背景及目的: 約30~60%的中風患者有手部功能障礙，手部動態矯具結合任務導向訓練是近年來新興的神經復健療法，然現有的手部動態矯具，結構未必符合生物力學，無法引導使用者以正確的對掌抓握方式運動。本研究的目的是1.開發一款符合人體工學的上肢動態矯具，名為Innovative Orthosis for Phalanx Extension Neurofacilitation，簡稱iOPEN；2.探討iOPEN於臨床中風患者上肢動作恢復之效益

研究方法: 此為二階段研究計畫，第一階段主要進行動態矯具設計與開發，共招募3位中風患者進行試用與回饋。第二階段為臨床療效追蹤驗證，共招募9位中風患者進行上肢動作功能復健介入，本階段採用等時間量的治療介入計畫，持續6~8週，每週2~3次，每次一小時，共14小時的總介入時數。主要的評估工具為改良版Ashworth量表、關節活動範圍、傅格梅爾上肢評量、箱子與積木測驗、手功能測試、動作活動紀錄量表以及疼痛數字量表。

研究結果: 第一階段中我們利用3D列印技術完成iOPEN的開發，並驗證布朗斯壯分期第三級的中風患者可使用iOPEN以對掌抓握模式進行抓握訓練。第二階段中，有六成的參與者張力改變量具有臨床意義；上肢主動關節活動範圍明顯增加，其中手肘以及手指活動範圍進步達到顯著差異；傅格梅爾上肢評量有七成五的參與者改變量達最小臨床重要差異值；箱子與積木測驗與手功能測試則分別有50%及25%的參與者有所增加；動作活動紀錄量表方面，雖然使用品質達到顯著差異，但使用品質與使用量的實際改變量都非常微小，所有參與者穿戴手部動態矯具都未反應有疼痛問題。
本研究結果顯示iOPEN可協助布朗斯壯分期第三級的中風患者進行抓握訓練，並能有效降低肌肉張力、提升上肢的關節活動範圍以及廣泛提昇上肢整體動作控制表現，但未來仍需增加樣本數、招募不同類型的中風患者，並增加對照組與追蹤評估，深入探討iOPEN對於不同中風階段的療效。

In modern times, dynamic hand orthoses have been used to improve the rehabilitation effectiveness of stroke patients. Nevertheless, the biomechanical structures of the current hand dynamic orthoses were not confirmed very well. This research included two stages. The first stage was to develop an “Innovative Orthosis for Phalanx Extension Neurofacilitation (iOPEN)” for stroke patients. Digital manufacturing tools such as 3D printers and 3D scanners are used to develop the prototypes. Three participants tried on iOPEN and provided feedback to improve the prototypes. The second stage was to verify the effectiveness of the revised iOPEN. Nine stroke patients were recruited and received the intervention for total of 14 hours during 6 to 8 weeks with 2 to 3 times a week and one hour each time. Researchers evaluated the subject’s performances before and after the intervention. The measures included The Modified Ashworth scale, joint protractor, Fugl-Meyer Assessment- Upper Extremity , Box and Block Test, Hand function test, Motor Activity Log and the Pain Numerical Rating Scale.
The results showed that iOPEN can help stroke patients at Brunnstom stage III with grasp and release training, and reduce their muscle tone, increase the AROM of the upper limbs, and improve upper limb movement performance. Future research requires larger sample sizes and more types of stroke patients, and the control groups and follow-up tests must be considered as well.

Aizawa, T., Shimada, Y., Iwami, T., Nakamura, K., Matsunaga, T., Misawa, A., . . . Itoi, E. A simulation model of FES for restoring hand grasp in hemiplegia.
Andriske, L., Verikios, D., & Hitch, D. (2017). Patient and Therapist Experiences of the SaeboFlex: A Pilot Study. Occup Ther Int, 2017, 5462078. doi: 10.1155/2017/5462078
Andriske, L., Verikios, D., & Hitch, D. (2017). Patient and therapist experiences of the SaeboFlex: A pilot study. Occupational therapy international, 2017.
