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研究生：	蔡孟芬 Tsai, Meng-Fen
論文名稱：	中風病人手指創新復健器 A Novel Digit Rehabilitation Apparatus for Patients with Stroke
指導教授：	蘇芳慶 Su, Fong-Chin
共同指導教授:	郭立杰 Kuo, Li-Chieh
學位類別：	碩士 Master
系所名稱：	工學院 - 生物醫學工程學系 Department of BioMedical Engineering
論文出版年：	2016
畢業學年度：	104
語文別：	英文
論文頁數：	94
中文關鍵詞：	手指獨立性、力量控制、手指獨立限制、生物回饋
外文關鍵詞：	Digit independence, Force control, Enslaving, Biofeedback
相關次數：	點閱：98 下載：15
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在中風病人中，受損的感覺及不正常的動作協同作用是常見的徵狀。此外，這兩種缺陷可能導致力量控制能力–手指施力獨立性的不足。最近生物回饋的手法被用來訓練中風病人的力量控制能力。然而，目前仍未有利用生物回饋來訓練手指施力獨立性的研究，且很少文獻提及手指施力獨立性與感覺、手功能之間的關聯性。
在這篇研究中，手指施力獨立性是由：施力指與五指合力的回歸係數矩陣計算而來。五位慢性中風病人被邀請參加提供五指力量視覺回饋的手指創新復健器的生物回饋訓練，此訓練頻率為一次十分鐘、在四到六周內完成十二次的訓練。在訓練前、後及四周的追蹤評估包含手指創新復健器的評估、臨床評估–感覺評估、手功能評估及肌力測量。除了中風病人以外，十四位健康成人也會參與所有評估內容，用以檢驗手指創新復健器的信度以及探討手指施力獨立性與上述臨床評估工具間的關聯性。
手指創新復健器在評估手指施力獨立性有很高的再測信度及區分中風病人的準確度。此外，臨床感覺測驗、手功能測驗及肌力測量皆與手指施力獨立性有顯著相關。即使握力與手指施力獨立性之間有顯著相關，有高握力的中風病人仍舊可能有不足的手指施力獨立性。在參加手指創新復健器訓練並維持原本常規復健的慢性中風病人中，大多數的中風病人在訓練後有較好的手功能表現、手指施力獨立性及感覺測試。但在四周的追蹤評估中，手指獨立性及感覺測驗卻無法維持。在未來的研究中，增加慢性中風病人的訓練時間也許可以維持訓練後進步的成效。

The impaired sensation and abnormal synergy are common deficits after stroke. Besides, both of those deficits may result in the disability of force control, especially the digit force independence. Recently, the rehabilitation training with biofeedback technique was used to improve the hand control ability in patients with stroke. However, there’s no research investigating the training effect on the digit force independence ability via biofeedback system yet. The relationship between digit force independence ability and sensory or hand functions was also kept unknown.
In this study, digit force independence ability was calculated from enslaving matrix which contained the regression coefficients between applied single digit force and total five digits forces. Five chronic stroke patients received six-week training of force control with the biofeedback system – Pressing Evaluation and Training System (PETS) which provided the visual feedback of five digit forces. The patients were evaluated before, after and four-week after the six-week training by the PETS evaluation and clinical assessments to quantify the training effects. There were fourteen healthy subjects recruited for examining the test-retest reliability of PETS evaluation and clarify the relationship between these clinical assessments and digit force independence ability.
The results showed that the PETS SDR had high test-retest reliability and accuracy to differentiate stroke patients from healthy group. The sensory status, hand function tests and grasp power were significantly correlated with the ability of digit force independence (p<0.05). Although the significant correlation was found between the grasp power strength and the ability of digit force independence, stroke patients had high grasp power might still had insufficient ability of digit force independence. Most of stroke patients had better hand function and temporarily improved digit force independence ability and sensation after training. In the four-week follow-up evaluation, those stroke participants had dropped down the performance in digit force independence ability and sensory. In the future, the increased training duration might help to keep the extra training effect in chronic stroke patients.

