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系統識別號 U0026-2608201604112500
論文名稱(中文) 任務之空間與時間侷限因子對中風個案伸手取物動作表現之影響
論文名稱(英文) The effect of spatio-temporal task constraints on reaching performance in patients with stroke
校院名稱 成功大學
系所名稱(中) 職能治療學系
系所名稱(英) Department of Occupational Therapy
學年度 104
學期 2
出版年 105
研究生(中文) 潘曉潔
研究生(英文) Hsiao-Chieh Pan
電子信箱 jjpan123@gmail.com
學號 T76024029
學位類別 碩士
語文別 中文
論文頁數 69頁
口試委員 指導教授-馬慧英
口試委員-郭立杰
召集委員-林克忠
口試委員-黃文柱
中文關鍵字 腦中風  任務侷限  伸手取物  運動學分析 
英文關鍵字 stroke  task constraint  reaching  kinematic analysis 
學科別分類
中文摘要 研究背景與目的:腦中風後的存活者經常伴隨著程度不等的動作問題。因為動作的不平順、緩慢與較弱的肌肉力量,使得個案在生活中使用患側上肢進行日常功能性活動的意願與頻率大幅降低。雖然動作速度對腦中風個案來說是重要的,但在傳統的復健活動中,多半採取緩慢的動作訓練,而較少在訓練時強調個案的動作速度。近來的研究則認為任務的時間侷限有可能提升中風個案的動作控制策略。此外,在臨床介入中鮮少使用動態性活動,但動態性活動除了提供時間侷限外,也提供了在空間中位置改變的視覺線索,必須仰賴個案同時整合時間與空間訊息來執行動作。過去研究顯示外在時間侷限與視覺線索能提升動作問題個案的動作表現。因此,本研究的目的是要探討侷限任務的空間與時間特性對中風個案伸手取物動作表現的影響。
研究方法:本研究採重複計量實驗設計,所有參與者均須執行研究中的所有任務情境,以進行參與者間與情境間之伸手取物動作表現比較。分為腦中風組與健康對照組,每組各20位參與者;伸手取球侷限任務分三種情境:靜止球、掉落球﹝時間侷限:時限內掉落﹞和滾動球﹝時間侷限伴隨空間視覺線索:時限內滾落﹞,並將時間侷限設為快速與慢速兩個層級,共為六個情境區段。參與者的伸手取物動作表現以動作分析儀器紀錄,並計算出反應時間、動作時間、尖峰速度、動作單元、加速度佔動作時間百分比和路徑比值等運動學參數。「腦中風個案腦傷對側手與同側手在三個不同取球情境及速度下的動作表現差異」與「腦中風組與健康對照組在不同情境下的動作表現差異」,均採用二因子變異數分析(two-way ANOVA)進行分析比較;而腦中風組個案與健康對照組個案的動作表現差距,是否受不同情境影響,則使用單因子變異數分析(one-way ANOVA),去比較情境間兩組表現的差值是否有顯著差異。
研究結果:腦中風個案腦傷對側手與同側手的動作表現在三個不同的伸手取球情境下會有差異,滾動球與掉落球情境能引發動作時間較短與尖峰速度較大等較佳的動作,而結合空間與時間兩項侷限因子的滾動球情境下,動作表現又較掉落球情境更好,且動態視覺提示亦能誘發較短的反應時間。比較情境對於腦中風組與健康對照組的影響,結果發現任務侷限的效應僅發生在腦中風組個案身上。且在滾動球情境下,腦中風個案伸手取物時的動作時間與尖峰速度與健康對照組最為接近。
結論:本研究使我們了解,調控任務的空間與時間特性,能使腦中風個案有較短的反應時間、動作時間與較大的尖峰速度,改善他們在日常生活中使用腦傷對側手時,動作緩慢、力量小等問題。未來研究可進一步利用此情境效應,發展成復健介入活動,並檢視其對個案動作的長期效應。

關鍵字:腦中風、任務侷限、伸手取物、運動學分析
英文摘要 SUNMMARY
The purpose of this research was to examine the effect of spatio-temporal task constraints on reaching performance in patients with stroke. This project utilized repeated-measures design and kinematic analysis. We included 20 stroke patients and 20 age-matched controls. All participants were instructed to reach balls under three conditions with different spatio-temporal constraints: dropping ball, moving ball, and stationary ball. Their motor performance was recorded for kinematic analysis. Our results revealed that stroke group could move their hemiparetic arm with shorter reaction time and movement time, and higher peak velocity under the moving ball condition than the dropping and stationary ball conditions. These findings give new ideas for developing intervention strategies to facilitate better performance of stroke patients, and extend the application in therapeutic activities by giving tasks with spatio-temporal constraints.

