研究背景與目的：中風患者常有軀幹控制受損的問題而使平衡能力受損。雖有研究利用不平穩平面來訓練中風病患的軀幹控制，但其成效仍不明確。本實驗旨在探討在不平穩平面上進行軀幹控制運動對於亞急性中風病患的軀幹控制、坐姿平衡、站姿平衡以及行走能力會有何種影響。
研究方法：本篇為雙盲隨機對照試驗，收取27位亞急性中風患者，受試者隨機分配到實驗組 (14名) 或控制組 (13名)。實驗組接受每回30分鐘、一周兩回、總長六周的不平穩平面軀幹運動，而控制組則是接受相同訓練時間的上肢活動訓練。首先利用傅格-梅爾下肢評估量表(Fugl-Meyer Assessment of lower limb)、手握力測試以及足底感覺閾值評估則用來測量受試者感覺動作功能，並使用測力板擷取受試者壓力中心之數值以偵測軀幹控制能力(坐姿且雙腳懸空)、坐姿平衡(坐姿且雙腳著地)以及站姿平衡 (站姿)表現，一種姿勢中各包含五種任務，分別為靜止狀態下張眼或閉眼、軀幹傾向患側邊或向前，以及健側手臂快速高舉過頭等任務。同時，也利用軀幹損傷量表 (Trunk Impairment Scale) 以及中風復健動作評估量表(Stroke Rehabilitation Assessment of Movement) 兩種臨床量表來測量受試者軀幹以及肢體的動作功能。另外，採用六公尺行走測試用來測試受試者行走能力。統計方面，在組間比較使用曼惠二氏U檢定法觀察組間前測及後測有無顯著差異，組內比較使用雙樣本中位數差異檢定來檢測組內在介入前後是否有顯著差異。
結果：在壓力中心方面，在坐姿且雙腳懸空的姿勢下做靜止維持張眼的任務時，實驗組在後測相較於控制組有顯著更小的壓力中心擺盪面積以及顯著更小的壓力中心前後擺盪範圍，實驗組在同一姿勢下的軀幹前傾及向患側傾之距離在後測皆顯著的高於控制組，在非患測手高舉過頭的任務也發現實驗組在後測時手舉速度顯著高於控制組。在坐姿且雙腳著地的姿勢下，兩組之間在後測沒有顯著的差異。在站姿時，實驗組的軀幹前傾及向患側傾之距離在後測皆顯著高於控制組，且實驗組在後測時，其非患側手高舉任務之手舉速度也顯著高於控制組。在六公尺行走測試中，實驗組相較於控制組在後測顯著地花費更少時間即能完成測試。在軀幹損傷量表以及中風復健動作評估量表評估中，兩組在後測無發現顯著的組間差異。
結論：在不平穩平面上進行軀幹控制運動對於促進亞急性中風病人在靜態、動態以及自發動作情況下之軀幹控制能力是有益的，同時也可以促進中風病人在動態以及自發動作情況之站立平衡以及行走功能。此種運動可以被運用在中風病患日常的復健療程當中，以促進他們的軀幹控制、站立平衡以及行走能力。

Introduction: Impaired trunk control is common in stroke patients, and may affect balance function. Unstable surface has been reported to be used in trunk control training for stroke patients; however, its effects are still unclear. The purpose of this study was to examine the effects of trunk exercise on unstable surface on trunk control ability in stroke patients, and investigate whether this exercise could also improve sitting balance, standing balance and walking ability of subacute stroke patients.
Methods: This was a double blind study. A total of 27 sub-acute stroke patients were randomly assigned to the experimental group (n = 14) or control group (n = 13). The experimental group received 30 minutes per session, 2 sessions per week for a total of 6 weeks of trunk control exercise on unstable surfaces, while the control group received upper extremities exercises for the same amount of time. Force plates were used to obtain and calculate the center of pressure (COP) to investigate trunk control ability (sitting dangling), sitting balance (sitting with feet supported) and standing (standing balance). There were 5 tasks in each posture, including static tasks with eyes open or closed, leaning to the affected side or forward, and the unaffected arm rising upward. The Trunk Impairment Scale (TIS) and Stroke Rehabilitation Assessment of Movement (STREAM) were used to assess trunk and limbs’ motor function. The 6 meters walking test was used to assess walking ability, and the Fugl-Meyer Assessment of lower limb, hand grip strength test and cutaneous sensation assessments were used to assess sensorimotor function. The between-group comparisons were made using Mann-Whitney U test, while the Wilcoxon signed rank test was used to analyze the within group differences.
Result: In the force plates assessments, during sitting dangling, the experimental group had significantly smaller COP sway area and anterior-posterior (AP) range than the control group while sitting static with eyes open after exercise. Significant greater trunk leaning distance and increased velocity of the unaffected arm raised were found in the experimental group during leaning tasks and arm raising task after exercise, compared to the control group. During sitting with feet supported, no significant differences between the experimental group and the control group were found after exercise. During standing, significantly greater trunk leaning distance and increased velocity of the unaffected arm raised were found in the experimental group after exercise, compared to the control group. What is more, the experimental group took significantly less time than the control group in 6 meters walking test after training. There were no significant differences in TIS and STREAM scales after training for the both group.
Conclusion: Trunk control exercise on unstable surface was beneficial for improving trunk control ability under static, dynamic, and self-initiated movement conditions. Also, it could improve standing balance under dynamic and self-initiated movement conditions and walking ability in sub-acute stroke patients. We recommended this exercise protocol to be implemented in stroke patients’ rehabilitation program to improve their balance and walking ability.

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