Ates, S., Lobo-Prat, J., Lammertse, P., van der Kooij, H., & Stienen, A. H. (2013). SCRIPT Passive Orthosis: Design and technical evaluation of the wrist and hand orthosis for rehabilitation training at home. Paper presented at the Rehabilitation Robotics (ICORR), 2013 IEEE International Conference on.
Barry, J. G., Ross, S. A., & Woehrle, J. (2012). Therapy incorporating a dynamic wrist-hand orthosis versus manual assistance in chronic stroke: A pilot study. Journal of Neurologic Physical Therapy, 36(1), 17-24.
Barry, J. G., Ross, S. A., & Woehrle, J. (2012). Therapy incorporating a dynamic wrist-hand orthosis versus manual assistance in chronic stroke: a pilot study. J Neurol Phys Ther, 36(1), 17-24. doi: 10.1097/NPT.0b013e318246203e
Bhargava, A. S., Eapen, C., & Kumar, S. P. (2010). Grip strength measurements at two different wrist extension positions in chronic lateral epicondylitis-comparison of involved vs. uninvolved side in athletes and non athletes: a case-control study. BMC Sports Science, Medicine and Rehabilitation, 2(1), 22.
Blanton, S., & Wolf, S. L. (1999). An application of upper-extremity constraint-induced movement therapy in a patient with subacute stroke. Physical therapy, 79(9), 847-853.
Bobath, B. (1990). Adult hemiplegia: evaluation and treatment: Elsevier Health Sciences.
Brunnstrom, S. (1970). Movement therapy in hemiplegia: a neurophysiological approach: Medical Department, Harper & Row.
Buonomano, D. V., & Merzenich, M. M. (1998). Cortical plasticity: from synapses to maps. Annual review of neuroscience, 21(1), 149-186.
Carr, J. H. (2011). Neurological Rehabilitation, 2/e: Elsevier India.
Carr, J. H., & Shepherd, R. B. (1987). A motor relearning programme for stroke: Aspen Pub.
Cauraugh, J. H., & Summers, J. J. (2005). Neural plasticity and bilateral movements: a rehabilitation approach for chronic stroke. Progress in neurobiology, 75(5), 309-320.
Chan, D. Y., Chan, C. C., & Au, D. K. (2006). Motor relearning programme for stroke patients: a randomized controlled trial. Clinical rehabilitation, 20(3), 191-200.
Chang, K., Chang, J., Huang, M., & Lee, L. (2018, 13-17 April 2018). Innovative orthosis for phalanx extension neurofacilitation (iOPEN) — Development of a 3D-printed hand orthosis for chronic stroke patient. Paper presented at the 2018 IEEE International Conference on Applied System Invention (ICASI).
Chang, W.-D., & Lai, P.-T. (2015). New design of home-based dynamic hand splint for hemiplegic hands: a preliminary study. Journal of physical therapy science, 27(3), 829-831.
Chen, H.-M., Chen, C. C., Hsueh, I.-P., Huang, S.-L., & Hsieh, C.-L. (2009). Test-retest reproducibility and smallest real difference of 5 hand function tests in patients with stroke. Neurorehabilitation and neural repair, 23(5), 435-440.
Control, C. f. D., & Prevention. (2012). Prevalence of stroke--United States, 2006-2010. MMWR. Morbidity and mortality weekly report, 61(20), 379.
Cox, A. M., McKevitt, C., Rudd, A. G., & Wolfe, C. D. (2006). Socioeconomic status and stroke. The Lancet Neurology, 5(2), 181-188.
Desrosiers, J., Bravo, G., Hébert, R., Dutil, É., & Mercier, L. (1994). Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies. Archives of physical medicine and rehabilitation, 75(7), 751-755.
Dipietro, L., Krebs, H. I., Fasoli, S. E., Volpe, B. T., Stein, J., Bever, C., & Hogan, N. (2007). Changing motor synergies in chronic stroke. Journal of neurophysiology, 98(2), 757-768.
Dudley, D. R., Knarr, B. A., Siu, K.-C., Peck, J., Ricks, B., & Zuniga, J. M. (2019). Testing of a 3D printed hand exoskeleton for an individual with stroke: a case study. Disability and Rehabilitation: Assistive Technology, 1-5.
