應用頭頸部垂直穩定訓練飛碟帽居家訓練對腦性麻痺青少年平衡能力之改善－初步探討

Effect of Balance in Home Program Training with Head and Neck Stability Device for Teenagers with Cerebral Palsy-A Preliminary Report

10.6315/TJPMR.202106_49(1).0004

許韶芝(Shao-Chih Hsu)；林瀛洲(Yin-Chou Lin)；鍾佳英(Chia-Ying Chung)；葉國光(Kuo-Kuang Yeh)；劉文瑜(Wen-Yu Liu)；張舒婷(Shu-Tin Chang)；黃美涓(Alice MK Wong)；陳智光(Chih-Kuang Chen)

腦性麻痺（cerebral palsy） ； 頭頸部穩定訓練（head and neck stability training） ； 平衡能力（balance） ； cerebral palsy ； head and neck stability training ； balance

台灣復健醫學雜誌

49卷1期（2021 / 06 / 01）

39 - 48

繁體中文

前言：腦性麻痺（cerebral palsy）是一種以運動功能障礙為主的多重障礙症候群，患者的張力（高張、低張、僵直性等）、肌力（不足、癱軟）、動作協調及動作技能都有可能出現各種不同程度的障礙，影響行動甚至吞嚥困難。也會伴隨感覺、認知、溝通及行為方面的種種障礙。其中，頸部肌肉功能下降影響周邊感覺輸入以及中樞神經訊息輸出，使得頭部及軀幹的平衡及姿勢穩定性受到影響，抑制了動作前回饋反應以及預期性姿勢調控。因此本篇研究主要的目的為針對學齡期腦性麻痺患者進行頭頸部垂直穩定訓練，探討其平衡成效。材料與方法：本研究介入方式是青少年腦性麻痺學生除維持常規復健訓練外，配戴受試者體重合適的頭頸部穩定訓練飛碟帽於居家訓練活動中使用，每次居家訓練活動時間為20分鐘，介入頻率為一週3次，持續四週。受試者進行訓練前後均接受伯格氏平衡量表（Berg Balance Scale, BBS）、電腦化平衡測定儀（SMART Balance Master System），用以測量受試者靜態及動態的平衡功能與姿勢的穩定性。結果：本研究共招募9名痙攣型腦性麻痺受試者（10-18歲），四週頭頸部穩定度訓練前、後的伯格氏平衡量表（BBS）分數自52.00 ± 5.92分至53.00 ± 5.15（p=0.041）及靜態平衡的感覺統合測試（sensory organization test, SOT）自69.56 ± 9.38分至77.67 ± 9.33（p=0.007）皆有顯著進步。動態平衡的規律性重量轉移測試（rhythmic weight shifting, RWS）則未達顯著差異，但動態平衡的穩定限度測試（limits of stability, LOS）及反應時間（reaction time, RT）數據顯示向後方的身體平衡、穩定的控制能力能有顯著改善（p＜0.05），對於降低跌倒的風險應有所成效。結論：痙攣型腦性麻痺青少年經由四週頭頸部飛碟帽穩定度訓練後，對於靜態平衡及向後方的身體平衡、穩定的控制能力均有改善。

Background and aims: Cerebral palsy (CP) is impaired development in movement and postural control due to brain damage during the fetal or early infancy stage of life. Poor control of the neck muscle affects the peripheral sensory input and central nervous signal output, inhibiting the pre-action feedback response and expected postural regulation, which might result in impaired postural stability of the head and trunk. Therefore, the main purpose of this study is to conduct head and neck vertical stabilization training for teenage students with cerebral palsy, and to examine its balance effect. Methods: In addition to maintaining regular rehabilitation training, teenage students with cerebral palsy wore head and neck stabilizing training UFO hats of appropriate weight in home training activities, for 20 minutes per day, three times per week, for four weeks. Subjects were tested before and after training by the Berg Balance Test, computerized balance tester (SMART Balance Master), to measure the static and dynamic balance function and postural stability. Results: A total of nine subjects (10-18 years old) with spastic cerebral palsy were recruited in this study. Before and after training, the Bursting Balance Scale (BBS) scores ranged from 52.00 ± 5.92 to 53.00 ± 5.15 (p=0.041) and the static balance sensory integration test (SOT) ranged from 69.56 ± 9.38 to 77.67 ± 9.33 (p=0.007), which was a significant improvement. The dynamic balance regular weight transfer test (RWS) did not reveal any significant difference, but the dynamic balance stability limit test (LOS) and response time (RT) data showed the body balance and stable control ability to the rear had significantly improved (p＜0.05). Conclusion: After four weeks of training in the stability of the head and neck program, teenage students with spastic cerebral palsy had significantly improved static balance and stability control to the rear, which might be effective in reducing the risk of falls.

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