中風患者其傾斜患側現象相關因子之探討

傾斜患側現象是中風初期常見的坐姿平衡缺失問題，其特徵為坐立時體姿重心偏傾患側，有時甚至會傾倒向患側。文獻曾探討過現象的消弭時間，與導致現象存在的相關因素，發現這個現象多數會在2個月內逐漸消失，具有時間序列的趨勢。因此，本研究收集了19位不具傾斜現象初期中風病人，和42位傾斜患側現象的初期中風病人，針對三個方向深入探討相關傾斜患側現象成因的關鍵。　　研究的第一部份，比較有無傾斜現象的相關因子差異；第二部份，將42位傾斜患者再依其會不會倒地分成兩組，檢定其日常生活功能及相關因子上的差異；第三部份，連續兩次，間隔一個月記錄42位傾斜患者坐姿平衡能力與其他相關因子的進展，將各相關因子當成自變項，傾斜角度作為應變項跑複回歸分析，以求取最佳回歸模式與較重要的相關因子。　　結果顯示：第一部份，在意識狀態、單側忽略、鉛垂線定位、空間知覺、本體感覺上、日常生活功能、及坐姿平衡上有顯著差異；第二部份，傾斜患側現象可能包含兩種型態的傾斜病人，因為個別比較上在意識狀態、單側忽略和鉛垂線定位能力有顯著水準，但在日常生活功能表現上並無不同。第三部份，求得回歸模式R2=0.69，且以動態坐姿平衡能力在傾斜復過程中相對較為重要。

Listing phenomenon is one of the common impairments in sitting balance after stroke. It has been characterized by that patients without the ability to sit independently would lean to their affected side, and if the listing is not checked, a fall may result. Time course and a number of factors associated with listing phenomenon have been identified. The present study was designed for three purposes. First, examined the difference between stroke patient with and without listing phenomenon. Second, identified if listing phenomenon contain two types. Third, determine the relative importance of consciousness, unilateral neglect, spatial perception, plumb line test, pinprick sensation, light touch, proprioception, lower limb recovery stage, static sitting balance and dynamic sitting balance as relating factors and predictors of listing phenomenon recovery course.　　All subjects included 19 non-listing patients and 42 listing patients who were successive admissions to Taichung Rehabilitation Hospital within 1 month after stroke. Non-listing patients were assessed after referral. Listing patients were assessed and recorded the consecutive evolutions of relating factors two times within a monthinterval after referral. The study methods were also containing three parts. Compared relating factors between patiens with listing phenomenon and patients without listing phenomenon, first. Classified the listing subjects into 2 groups according to falling or not, then examined the ADL performance (Activities of daily living) and relating factors, second. Applied multiple regression to analyze the relationship between independent variables resulted in difference of two assessments and dependent variable obtained from evolution of listing phenomenon recovery, third.　　Between patients with listing or not, results showed significant difference in consciousness, unilateral neglect, and plumb line test. Listing phenomenon maybe contained two types, because consciousness, unilateral neglect, and plumb line test reveal significance, but ADL manifest no difference. The created regression model owns 0.69 of coefficient of determination, and provided dynamic sitting balance the most important factor relatively within one-month revolution.