Duncan, P. W., Propst, M., & Nelson, S. G. (1983). Reliability of the Fugl-Meyer assessment of sensorimotor recovery following cerebrovascular accident. Physical therapy, 63(10), 1606-1610.
Farrell, J. F., Hoffman, H. B., Snyder, J. L., Giuliani, C. A., & Bohannon, R. W. (2007). Orthotic aided training of the paretic upper limb in chronic stroke: results of a phase 1 trial. NeuroRehabilitation, 22(2), 99-103.
Franck, J. A., Timmermans, A. A., & Seelen, H. A. (2013). Effects of a dynamic hand orthosis for functional use of the impaired upper limb in sub-acute stroke patients: A multiple single case experimental design study. Technology and Disability, 25(3), 177-187.
Godfrey, S. B., Schabowsky, C. N., Holley, R. J., & Lum, P. S. (2010). Hand function recovery in chronic stroke with HEXORR robotic training: A case series. Paper presented at the Engineering in Medicine and Biology Society (EMBC), 2010 Annual International Conference of the IEEE.
Goff, D. C., Lloyd-Jones, D. M., Bennett, G., Coady, S., D’agostino, R. B., Gibbons, R., . . . O’donnell, C. J. (2014). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 63(25 Part B), 2935-2959.
Gordon, J. (1987). Assumptions underlying physical therapy intervention: Theoretical and historical perspectives. Movement science: Foundations for physical therapy in rehabilitation, ed. J. Carr & R. Sheppard.
Gowland, C. (1982). Recovery of motor function following stroke: profile and predictors. Physiotherapy Canada, 34(2), 77-84.
Hoffman, H. B., & Blakey, G. L. (2011). New design of dynamic orthoses for neurological conditions. NeuroRehabilitation, 28(1), 55-61. doi: 10.3233/NRE-2011-0632
Jeon, H. S., Woo, Y. K., Yi, C. H., Kwon, O. Y., Jung, M. Y., Lee, Y. H., . . . Choi, B. R. (2012). Effect of intensive training with a spring-assisted hand orthosis on movement smoothness in upper extremity following stroke: a pilot clinical trial. Top Stroke Rehabil, 19(4), 320-328. doi: 10.1310/tsr1904-320
Jette, D. U., Latham, N. K., Smout, R. J., Gassaway, J., Slavin, M. D., & Horn, S. D. (2005). Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities. Physical therapy, 85(3), 238-248.
Jiang, L., Xu, H., & Yu, C. (2013). Brain connectivity plasticity in the motor network after ischemic stroke. Neural plasticity, 2013.
Kahn, L. E., Zygman, M. L., Rymer, W. Z., & Reinkensmeyer, D. J. (2006). Robot-assisted reaching exercise promotes arm movement recovery in chronic hemiparetic stroke: a randomized controlled pilot study. Journal of neuroengineering and rehabilitation, 3(1), 12.
Kamper, D., Harvey, R., Suresh, S., & Rymer, W. (2003). Relative contributions of neural mechanisms versus muscle mechanics in promoting finger extension deficits following stroke. Muscle & Nerve: Official Journal of the American Association of Electrodiagnostic Medicine, 28(3), 309-318.
Kleim, J. A., & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. Journal of speech, language, and hearing research, 51(1), S225-S239.
Kwakkel, G., Kollen, B. J., & Krebs, H. I. (2008). Effects of robot-assisted therapy on upper limb recovery after stroke: a systematic review. Neurorehabilitation and neural repair, 22(2), 111-121.
Kwakkel, G., Kollen, B. J., van der Grond, J., & Prevo, A. J. (2003). Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke, 34(9), 2181-2186.
Kwakkel, G., Wagenaar, R. C., Kollen, B. J., & Lankhorst, G. J. (1996). Predicting disability in stroke—a critical review of the literature. Age and ageing, 25(6), 479-489.