Key Words: stroke, task constraint, reaching, kinematic analysis


論文目次 中文摘要 I
英文延伸摘要 III
誌謝 VI
目錄 VIII
表目錄 X
圖目錄 XI
第一章 文獻回顧 1
第一節、 腦中風盛行率及其影響 1
第二節、 中風個案伸手取物動作表現 2
第三節、 伸手取物動作控制介入之相關理論與概念 3
壹. 動態系統理論之任務調控 3
貳. 時間侷限對伸手取物動作表現之影響 5
參. 空間位置之動態視覺線索與時間侷限對伸手取物動作表現之影響 6
第二章 研究重要性、目的與研究假設 9
第三章 研究方法 11
第一節、 研究設計 11
第二節、 研究對象 12
第三節、 研究工具 13
壹. 臨床篩檢工具 13
貳. 軌道設計 17
參. 動作分析儀器 18
肆. 高畫質攝錄放影機 (High Definition Video Camera) 19
第四節、 研究流程 20
第五節、 參數定義與資料處理 21
第六節、 資料分析與統計方法 23
第四章 研究結果 24
第一節、 研究對象之基本資料與運動學表現數據 24
第二節、 中風個案腦傷對側手在不同情境下之伸手取物動作表現差異 25
第三節、 中風個案腦傷同側手在不同情境下之動作表現差異 27
第四節、 腦中風組個案與健康對照組在不同情境下之動作表現差異 29
第五節、 腦中風個案與健康對照組個案在各別情境下表現差距之比較 31
第五章 討論 32
第一節、 空間與時間侷限因子對腦中風個案腦傷對側手動作表現之影響 32
第二節、 空間與時間侷限因子對腦中風個案腦傷同側手動作表現之影響 35
第三節、 空間與時間侷限因子對腦中風個案及健康對照組之效應比較 38
第四節、 腦中風個案與健康對照組個案在不同情境下的表現差異 40
第五節、 研究限制與未來研究方向 41
第六章 結論 43
參考文獻 45

參考文獻 Agency for Health Care Policy and Research. (1995). Post-stroke rehabilitation: assessment, referral and patient management. Post-Stroke Rehabilitation Guideline Panel.
Arya, K. N., & Pandian, S. (2014). Interlimb neural coupling: Implications for poststroke hemiparesis.Annals of physical and rehabilitation medicine, 57(9), 696-713.
Bailey, M. J., Riddoch, M. J., & Crome, P. (2000). Evaluation of a test battery for hemineglect in elderly stroke patients for use by therapists in clinical practice. Neurorehabilitation, 14(3), 139-150.
Bailey, M. J., Riddoch, M. J., & Crome, P. (2004). Test-retest stability of three tests for unilateral visual neglect in patients with stroke: Star Cancellation, Line Bisection, and the Baking Tray Task. Neuropsychological Rehabilitation, 14(4), 403-419.
Brewer, L., Horgan, F., Hickey, A., & Williams, D. (2013). Stroke rehabilitation: recent advances and future therapies. QJM, 106(1), 11-25.
Davids, K., Button, C., Araújo, D., Renshaw, I., & Hristovski, R. (2006). Movement models from sports provide representative task constraints for studying adaptive behavior in human movement systems. Adaptive Behavior, 14(1), 73-95.
