本體感覺神經肌肉誘發治療對慢性中風病人平衡能力及功能性活動之療效

Effects of Proprioceptive Neuromuscular Facilitation on Balance and Mobility Performance in Individuals with Chronic Stroke

系所名稱：物理治療研究所 學位別：碩士 畢業學年：95年 指導教授：王瑞瑤 前言：平衡能力攸關中風病人日常活動之表現，許多中風一年以上之病人都有姿勢控制能力變差以及日常生活功能下降等問題，所以平衡能力的改善對於慢性中風病人而言是首要的治療目標之一。本體感覺神經肌肉促進治療是一完善的運動治療模式，可針對慢性中風病人常見的機能缺失，如:半側偏癱所導致的靜態、動態平衡功能下降、功能性活動能力的喪失等，來設計適合病患的治療。本研究的目的在觀察本體感覺神經肌肉促進治療對於慢性中風病人平衡能力與功能性活動之療效，是否比一般物理治療的改善更為明顯。研究方法：從公、私立醫院選取一年以上之第一次中風病人，其柏格式平衡量表分數為56分以下。以單盲設計隨機分組方式分成實驗組與對照組。實驗組接受為期6週、共12次每次30分鐘之本體感覺神經肌肉促進治療，對照組則接受同等治療時間及次數之一般物理治療，含：電、熱療，運動治療、平衡訓練、行走訓練、肌、耐力訓練等。治療前與治療後各評估一次，評估內容為靜態平衡能力之站立不對稱性、動態平衡能力之最大位移極限—最大位移量與方向控制準確度、功能性平衡活動之坐到站之動作時間、柏格式平衡量表與步行速度。統計上以雙向變異數分析方式檢定組間彼此成效，顯著差異水準訂為0.05。結果：共有實驗組12人，對照10人參加本研究，研究結果顯示，實驗組與控制組在各評估項目上無明顯差異，但觀察各組內個人趨勢圖之變化，則發現實驗組在最大位移量、方向控制準確度、柏格式平衡量表與步行速度等有進步之趨勢，而控制組僅在柏格式平衡量表有進步之趨勢。討論與結論：目標導向與設計嚴謹之本體感覺神經肌肉促進治療對於中風一年以上之病人在動態平衡與功能性活動上有進步之趨勢，但需要更多的樣本數來證明其療效。對照組在柏格式平衡量表上有改善趨勢，可推論一般物理治療對於中風一年以上病人在功能活動上也有療效。本研究受試者在站立不對稱性與坐到站之動作時間等兩項評估上皆無進步之趨勢，可能測試值已趨近正常之故。從研究結果而言，動態平衡能力的改善較強調目標導向之運動治療模式，同時也是一年以上之中風患者主要治療之目標。

Introduction: Balance is the ability to maintain or move within a weight-bearing posture without falling and is associated with the performance of activity of daily living (ADL). The purpose of treatment for patients with stroke is to improve balance and functional abilities. Proprioceptive neuromuscular facilitation (PNF) is one of the major approaches in physical therapy for patient with stroke. The purpose of this study was to compare the therapeutic effects of PNF and general treatment on balance and mobility performance in patients with chronic stroke. Methods: Outpatients with hemiparesis secondary to stroke participated in this study and were randomly assigned to either the experimental or the control group. Subjects in the experimental group received 30 min PNF treatment twice a week for a total of 12 sessions, while subjects in the control group received general treatment for the same amount of duration and frequency as in the experimental group. Postural asymmetry, maximal excursion and directional control of limit of stability (LOS), transfer time during sit-to-stand, Berg balance score and gait speed were measured before and after completing the 12 treatment sessions. The dependent variables were assessed using a two-way analysis of variance to examine the differences (p<0.05) between the two groups . Results: Our data (n=12 in the experimental group and n=10 in the control group) showed a trend of improvement regarding the maximal excursion and directional control of limit of stability, Berg balance score and gait speed in the experimental group. Such trends were not found in the control group, except Berg balance score. However, the difference between two groups could not be established. Discussion and conclusions: The goal-oriented PNF approach results in a trend of improvements on dynamic balance and gait speed. Subjects in both groups showed improvement in Berg balance score after receiving 12-session of physical therapy program. More subjects are needed to further document the significant effects of PNF approach in individuals with chronic stroke.