背景:過去研究已支持機器輔助治療 (Robot-assisted therapy, RAT) 對中風患者的肢體訓練具有正向效果。機器主要分為外骨骼型 (Exoskeletal type) 和終端控制型 (End-effector type) 兩種設計。然而，對於這兩種類型機器的成效優劣，文獻並未達成一致的定論。本研究首創提出將這兩種機器結合成複合式機器輔助治療，並與單獨使用外骨骼型及終端控制型機器做比較，以瞭解其在動作表現、日常生活功能和生活品質方面的介入成效。方法:本研究為單盲隨機控制試驗，採用便利取樣方式於醫院中招募受測者，並隨機分派至「複合式機器輔助治療組」、「外骨骼機器輔助治療組」以及「終端控制機器輔助治療組」。所有受測者均接受 18 次的介入，一次 60分鐘，每周 3 次，持續 6 周。訓練流程為機器輔助治療 40 分鐘 (10 分鐘被動模式、20 分鐘主動協助模式以及 10 分鐘主動模式) 加上功能性訓練 20分鐘。主要成效評估為動作表現，含:傅格梅爾評估量表 (Fugl-Meyer Assessment, FMA)、改良版艾許沃斯氏量表 (modified Ashworth scale, MAS)、沃夫動作功能測驗-時間及功能性能力分量表 (Wolf Motor Function Test [WMFT]–Time and Functional Ability Scale [FAS])；次要成效評估為日常生活功能以及生活品質，評估工具分別為動作活動日誌-使用量及使用品質 (Motor Activity Log [MAL]–Amount of Use [AOU] and Quality of Movement [QOM]) 以及中風影響量表 (Stroke Impact Scale, SIS)。本研究採用 KruskalWallis 定以分析三個不同組別在治療前和治療後之介入效果，並計算Cohen’s d 效果值分析組內以及組間差異以了解治療成效差異。結果:Kruskal-Wallis 分析結果顯示所有變項皆未達顯著差異。根據組內差異之效果值，「複合式機器輔助治療組」(n = 6) 在 FMA (d = 1.34)、MAS (d = 0.91) 以及 WMFT-FAS (d = 0.83) 有高程度的提升，在 WMFTTime (d = 0.5)、MAL-AOU (d = 0.51) 以及 MAL-QOM (d = 0.55) 有中等程度的改善，在 SIS (d = 0.16) 則僅有微小的改變。根據組間差異之效果值，「複合式機器輔助治療組」比「外骨骼機器輔助治療組」(n = 3) 在 MAL-AOU (d = 0.48) 以及 MAL-QOM (d = 0.40) 有較佳的改善；比「終端控制機器輔助治療組」(n = 4) 在 MAS (d = 0.88)、WMFT-FAS (d = 0.51) 以及MAL-AOU (d = 0.41) 有較佳的改善。結論:複合式機器輔助治療相較於外骨骼機器輔助治療在患側肢體的使用量和使用品質有較好的提升；和終端控制機器輔助治療相比，則在肌肉張力、功能性任務的動作品質以及患側肢體的使用量有較佳的改善。但未來研究需再增加受測者人數，並做追蹤評估分析長期效益。

Background: Previous studies have demonstrated the effectiveness of robot-assisted therapy (RAT) in upper extremity motor recovery for stroke patients. This research aimed to investigate the effectiveness of hybrid RAT, combining exoskeleton (EXO) and end-effector (EE) devices, on motor performance, activities of daily living (ADL), and quality of life (QoL) for subacute and chronic stroke patients. Methods: Participants were randomly assigned to the Hybrid, EXO, and EE groups. All participants received 18 sessions of intervention, lasting 60 minutes each, three times a week for six weeks. Assessments were conducted at both pre- and post-test. Results: The Hybrid group showed better improvement than the EXO group in the MAL–AOU (d = 0.48) and MAL–QOM (d = 0.40), and also had greater improvement than the EE group in the MAS (d = 0.88), WMFT–FAS (d = 0.51), and MAL–AOU (d = 0.41). Conclusion: As compared to the exoskeleton and end-effector RAT, the hybrid RAT exhibits some advantages in motor performance and ADL but not much improvement in QoL.

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