2026-11-092026-11-09https://scholars.csmu.edu.tw/handle/123456789/38828Purpose The purpose of this study are to investigate the short and long term effects of electrical stimulation(ES) or vibration in addition to stretching on range of motion, flexibility, muscle tone , gait , electromyography of lower extremity and dynamic muscle–tendon unit(MTU) length of gastrocnemius in children with cerebral palsy using a randomized double-blind placebo-controlled clinical trial. There are two annual programs in this study. Method Thirty children with spastic cerebral palsy(GMFCS I-III/IV) are included in the present study. In first annual program, this program is to investigate the short term effects of electrical stimulation or vibration in addition to stretching on spasticity and contracture of lower extremity in children with cerebral palsy Thirty subjects were randomly assigned to stretching with ES group, stretching with vibration group and only stretching-control group. The stretching program involved a active stretching in sit-to reach position for 15 minutes per day for 3 days in each group. All subjects sat on the vibration in long sitting position and electrodes were placed on the legs. A additional electrical stimulation(frequency 20Hz, pulse width 200us) by a neuromuscular electrical stimulator were applied on quadriceps and tibial anterior in stretching with ES group. The intensity of electrical current resulted in muscle contraction were decided by children that they feel comfortable. A additional vibration (frequency 20Hz, amplitude 2mm) produced by a vibrator were applied in stretching with vibration group. Maximal range of motion were measured by active and passive flexion and extension(or plantarflexion and dorsiflexion) of hip ,knee, ankle joint extension using electrogoniometry. Flexibility were measured using sit-to-reach test and forward split test. Muscle tone were measured using the modified Ashworth scale and pendulum test. Pre-test and post-test in every day were performed. The difference between pre-test and post test were compared. The effects for different groups and days on stretching effectiveness were evaluated. In second annual program, this program is to investigate the long effects of electrical stimulation or vibration in addition to stretching on gait and gastrocnemius muscle length in ambulant children with cerebral palsy. Thirty subjects were randomly assigned to stretching with ES group, stretching with vibration group and only stretching-control group. The stretching program involved a active stretching in sit-to reach position for 15 minutes per times, 3 times per week for 2 months in each group. All subjects sat on the vibration in long sitting position and electrodes were placed on the legs. A additional electrical stimulation(frequency 20Hz, pulse width 200us) by a neuromuscular electrical stimulator were applied on quadriceps and tibial anterior in stretching with ES group. The intensity of electrical current resulted in muscle contraction were decided by children that they feel comfortable. A additional vibration (frequency 20Hz, amplitude 2mm) produced by a vibrator were applied in stretching with vibration group. Maximal range of motion were measured by active and passive flexion and extension(or plantarflexion and dorsiflexion) of hip ,knee, ankle joint extension using electrogoniometer. Muscle tone were measured using the modified Ashworth scale and pendulum test. Velocity, cadence, step length in time-space parameters , electromyography changes and dynamic gastrocnemius muscle length in gait were evaluated. Above parameters are measured before treatment , at 1st month during treatment, after treatment, post 1 months after treatment. The effects for different groups and times on stretching effectiveness were evaluated. The relationships among evaluated parameters were also analyzed.本研究目的為用隨機雙盲對照控制的試驗方式探討牽張結合電刺激或振動刺激對 腦性麻痺孩童下肢關節活動度、柔軟度、肌張力、步態與肌電圖以及動態腓腸肌長度的 長期和短期影響。 第一年 探討牽張結合電刺激或振動對腦性麻痺孩童下肢痙攣與攣縮的短期效果 第二年 探討牽張結合電刺激和振動對可步行腦性麻痺孩童步態和腓腸肌肌肉長度 的長期影響 研究方法:受試者為30 位痙攣型腦性麻痺孩童(GMFCS I-III/IV) 第一年研究計畫: 牽張結合電刺激或振動對腦性麻痺孩童的下肢痙攣與攣縮的短期 效果 30 位受試者隨機分成三組（牽張合併電刺激組、牽張合併振動刺激組和只有牽 張的控制組）接受牽張治療均長坐在震動平台上和腳綁電極片，在坐姿體前彎姿勢 下做靜態的主動牽張治療，每組每回治療皆15 分鐘，連續三天的牽張治療;牽張合 併電刺激組為由神經肌肉電刺激器產生電刺激頻率20Ｈz, 波寬200us 刺激股四頭肌 和脛前肌，電流強度為孩童覺得舒服的肌肉收縮的強度; 牽張合併振動組由振動機 提供振動頻率為20Hz, 振幅為2mm 的振動刺激;於每天牽張治療前和後接受評估， 共三天評估下肢髖、膝、踝的主動與被動關節角度、坐姿體前彎距離和向前劈腿距 離、修正阿斯渥量表和鐘擺測試。最後比較各組的評估參數在牽張治療前和後的差 異和三組和不同時間因素對療效的影響。 第二年研究計畫: 牽張結合電刺激和振動對可步行腦性麻痺孩童步態和 腓腸肌肌肉長度的長期影響 30 位受試者隨機分成三組（牽張合併電刺激組、牽張併振動刺激組和只有牽張的控 制組）接受牽張治療均長坐在震動平台上和腳綁電極片，在坐姿體前彎姿勢下做靜態的 主動牽張治療，每回治療15 分鐘，每週3 次，連續治療2 個月;牽張合併電刺激組為由 神經肌肉電刺激器產生電刺激頻率20Ｈz, 波寬200us 刺激股四頭肌和脛前肌，電流強 度為孩童覺得舒服的肌肉收縮的強度; 牽張合併振動組由振動機提供振動頻率為20Hz, 振幅為2mm 的振動刺激;三組於接受治療前、治療期間(第1 個月)、治療後(第2 個月)、 追蹤治療後1 個月（第3 個月）接受評估，評估髖、膝、踝的主動與被動關節角度、下 肢修正阿斯渥量表和鐘擺測試、分析其步態步速、步頻、步長等時間-空間參數變化和 步態各時期髖、膝、踝關節角度與肌電圖變化，以及腓腸肌最長與最短的長度，比較三 組和不同時間對關節活動、肌張力、步態和動態腓腸肌肌肉長度的影響，並分析各評估 參數間的關係，以及步態與肌電圖的關係。腦性麻痺牽張電刺激振動cerebral palsystretchingelectrical stimulationvibrationProject