研究背景：雙手協調對於日常生活功能表現十分重要，舉凡吃飯、洗澡、開車……等等，皆需要良好的雙手協調能力，使人們能夠獨立完成日常生活任務。雙手協調可根據時間和空間特性區分為：對稱性以及非對稱性任務，以及獨立目標與共同目標任務。然而，中風個案經常因為兩點辨識覺、力量控制，或是執行功能受損，導致雙手協調表現受損。已知兩點辨識覺與力量控制受損會導致感覺動作整合能力受損，執行功能受損則可能會影響動作計畫能力，皆會使得動作控制表現變差。針對中風個案過去已經有研究發現，左腦傷和右腦傷的單手動作控制表現，呈現大腦特異化現象。然而，在雙手協調任務上，考量到不同類型的雙手任務，具備不同時間空間特性，因此仍需要更多文獻探討，不同類型的雙手協調任務是否亦具有大腦特異化。此外，在中風亞急性期，雙手協調缺損已出現，且此階段為動作復元成效最顯著的階段。若能夠了解亞急性期左腦傷與右腦傷個案在雙手協調表現，有助於治療師預測其預後，並且設定更具任務性的介入計畫。
研究目的：本研究目的為探討左腦傷與右腦傷亞急性中風個案在雙手協調表現之差異，欲探討 (1) 在對稱型雙手任務中，患側手的軌跡控制是否具半球特異性；(2) 在非對稱型任務中，患側手的軌跡控制是否具半球特異性；(3) 在四項雙手任務中，患側手的定位點控制是否具半球特異性。
研究方法：本研究將納入26位中風個案 (左腦傷與右腦傷各26位)。所有受試者須為第一次中風，且處於亞急性期，動作表現為輕微受損。受試者的主要評估項目為雙手積木測驗 (Bimanual Block Test)，兩點辨識覺測驗 (2-point discrimination test)、捏力測驗 (Hydraulic Jamar Pinch Guage)，以及顏色路徑測驗 (Color Trail Test 1, 2) 也會評估以作為共變項因子探討。雙手積木測驗是根據過去文獻而設計，總共包含四種任務類型：對稱獨立目標(symmetric independent)、對稱共同目標(symmetric common)、非對稱獨立目標(asymmetric independent)、非對稱共同目標(asymmetric common)。雙手協調任務將會使用開源軟體Kinovea紀錄並獲得運動學資訊，並進一步使用MATLAB分析，得到三項運動學相關參數：定位點向量差、距離/位移比，以及任務完成時長。最後，ANCOVA用於比較左腦傷、右腦傷兩組在四項雙手任務的表現，並將指側捏力納入為共變項。
研究結果：本研究結果有三個主要研究結果。首先，研究發現患側手的定位點向量差，在對稱獨立目標任務中，左腦傷組的向量差顯著大於右腦傷，表示左腦傷在此任務對於定位點的控制較弱。第二，研究發現患側手的距離/位移比，在非對稱型共同目標任務中，右腦傷組的筆直顯著大於左腦傷，表示右腦傷在此任務的軌跡控制較弱；而在相同任務中，非患側手的比值則是左腦傷顯著大於右腦傷。在任務完成時常這項參數中，沒有發現顯著組間差異。
討論與總結：本研究發現，在執行雙手任務時，左腦傷患者在空間控制相關的指標，例如：position error 和 path ratio表現普遍較差，但在任務完成時間，左右腦傷患者之間並沒有明顯差異。這可能代表左腦損傷後，患者在雙手協調時的困難，可能主要來自於空間上的控制不穩定，而不是動作時序的落差；也就是左腦傷的個案的雙手動作可能能同步完成，但無法準確到達正確的空間位置。因此，在未來的臨床訓練上，建議可針對左腦傷患者安排更多提升動作準確性與空間對應能力的練習，例如目標導向的抓取練習、雙手操作定位訓練等，以改善其在日常生活中雙手協調的表現。

Introduction: Bimanual coordination plays a crucial role in activities of daily living (ADL) and, based on their spatiotemporal characteristics, can be categorized into symmetric and asymmetric tasks. Stroke survivors frequently experience deficits in bimanual coordination owing to impaired tactile discrimination, force control, or executive function, which subsequently impairs sensorimotor integration and motor control. Although hemispheric specialization in unimanual motor control has been observed in patients with stroke and left and right hemisphere damage (LHD and RHD, respectively), there is limited research on the spatiotemporal aspects of bimanual coordination and hemispheric differences.
Purpose: This study aimed to investigate differences in bimanual coordination performance between patients with LHD and RHD after subacute stroke. Specifically, the following three objectives were addressed: (1) To examine whether there are hemispheric differences in path ratio performance between the LHD and RHD groups during symmetric tasks; (2) To examine whether there are hemispheric differences in path ratio during asymmetric tasks; and (3) To examine whether there are hemispheric differences in absolute position error (APE) across the four types of bimanual tasks.
Method: In total, 26 first-time subacute stroke patients with mild motor impairment were enrolled. They were evenly divided between LHD and RHD. Bimanual coordination performance was assessed using the Bimanual Block Test (BiBT), with three kinematic parameters: APE, path ratio, and movement time from the four bimanual tasks, symmetric independent (SI), symmetric common (SC), asymmetric independent (AI), and asymmetric common (AC). To account for confounding factors, tactile discrimination was evaluated through the 2-point discrimination test (2PD), pinch strength with the hydraulic Jamar Pinch Gauge (HJPG), and executive function was assessed by Color Trail Test 1 and 2 (CTT-1, CTT-2). The bimanual coordination performance was recorded by the open software “Kinovea” and further analyzed through MATLAB. ANCOVA was used to compare performance between LHD and RHD group, with pinch strength as the covariate.
Results: The ANCOVA revealed three significant between-group differences. First, the APE of the affected hand was significantly greater in the LHD group than in the RHD group during the SI task. Second, a significant between-group difference in path ratio of the affected hand was observed during the AC task, with the RHD group exhibiting a higher path ratio than the LHD group. Third, for the unaffected hand in the AC task, the LHD group showed a significantly higher path ratio than the RHD group. No significant between-group differences were found in movement time across tasks.
Discussion and Conclusion: Those with LHD demonstrated worse bimanual coordination with spatial characteristics, such as APE and path ratio, both in the affected and unaffected hand. This result revealed that in LHD, when performing bimanual tasks, unsuccessful bimanual coordination may result from the unstable control in the space between hands. Thus, future interventions for LHD should involve more exercises regarding movement accuracy in space, such as goal-oriented reach-to-grasp and bimanual positioning.

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