Kwakkel, G., Wagenaar, R. C., Twisk, J. W., Lankhorst, G. J., & Koetsier, J. C. (1999). Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. The Lancet, 354(9174), 191-196.
Lang, C. E., Macdonald, J. R., Reisman, D. S., Boyd, L., Jacobson Kimberley, T., Schindler-Ivens, S. M., . . . Scheets, P. L. (2009). Observation of amounts of movement practice provided during stroke rehabilitation. Arch Phys Med Rehabil, 90(10), 1692-1698. doi: 10.1016/j.apmr.2009.04.005
Langhammer, B., & Stanghelle, J. K. (2000). Bobath or motor relearning programme? A comparison of two different approaches of physiotherapy in stroke rehabilitation: a randomized controlled study. Clinical rehabilitation, 14(4), 361-369.
Levin, M. F. (1996). Interjoint coordination during pointing movements is disrupted in spastic hemiparesis. Brain, 119(1), 281-293.
Lin, D. J., Finklestein, S. P., & Cramer, S. C. (2018). New directions in treatments targeting stroke recovery. Stroke, 49(12), 3107-3114.
Lin, K.-c., Wu, C.-y., Liu, J.-s., Chen, Y.-t., & Hsu, C.-j. (2009). Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabilitation and Neural Repair, 23(2), 160-165.
Luft, A. R., Macko, R. F., Forrester, L. W., Villagra, F., Ivey, F., Sorkin, J. D., . . . Goldberg, A. P. (2008). Treadmill exercise activates subcortical neural networks and improves walking after stroke: a randomized controlled trial. Stroke, 39(12), 3341-3350.
Lum, P. S., Mulroy, S., Amdur, R. L., Requejo, P., Prilutsky, B. I., & Dromerick, A. W. (2009). Gains in upper extremity function after stroke via recovery or compensation: potential differential effects on amount of real-world limb use. Topics in stroke rehabilitation, 16(4), 237-253.
Mang, C., Lagerquist, O., & Collins, D. (2010). Changes in corticospinal excitability evoked by common peroneal nerve stimulation depend on stimulation frequency. Experimental brain research, 203(1), 11-20.
Marshall, R. S., Perera, G. M., Lazar, R. M., Krakauer, J. W., Constantine, R. C., & DeLaPaz, R. L. (2000). Evolution of cortical activation during recovery from corticospinal tract infarction. Stroke, 31(3), 656-661.
Mathiowetz, V., Volland, G., Kashman, N., & Weber, K. (1985). Adult norms for the Box and Block Test of manual dexterity. American Journal of Occupational Therapy, 39(6), 386-391.
McCrea, P. H., Eng, J. J., & Hodgson, A. J. (2005). Saturated muscle activation contributes to compensatory reaching strategies after stroke. Journal of neurophysiology, 94(5), 2999-3008.
Nakayama, H., Jørgensen, H. S., Raaschou, H. O., & Olsen, T. S. (1994). Recovery of upper extremity function in stroke patients: the Copenhagen Stroke Study. Archives of physical medicine and rehabilitation, 75(4), 394-398.
Nelles, G., Jentzen, W., Jueptner, M., Müller, S., & Diener, H. (2001). Arm training induced brain plasticity in stroke studied with serial positron emission tomography. Neuroimage, 13(6), 1146-1154.
Perry, J., Garrett, M., Gronley, J. K., & Mulroy, S. J. (1995). Classification of walking handicap in the stroke population. Stroke, 26(6), 982-989.
Platz, T., Pinkowski, C., van Wijck, F., Kim, I.-H., Di Bella, P., & Johnson, G. (2005). Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study. Clinical rehabilitation, 19(4), 404-411.
Pomeroy, V., Aglioti, S. M., Mark, V. W., McFarland, D., Stinear, C., Wolf, S. L., . . . Fitzpatrick, S. M. (2011). Neurological principles and rehabilitation of action disorders: rehabilitation interventions. Neurorehabil Neural Repair, 25(5 Suppl), 33S-43S. doi: 10.1177/1545968311410942
Poungvarin, N. (1998). Stroke in the developing world. The Lancet, 352, S19-S22.
