振動式感覺訊號激發之中風手部動作復健---可行性研究

Abstract

手部動作不便為中風後最常見且持續最久的後遺症，並對病人的生活品質有極為負面的 影響。中風所造成手部動作的不便主要來自於失去有效個別控制手指運動之能力。計畫 主持人先前於美國及目前國科會補助的研究發現微肌肉振動可暫時改便長期中風病人 腦運動中樞對手部肌肉的控制訊號且有助於區分不同肌肉之運動神經通路。本三年期計 畫為目前國科會計畫之延伸, 針對台灣地區中風病人, 將以神經生理 (Neurophysiological)及生物力學(Biomechanical)研究探討以微肌肉振動做為神經復健工 具的可行性。藉由非侵入性穿顱磁刺激 (Transcranial Magnetic Stimulation) 量化肌肉振 動時運動中樞對不同手部肌肉控制暫時性之變化，以及長時間振動與受測者注意力所造 成運動神經控制持續性的影響, 並找出病人個別之差異與其中風受損部位 (lesion location) 與運動不便等級 (配合臨床之診斷, Clinical assessments) 之關聯。此關聯性的 研究將有助於決定那一族群中風病人將最適合採取此種微肌肉振動輔助的復健。此計畫 將更進一部配合手指動作控制之生物力學研究, 以實驗方式量化振動對自主性手指動作 控制在微肌肉振動時及長時間振動後之改善。這個研究將會增進我們對人體, 特別是中 風病人, 在中樞神經受損後感覺運動神經的互動,將評估此類肌肉振動用於復健之可行 性及發展創新有效之中風手部復健模式。

Stroke is the leading cause of long-term disability. Hand dysfunction is the most common impairment in stroke survivors and this impairment has a dramatic, negative impact on the quality of life. Lack of finger muscle individuation is a major contributor to hand dysfunction and rehabilitation paradigms that increase the ability to selectively activate hand muscles may significantly improve hand function in the stroke population. We have shown in our current NSC-funded project that small-amplitude muscle vibration could induce differential changes to the excitability of motor pathways controlling stroke-affected hand muscles. If these changes in excitability lead to corresponding changes in the ability to voluntarily activate individual hand muscles, vibration may prove to be an effective method for augmenting movement training following stroke. This study represents an extension of our current research towards assessing the feasibility of such a rehabilitation paradigm, especially targeting the stroke populations in Taiwan. We will employ neurophysiological (including transcranial magnetic stimulation and stretch reflex assessments) and biomechanical studies to evaluate the possibility and strategies of using muscle vibration in stroke hand neurorehabilitation. Three aims will be studied to determine the patterns of modulation of hand corticomotor excitability during muscle vibration and following prolonged vibration in combination of subject』s attention to the vibration, and the impact of the neurophysiological modulations on control of finger movements. These aims will further our knowledge of the sensory-motor interactions that occur post stroke and how these interactions may be used in the development of enhanced rehabilitation paradigms.