,在穿戴足踝副木跨越障礙物時,所測得的足尖最小垂直高度(toe clearance)及踝關節背屈角度,均大於另外兩種實驗狀況。此外,在穿戴足踝副木跨越障礙物時,所測得的踝關節活動度是三個實驗狀況中最小。比較貼紮前和貼紮後的MAS分數,發現貼紮後的MAS分數低於貼紮前。

結論:對於有垂足症狀的中風病人,在進行跨越障礙物時,沒有因給予彈性貼紮或穿戴足踝副木而有較好的表現。然而,彈性貼紮後所測得的肌肉痙攣程度下降,需要更多研究以確認是否為貼紮的功效,或是受到擺位影響。本研究並未發現彈性貼紮的立即效益,未來可探討於較長時間下,彈性貼紮與傳統物理治療的搭配是否有較好的治療效益。
英文摘要 Introduction: Foot drop is a common impairment in the stroke patients. The stroke patients with foot drop are unable to dorsiflex the foot actively during the swing phase of gait. As a result, it appears abnormal gait pattern such as foot drag, hip hiking, and circumduction. The impairment increase the risk of falls which is a major concern for the stroke patients. Although the ankle-foot orthosis (AFO) is commonly used to correct foot drop, it may constrain ankle joint from adjustments. An alternative option is functional electrical stimulation (FES) which may not be affordable for everyone. Elastic tape that allows ankle joint motion and is less expensive may be a possible solution for the stroke patients with foot drop. The purpose of this study was to determine if the stroke patients with foot drop would have immediate benefit from elastic taping.

Methods: Sixteen stroke patients who regularly used AFO to correct foot drop participated in this study. Subjects were requested to step over a 4-cm-height obstacle with self-selected speed under 3 conditions: (1) taping without wearing an AFO (KTP), (2) wearing an AFO without taping (AFO) and (3) without taping and without AFO (NON). The order of the conditions was randomized. Eight trials were performed for each condition. The motions were collected by a 3-D motion analysis system. Two strips of elastic taping were applied to the affected ankle, one for facilitating the tibialis anterior muscle and the other for inhibiting the calf muscles. The successful rate, Modified Ashworth scale, end-point control variables and the ankle joint ROM were analyzed. The repeated measure univariance ANOVA was used as a statistical test.

Results: No significant differences were found for the successful rate, step time, step length, and the ratio of heel-obstacle distance to step length between 3 conditions. The toe clearance and dorsiflexion angle at the moment of obstacle crossing under AFO condition were significantly larger than the other 2 conditions. The AFO condition showed smaller ankle ROM during obstacle crossing than the other 2 conditions. All of the performance such as successful rate, spatial-temporalvariables and ankle joint ROM in KTP condition was similar to NON condition. The MAS score was decreased after taping than before taping.

Conclusions: Our results showed that the performance of obstacle crossing was not changed by applying elastic taping on the stroke patients. The stroke patients with AFO did not have better performance than the condition without taping and without AFO, either. Although the MAS score decreased after taping, it needs further study to exclude the effects from the taping procedure. With the results lacking of immediate effect, we suggest investigating the effects of elastic taping combine with conventional therapy over a period of time in the future.
論文目次 摘要...I
Abstract...III
誌謝...V
Contents...VI
List of Tables...VIII
List of Figures...IX

Chapter 1. Introduction...1

Chapter 2. Methods...11
2.1 Subjects...11
2.2 Experimental Setting...11
2.3 Experimental procedures...12
2.4 Data analysis...15
2.4.1 Successful rate...15
2.4.2 Spatial-temporal variables...15
2.4.3 Joint angles captured at the time of obstacle crossing...17
2.4.4 Modified Ashworth Scale...18
2.5 Statistical test...18

Chapter 3. Results...19
3.1 Successful rate...19
3.2 Spatial-temporal variables...19
3.3 Joint angles captured at the time of obstacle crossing...20
3.4 Modified Ashworth Scale...22

Chapter 4. Discussion...23
4.1 Performance of obstacle crossing was not changed by applying elastic taping on the stroke patients...23
4.2 Effect of elastic taping on reducing spasticity needs further study...26
4.3 Mobility and self-learning constrained by AFO...27

Chapter 5. Conclusion...30

References...31
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