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系統識別號 U0026-2307201915100000
論文名稱(中文) 創新生理回饋復健系統用於中風病人手部訓練之成效
論文名稱(英文) Training Effects of a Novel Biofeedback System on Hand Function for Stroke Patients
校院名稱 成功大學
系所名稱(中) 生物醫學工程學系
系所名稱(英) Department of BioMedical Engineering
學年度 107
學期 2
出版年 108
研究生(中文) 舒瑀
研究生(英文) Yu Shu
學號 P86054218
學位類別 碩士
語文別 英文
論文頁數 72頁
口試委員 指導教授-蘇芳慶
口試委員-郭立杰
口試委員-徐秀雲
口試委員-張志涵
口試委員-楊岱樺
中文關鍵字 手指獨立性  力量控制  生物回饋  協調性 
英文關鍵字 Digit independence  force control  biofeedback  coordination 
學科別分類
中文摘要 中風病人經常因中風後導致手功能受損進而大幅影響其生活品質,不正常的協同動作和受損的感覺會導致病人無法有效控制手部力量,使病人手指獨立性降低、手指協調差。臨床上,目標導向的介入經常用來作為中風後的訓練,過去亦有許多研究提出創新的手指訓練方式和儀器,但是目前尚未有一個強烈推薦有效的方式可用於手指獨立性和力量控制訓練。
本篇研究中,共有15位中風病人參與,本研究使用創新抓握訓練器搭配生理回饋系統以訓練病人手指功能,訓練總共12次,一次30分鐘,每周2~3次。訓練分成兩部分:(1)穩定抓握以達目標角度;(2)穩定施力以達目標力量。評估方式除了臨床評估外,亦使用該創新抓握訓練器和按壓訓練器作為評估工具,評估總共三次,分別在訓練前、訓練後和訓練後一個月追蹤。
研究結果顯示,病人接受訓練後整體手指功能提升,尤其是手指獨立性和手部穩定性,在訓練後顯著的進步,且該成效在追蹤評估時亦能維持。抓握調整能力在訓練後有顯著的進步;臨床評估和抓握力量訓練後則呈現進步趨勢但未達統計上顯著差異,然而病人訓練後的感覺功能並未提升,由於該訓練並未針對感覺功能,故此結果為合理可預期的。
總體來說,該創新抓握訓練儀器可有效應用於提升手部功能和手指控制能力,此外,該儀器除用於訓練,亦可作為評估工具,能將病人手部功能表現量化,幫助病人和臨床醫療人員清楚了解病人目前進步程度。未來的研究可考慮納入更多的病人,以降低中風病人間的變異性。未來亦可考慮精簡該創新抓握訓練儀器,使該儀器能更方便使用、降低成本,以便此儀器能廣泛的在醫療院所中使用。
英文摘要 Stroke patients usually suffer from poor hand function which causes significant inconvenience in their daily activities. The abnormal synergy pattern and impaired sensation result in the deficits of force control especially poor digit independence, and poor digit coordination. Clinically, task oriented training is widely used for post-stroke recovery. There are also several novel hand coordination trainings had been proposed. However, there’s still lacking a strongly recommended training method that’s effective and specific for digit force control and finger independence.
In this study, 15 stroke patients voluntarily involved in this experiment. Grasping Training System (GTS) with visual biofeedback was used to train and evaluate finger function. All subjects finished 12 times 30 minutes training with the frequency of 2 to 3 times per week. The training program consisted two parts: (1) stably meet target force and (2) accurately meet target angle. To evaluate participants’ hand function improvements, besides clinical assessments, GTS and Pressing Evaluation Training System (PETS) were also used in evaluation. The evaluations were conducted before, after and 1 month after training.
The results showed that subjects’ performance generally improved after GTS training. Patients’ digit independence and hand steadiness were significantly improved after training and the training effects could be maintained in follow-up test. The temporal coupling between grip force and load force was also significantly decreased. Clinical hand function test and grasping and pinch force showed trend of improvement but no statistical difference. However, the GTS training didn’t have effect on sensory improvement which is reasonable as the training programs were not focus on sensory function.
Overall, GTS provide clinicians and stroke patients an effective and innovative way to train hand function and digit control. Moreover, it can also be used to quantify patients’ performance which provide clinicians a clearer image of patients’ rehabilitation progress. In the future, studies can increase the sample size of subjects which can possibly lower the variability of stroke patients. Furthermore, to make GTS training and evaluation system more widely used in clinics and commercialized, the device can be simplified so that it can be cheaper and easier for therapists to operate.
論文目次 摘要 I
Abstract II
致謝 IV
List of Tables VIII
List of Figures IX
Chapter 1 Introduction 1
1.1 Importance of hand function 1
1.1.1 Role of grasping position 1
1.1.2 Grasping planning and adjustment 2
1.2 Hand function of stroke patients 3
1.3 Synergy pattern 3
1.4 Sensorimotor deficit in stroke patients 5
1.5 Digital force control deficit in stroke patients 5
1.6 Finger independence 6
1.7 Hand function intervention for stroke patients 7
1.7.1 Post stroke recovery: brain plasticity 7
1.7.2 Traditional task-oriented training 8
1.7.3 Biofeedback training 8
1.7.4 Novel hand coordination training 9
1.8 Grasping Training System (GTS) and Pressing Evaluation and Training System (PETS) 10
1.9 Motivation 11
1.10 Purpose 12
Chapter 2 Materials and Methods 13
2.1 Participants 13
2.2 Equipment 14
2.2.1 Grasping Training System (GTS) 14
2.2.2 Pressing Evaluation and Training System (PETS) 17
2.2.3 Visual feedback system 18
2.3 Experimental setting and procedure 19
2.3.1 The experimental setting 19
2.3.2 The experiment procedure 20
2.4 Outcome measures 22
2.4.1 GTS evaluation 22
2.4.2 PETS evaluation - FTT 23
2.4.3 Clinical assessment – strength test 25
2.4.4 Clinical assessment – hand function test 28
2.4.5 Clinical assessment – sensory test 31
2.5 Training program 32
2.5.1 Target force training program 33
2.5.2 Target angle training program 35
2.6 Data processing and analysis 36
2.6.1 Parameters of PETS – EN 36
2.6.2 Parameter of PETS - RMSD 37
2.6.3 Parameter of GTS – grasping efficiency 38
2.6.4 Parameter of GTS – reaction time 39
2.6.5 Parameter of GTS – coefficient variance of force 39
2.6.6 Parameter of GTS – coefficient variance of acceleration 40
2.7 Statistical analysis 40
Chapter 3 Results 41
3.1 Training effects on EN 41
3.2 Training effects on RMSD 42
3.3 Training effects on grasping efficiency 44
3.4 Training effects on reaction time 45
3.5 Training effects on coefficient variance of force 46
3.6 Training effects on coefficient variance of acceleration 49
3.7 Training effects on clinical assessments – strength 51
3.7 Training effects on clinical assessments – hand function 52
3.7.1 Box and blocks (B&BT) 52
3.7.2 Purdue 53
3.8 Training effects on clinical assessments – sensory 54
3.8.1 Semmes-Weinstein (S-W) test 54
3.8.2 Two-point discrimination (2-PD) test 55
Chapter 4 Discussion 58
4.1 EN improvement 58
4.2 Anticipatory grip force modulation 58
4.3 Force adjustment 59
4.4 Force smoothness 61
4.5 Hand steadiness 62
4.6 Limitations and future works 63
Chapter 5 Conclusion 64
Reference 66
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