DeJong, S. L., Schaefer, S. Y., & Lang, C. E. (2012). Need for speed: better movement quality during faster task performance after stroke. Neurorehabilitation and Neural Repair, 26(4), 362-373.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Jounal of Psychiatric Research, 12(3), 189-198.
Freitas, S. M., Gera, G., & Scholz, J. P. (2011). Timing variability of reach trajectories in left versus right hemisphere stroke. Brain Research, 1419, 19-33.
Gao, K. L., Ng, S. S., Kwok, J. W., Chow, R. T., & Tsang, W. W. (2010). Eye-hand coordination and its relationship with sensori-motor impairments in stroke survivors. Journal of Rehabilitation Medicine, 42(4), 368-373.
Heller, A., Wade, D. T., Wood, V. A., Sunderland, A., Hewer, R. L., & Ward, E. (1987). Arm function after stroke - measurement and recovery over the 1st 3 months. Journal of Neurology Neurosurgery and Psychiatry, 50(6), 714-719.
Huang, Z.-S., Chiang, T.-L., & Lee, T.-K. (1997). Stroke prevalence in Taiwan. Findings from the 1994 National Health Interview. Stroke, 28(8), 1579-1584.
Lang, C. E., Wagner, J. M., Bastian, A. J., Hu, Q. L., Edwards, D. F., Sahrmann, S. A., & Dromerick, A. W. (2005). Deficits in grasp versus reach during acute hemiparesis. Experimental Brain Research, 166(1), 126-136.
Leo, K. C., & Soderberg, G. L. (1981). Relationship between perception of joint position sense and limb synergies in patients with hemiplegia. Physical Therapy, 61(10), 1433-1437.
Li, F., Wu, Y., & Li, X. (2014). Test-retest reliability and inter-rater reliability of the Modified Tardieu Scale and the Modified Ashworth Scale in hemiplegic patients with stroke. European Journal of Physical and Rehabilitation Medicine, 50(1), 9-15.
Liebermann, D. G., Levin, M. F., McIntyre, J., Weiss, P. L., & Berman, S. (2010). Arm path fragmentation and spatiotemporal features of hand reaching in healthy subjects and stroke patients. Conference Proceedings:Annual Conference Proceedings of the IEEE Engineering in Medicineand Biology Society, 2010, 5242-5245.
Lin, J. H., Hsu, M. J., Sheu, C. F., Wu, T. S., Lin, R. T., Chen, C. H., & Hsieh, C. L. (2009). Psychometric comparisons of 4 measures for assessing upper-extremity function in people with stroke. Physical Therapy, 89(8), 840-850.
Lin, K. C., Tang, F. T., Chen, H. C., Wu, C. Y., & Shen, I. H. (2001). Effects of contextual constraints on reaching performance in adults without disabilities: A kinematic study. Occupational Therapy Journal of Research, 21(3), 168-184.
Lin, K. C., Wu, C. Y., Lin, K. H., & Chang, C. W. (2008). Effects of task instructions and target location on reaching kinematics in people with and without cerebrovascular accident: a study of the less-affected limb. The American Journal of Occupational Therapy, 62(4), 456-465.
Magill, R. A. (2011). Motor learning and control : concepts and applications / Richard A. Magill (9th ed ed.). New York McGraw-Hill.
Majsak, M. J., Kaminski, T., Gentile, A. M., & Flanagan, J. R. (1998). The reaching movements of patients with Parkinson's disease under self-determined maximal speed and visually cued conditions. Brain, 121 ( Pt 4), 755-766.
Majsak, M. J., Kaminski, T., Gentile, A. M., & Gordon, A. M. (2008). Effects of a moving target versus a temporal constraint on reach and grasp in patients with Parkinson's disease. Exprimental Neurology, 210(2), 479-488.
Mani, S., Mutha, P. K., Przybyla, A., Haaland, K. Y., Good, D. C., & Sainburg, R. L. (2013). Contralesional motor deficits after unilateral stroke reflect hemisphere-specific control mechanisms. Brain, 136(Pt 4), 1288-1303.
Massie, C. L., & Malcolm, M. P. (2012). Instructions emphasizing speed improves hemiparetic arm kinematics during reaching in stroke. Neurorehabilitation, 30(4), 341-350.