Sanford, J., Moreland, J., Swanson, L. R., Stratford, P. W., & Gowland, C. (1993). Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Physical therapy, 73(7), 447-454.
Schmidt, R. A., Lee, T. D., Winstein, C., Wulf, G., & Zelaznik, H. N. (2018). Motor control and learning: A behavioral emphasis: Human kinetics.
Simpson, L. A., & Eng, J. J. (2013). Functional recovery following stroke: capturing changes in upper-extremity function. Neurorehabilitation and neural repair, 27(3), 240-250.
Smania, N., Picelli, A., Munari, D., Geroin, C., Ianes, P., Waldner, A., & Gandolfi, M. (2010). Rehabilitation procedures in the management of spasticity. Eur J Phys Rehabil Med, 46(3), 423-438.
Smith, M. (2015). Neurological rehabilitation: Optimizing motor performance. Physiotherapy Canada, 67(2), 215.
Stratford, P. W., Binkley, J. M., Riddle, D. L., & Guyatt, G. H. (1998). Sensitivity to change of the Roland-Morris back pain questionnaire: part 1. Physical therapy, 78(11), 1186-1196.
Sunnerhagen, K. S., Olver, J., & Francisco, G. E. (2013). Assessing and treating functional impairment in poststroke spasticity. Neurology, 80(3 Supplement 2), S35-S44.
Taub, E., Crago, J. E., Burgio, L. D., Groomes, T. E., Cook III, E. W., DeLuca, S. C., & Miller, N. E. (1994). An operant approach to rehabilitation medicine: overcoming learned nonuse by shaping. Journal of the experimental analysis of behavior, 61(2), 281-293.
Taub, E., Miller, N. E., Novack, T. A., Cook, E. W., Fleming, W., Nepomuceno, C., . . . Crago, J. (1993). Technique to improve chronic motor deficit after stroke. Archives of physical medicine and rehabilitation, 74(4), 347-354.
Towles, J. D., Kamper, D. G., & Rymer, W. Z. (2010). Lack of hypertonia in thumb muscles after stroke. J Neurophysiol, 104(4), 2139-2146. doi: 10.1152/jn.00423.2009
Van der Lee, J., Beckerman, H., Knol, D., De Vet, H., & Bouter, L. (2004). Clinimetric properties of the motor activity log for the assessment of arm use in hemiparetic patients. Stroke, 35(6), 1410-1414.
Van Vliet, P. M., & Wulf, G. (2006). Extrinsic feedback for motor learning after stroke: what is the evidence? Disability and rehabilitation, 28(13-14), 831-840.
Veldman, M., Maffiuletti, N., Hallett, M., Zijdewind, I., & Hortobágyi, T. (2014). Direct and crossed effects of somatosensory stimulation on neuronal excitability and motor performance in humans. Neuroscience & Biobehavioral Reviews, 47, 22-35.
Waller, S. M., Whitall, J., Jenkins, T., Magder, L. S., Hanley, D. F., Goldberg, A., & Luft, A. R. (2014). Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke. bmc neurology, 14(1), 236.
Young, J., & Forster, A. (2007). Review of stroke rehabilitation. Bmj, 334(7584), 86-90.
Zackowski, K. M., Dromerick, A., Sahrmann, S., Thach, W., & Bastian, A. (2004). How do strength, sensation, spasticity and joint individuation relate to the reaching deficits of people with chronic hemiparesis? Brain, 127(5), 1035-1046.
徐秀雲. (2006). 手指感覺與捏力控制間之相關性探討. (碩士), 國立成功大學, 台南市. Retrieved from https://hdl.handle.net/11296/h8d33k
黃宗毅. (2017). 慢性中風個案之3D列印輔助手部裝置開發與研究. (碩士), 國立陽明大學, 台北市. Retrieved from https://hdl.handle.net/11296/8v3duz
簡廷祐. (2017). 單側與雙側複合療法應用於慢性中風病人在動作功能、日常功能以及動作控制策略上的療效初探：個案系列研究. (碩士), 國立臺灣大學, 台北市. Retrieved from https://hdl.handle.net/11296/bzs2gs