上肢活動訓練計畫對改善中風單側偏癱患者日常活動自我效能、患肢活動量的成效探討

研究目的：驗證傳統復健治療與傳統復健治療合併給予移動式上肢滑輪活動輔具 (portable overhead pulley exercise)使用後，對於單側偏癱中風患者日常活動自我效能、患側上肢活動量的影響。研究方法：本研究採立意取樣法，以隨機控制實驗為研究設計，以32位罹患急性腦中風、單側偏癱、意識清楚，生命徵象穩定的受試者為樣本，以隨機分配至移動式上肢滑輪活動輔具之實驗組與僅接受傳統復健治療的控制組。實驗組樣本除接受傳統復健治療外，另使用移動式上肢滑輪活動輔具輔助患側上肢行復健活動。研究開始時，介入處置為將移動式上肢滑輪活動輔具架設於兩側床緣，實驗組樣本於病床上採45-60度半坐臥姿勢，將健側上肢抓握於同側滑輪輔具的握把上，再將病人患側上肢固定於副木上，隨後將患側上肢肘關節呈90度，手心面向病人內側，將前臂垂直掛於患側邊輔具繩索上，請樣本以健側上肢經由輔具之繩索滑輪組協助患側上肢行被動關節活動，並以活動記錄器記錄24小時的患側肢體活動量，持續記錄7日，控制組樣本於研究期間則維持僅接受傳統復健治療的模式，患側上肢亦配戴活動紀錄器，同樣記錄7日。實驗前利用自陳式人口學特性與疾病特性問卷、日常活動自我效能量表與電子活動紀錄器做資料收集，利用卡方檢定、獨立 T-test、Pearson相關分析，結果發現在兩組樣本中人口學特性及疾病特性，並無顯著差異；在兩組後測自我效能有顯著差異(p=0.034)；在兩組每日平均活動量與每日平均活動時間比率也有顯著差異(p<0.001)；然而在自我效能後測與平均活動量做相關分析中，僅發現在單純性上肢活動部分項目有呈正相關，複合性活動及依靠下肢活動部分呈弱到不相關程度，故研究結果表示，樣本藉由輔具介入在病房內為自己做手部復健活動，可以顯著增加本身日常活動自我效能與患肢活動量，自我效能為日後復健動機之重要預測因子，病人因突發性中風失能，會失去對肢體控制之能力，直接失去生活獨立能力與社會角色功能， 故本研究藉由早期介入，化被動為主動，強調復健治療中肢體用進廢退之觀念，給予病人自控式床邊復健輔具，隨時處於一個復健的氛圍，隨時可以幫自己患側做活動，提高患側肢體活動量與本身之自我效能，提升將來長期復健的動機與希望，此研究結果建議做為未來中風病房復健治療中的一環，使病人在住院期間利用高密度、高專一性與高頻率之復健活動，把握復健黃金時期，以期早日康復。

Objective: To compare the effect of 3-day conventional rehabilitation treatment and conventional rehabilitation plus overhead pulley exercise on the self-efficacy of patients with hemiplegic stroke and the frequency of upper limb movement. Methods: The study design was a randomized controlled trial. Forty-eight first stroke patients who were hemiplegic, conscious, and had stable vital signs were randomly assigned to the experimental (conventional rehabilitation plus overhead pulley exercise) and control (conventional rehabilitation treatment only) groups. The subjects in the experimental group not only received traditional rehabilitation but also were given overhead pulley exercises. The pulley system was firmly set up on the edge of the bed as the study began. The subject was placed in a semi sitting position of 45-60 degrees and used the unaffected upper limb to hold the pulley handgrip on the same side. The elbow of the affected arm was bent at a 90-degree angle with a long strip of cloth and the forearm was vertically fixed on the handgrip on the same side. After testing patient’s muscle tone of the affected upper limb and adjusting the pull-up distance, the subjects were asked to pull and release the rope in the pulley with the unaffected arm so the contralateral arm can perform passive pulley exercises. The frequency of movement of the affected limb was recorded daily between 9 a.m. and 9 p.m. for 3 consecutive days. The subjects in the control group received only traditional rehabilitation treatment during the study period. Outcome evaluations were performed on subjects in both groups before and after the study. Outcome evaluations include the general self-efficacy scale to assess perceived self-efficacy in the patients and actigraphy testing to measure the frequency of movement. Expected results: 1. Self-efficacy of the patients in the experiment group was enhanced significantly. 2. Patients used overhead pulley exercisers had a significant increase in the frequency of movement, compared with those without using them.