Morris, J. H., van Wijck, F., Joice, S., & Donaghy, M. (2013). Predicting health related quality of life 6 months after stroke: the role of anxiety and upper limb dysfunction. Disability and Rehabilitation, 35(4), 291-299.
Nakayama, H., Jorgensen, H. S., Raaschou, H. O., & Olsen, T. S. (1994). Compensation in recovery of upper extremity function after stroke - the copenhagan stroke study. Archives of Physical Medicine and Rehabilitation, 75(8), 852-857.
Newell, K. M. (1985). Coordination, Control and Skill. In R. B. W. David Goodman & M. F. Ian (Eds.), Advances in Psychology,27, 295-317.
Oldfield, R. C. (1971). The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia, 9(1), 97-113.
Ricken, A. X., Savelsbergh, G. J., & Bennett, S. J. (2006). External timing constraints facilitate performance of everyday interceptive actions in children with Spastic Hemiparetic Cerebral Palsy. Neuroscience Letters, 410(3), 187-192.
Ricken, A. X., Savelsbergh, G. J., & Bennett, S. J. (2007). Interception of moving objects while walking in children with spastic hemiparetic cerebral palsy. Disability and Rehabilitation, 29(1), 69-77.
Sartori, L., Straulino, E., & Castiello, U. (2011). How objects are grasped: the interplay between affordances and end-goals. Public Library of Science One, 6(9), e25203.
Savelsbergh, G. J., Ledebt, A., Smorenburg, A. R., & Deconinck, F. (2013). Upper limb activity in children with unilateral spastic cerebral palsy: the role of vision in movement strategies. Developmental Medicine and Child Neurology, 55 Supplement 4, 38-42.
Schenk, T., Baur, B., Steude, U., & Bötzel, K. (2003). Effects of deep brain stimulation on prehensile movements in PD patients are less pronounced when external timing cues are provided. Neuropsychologia, 41(7), 783-794.
Schmidt, R. A. (2008). Motor learning and performance: a situation-based learning approach: Human Kinetics.
Shumway-Cook, A., & Woollacott, M. H. (2012). Motor control: translating research into clinical practice (4th ed.): Lippincott Williams & Wilkins.
Sveen, U., Bautz-Holter, E., Sodring, K. M., Wyller, T. B., & Laake, K. (1999). Association between impairments, self-care ability and social activities 1 year after stroke. Disability and Rehabilitation, 21(8), 372-377.
Tombaugh, T. N., & McIntyre, N. J. (1992). The mini-mental state examination: a comprehensive review. Journal of American Geriatrics Society, 40(9), 922-935.
Veale, J. F. (2014). Edinburgh Handedness Inventory - Short Form: a revised version based on confirmatory factor analysis. Laterality, 19(2), 164-177.
Wang, C.-Y., Hwang, W.-J., Fang, J.-J., Sheu, C.-F., Leong, I.-F., & Ma, H.-I. (2011). Comparison of Virtual Reality Versus Physical Reality on Movement Characteristics of Persons With Parkinson's Disease: Effects of Moving Targets. Archives of Physical Medicine and Rehabilitation, 92(8), 1238-1245.
Wu, C., Trombly, C. A., Lin, K., & Tickle-Degnen, L. (2000). A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability. Archives of Physical Medicine and Rehabilitation, 81(1), 95-101.
Wu, C. Y., Lin, K. C., Lin, K. H., Chang, C. W., & Chen, C. L. (2005). Effects of task constraints on reaching kinematics by healthy adults. Perceptual and Motor Skills, 100(3), 983-994.
Wu, C. Y., Wong, M. K., Lin, K. C., & Chen, H. C. (2001). Effects of task goal and personal preference on seated reaching kinematics after stroke. Stroke, 32(1), 70-76.
Yancosek, K. E., & Howell, D. (2010). Integrating the dynamical systems theory, the task-oriented approach, and the practice framework for clinical reasoning. Occupational Therapy in Health Care, 24(3), 223-238.

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