摘要	I
Abstract	II
致謝	IV
Contents	V
List of Table	IX
List of Figure	X
Abbreviation list	XIV
Chapter 1 Introduction	1
1 Background	1
2 The sensori-motor processing pathway in brain	2
3 The importance of feedback mechanism	3
4 The motor deficit, evaluation and rehab program for motor reconery in stroke patients	3
5 The sensory deficit in stroke patients	5
6 The digit force control deficit in stroke patients	6
7 Digit force independence related studies	7
8 The reason why stroke patients need biofeedback intervention and how biofeedback training promote the motor recovery	8
9 Current commercialized biofeedback training system in hand therapy	9
10 Motivation	10
11 Purpose	11
Chapter 2 Materials and Methods	13
1 Subjects	13
2 Visual feedback for Digit Force Independence Training	15
3 Experimental setting and procedure	20
3.1 The experimental setting	20
3.2 The experimental procedure	21
4 Evaluation	24
4.1 Clinical assessment – Hand Function Test	24
4.1.1 Action Research Arm Test (ARAT)	24
4.1.2 Box and Blocks Test (B&BT)	25
4.2 Clinical assessment – Traditional Sensory Test	27
4.2.1 Semmes-Weinstein (S-W) test	27
4.2.2 Two-point Discrimination (2-PD)	28
4.3 PETS evaluation – SDR	28
5 Training program	31
6 Parameters of digit force independence – EN	34
7 Statistical analysis	35
Chapter 3 Result	37
1 Develop the visual single digit force feedback training system	37
1.1 the intra-correlation coefficient within-day and between-day of SDR in the PETS	37
2 Assess the control ability of digit force independence with a new developed system – PETS	40
2.1 The difference of the EN between healthy subjects and stroke patients	40
2.2 The feasibility of using PETS SDR to differentiate stroke patients and healthy group	42
3 Correlation between EN and clinical assessments	44
4 Using PETS to train the stroke patients’ digit force independence	45
4.1 The changes during pre-training, post-training and four weeks follow up in M03	46
4.1.1 The change of digit force independence – EN	46
4.1.2 The change of sensory status including S-W test, static 2-PD test and moving 2-PD test	47
4.1.3 The change of hand function tests including B&BT and ARAT	50
4.1.4 The change of strength measurements including grasp power, palmar pinch and three jaw pinch strength	51
4.2 The changes during pre-training, post-training and four weeks follow up in M05	52
4.2.1 The change of digit force independence – EN	52
4.2.2 The change of sensory status including S-W test, static 2-PD test and moving 2-PD test	53
4.2.3 The change of hand function tests including B&BT and ARAT	56
4.2.4 The change of strength measurements including grasp power, palmar pinch and three jaw pinch strength	58
4.3 The changes during pre-training, post-training and four weeks follow up in F01	59
4.3.1 The change of digit force independence – EN	59
4.3.2 The change of sensory status including S-W test, static 2-PD test and moving 2-PD test	60
4.3.3 The change of hand function tests including B&BT and ARAT	62
4.3.4 The change of strength measurements including grasp power, palmar pinch and three jaw pinch strength	64
4.4 The changes during pre-training, post-training and four weeks follow up in F02	65
4.4.1 The change of digit force independence – EN	65
4.4.2 The change of sensory status including S-W test, static 2-PD test and moving 2-PD test	66
4.4.3 The change of hand function tests including B&BT and ARAT	69
4.4.4 The change of strength measurements including grasp power, palmar pinch and three jaw pinch strength	71
4.5 The changes during pre-training, post-training and four weeks follow up in F04	72
4.5.1 The change of digit force independence – EN	72
4.5.2 The change of sensory status including S-W test, static 2-PD test and moving 2-PD test	73
4.5.3 The change of hand function tests including B&BT and ARAT	75
4.5.4 The change of strength measurements including grasp power, palmar pinch and three jaw pinch strength	77
Chapter 4 Discussion	79
1 Correlation between clinical assessments and EN	79
2 Comparing to previous study of digit force independence	79
3 Using PETS to train the stroke patients’ digit force independence	81
3.1 Changes of Digit Force Independence ability – EN	82
3.2 Changes of strength measurements	83
Chapter 5 Conclusion	84
References	86
Appendix	92
                                    

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