| Summary: | 碩士 === 中山醫學大學 === 醫學研究所 === 96 === Background: For poststroke patients, increasing muscle tone and associated reaction in the paretic limbs sometimes disturb the activities of daily living. Patients with asymmetrical lower limb functions are difficult to perform continuous and smooth reciprocal movements in the lower limb, such as walking. For this reason, decay in cardiopulmonary function and muscle atrophy will also cause them much physical restrictions in the daily life. To enhance residual functions of patients with partial motor disorders, electrical stimulation (ES) combined with cycling exercise has been utilized as a rehabilitation technology recently. Mazzocchio and colleagues were the first investigators who reported on the ability to establish a target speed increased and H-reflex size decreased more after cycling training involving frequent changes in pedal resistance that required calibrated locomotor compensatory action than with training involving constant pedal resistances and lesser compensation. The degree of performance improvement correlated with the reduction in the amplitude of the H-reflex. But there were no detailed report in documents about the effects of muscle tone and functional standing balance with neural plastic changes after the pedaling exercise. Therefore, the purpose of this study was to investigate whether (1) a single bout cycling training with stroke can improve abnormal tone and functional standing balance of paretic leg; (2) ES to the paretic leg during cycling has more effects than cycling without ES. Material and Method: Eighteen stroke patients were recruited, 15 male and 3 female, all subjects gave informed consent as approved by the internal review board of the Chung Shan Medical University School of Medicine and were randomly devided into 2 groups. The experimental group (ES-LCE) performed leg cycling exercise with tolerable ES that evoked muscle contractions during a lower resistance and constant speed cycling training; to evaluate muscle tone and standing balance before and after the training period (20 min). The control group (LCE) received the same study protocol except the ES. In this study, we used the paired sample t-test to assess the changes between the baseline and post-test, and on the other hand the repeated measures ANCOVA was used to analysis the differences between groups. Results: The H/Mmax ratio was significantly decreased in ES-LCE (p= 0.027) and LCE (p= 0.004). The RI was significantly increased in the ES-LCE (p= 0.012), but not in the LCE (p= 0.078). Muscle strength was not significantly changed after training. Scores on the forward limits of stability (LOS) control improved (ie, the MXE increased in the ES-LCE (p= 0.012), and furthermore the significant improvements of RT (p= 0.044), MVL (p= 0.009) and EPE (p= 0.044) were in the LCE). On the other hand scores on the EPE, MXE, and DCL in the affected-ward trial were significantly improved in 2 groups. Training-induced temporal changes of H/Mmax , RI and LOS were no significant difference between the 2 groups. Discussion and Conclusion: This present study showed that a short cycling training program is an useful therapeutic intervention to reduce the muscle tone and to improve the standing balance control of lower paretic limb in patients with stroke. But the use of ES had no additional effects in this specific group of subjects with stroke.
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