Effects of Smart Home-based Exercise on the Patients with Cervical Spondylotic Myelopathy following Spinal Surgery

• Main Authors: Yu Chih Chiang, 江宇智
• Other Authors: C. H. Cheng
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/28wq44

碩士 === 長庚大學 === 物理治療學系 === 107 === Background and Purposes: The prevalence of cervical spondylotic myelopathy (CSM) increased with aging. The sensory and motor problems of CSM usually influence the patient's daily function and quality of life. The severe cases eventually need the surgical treatment. However, the problems of head control ability usually remain after surgical intervention. Exercises supervised by physiotherapists are usually time and manpower consuming. Nowadays, there are lots of therapeutic exercises can improve the head control ability of neck pain patients. The purpose of our study is to investigate whether these exercises via the home training are effective for the post-surgical CSM patients. Method: After spinal decompression surgery, subjects received eight-week smart home-based exercise with the head-mounted rehabilitation equipment which was developed by our laboratory. Then, the subjects would be divided into high completion group and low completion group according to their exercise status. Subjects were evaluated by physiotherapist at pre-surgery, post-3month and post-exercise. The assessment included Numeric rating scale (NRS), Taiwanese version of neck disability index (NDI), Chinese version of Japanese orthopedic association cervical myelopathy evaluation questionnaire (JOACMEQ), functional tests of upper and lower limbs, cervical range of motion (ROM), cervicocephalic kinesthetic sensibility, maximal neck muscle strength and slow movement test. After eight-week exercise, exercise status was recorded and Taiwanese version of Quebec user evaluation of satisfaction with assistive technology (T-QUEST) and chinese version of psychosocial impact of assistive devices scale (PIADS) were given. The nonparametric analysis, including the Friedman test and Mann-Whitney U test, were used to identify the difference of the measurements in terms of the time periods and groups respectively, and the Spearman rank correlation coefficient was used examine the correlation among the measurements. Results: 14 males and 5 females were recruited in our study. The high completion group revealed that the home-based exerecises help to decrease NDI scores significantly, and improved pain status and JOACMEQ performance. The functional performance of hand and foot were improved significantly. Cervical ROM was close to that in the pre-surgery status especially in extension and rotation movements. Maximal neck muscle strength significantly increased. Muscle activation significantly decreased during the slow movement test. The NRS significantly associated with NDI, quality of life, muscle strength, proprioception and muscle activation. The cervicocephalic kinesthetic sensibility significantly associated with the ROM and muscle activation. The muscle activation significantly associated with ROM and muscle strength. The participants showed the middle level of satisfaction of equipment. Conclusion: This study found that function of the post-surgical CSM patients could be further improved through the smart home-based exercise. The subjects who followed the recommendation in eight-week exercise showed the benefits of relieved neck pain, increased cervical ROM and muscle strength, improved proprioception, and improved muscle activation and quality of life. Future studies are suggested to incorporate with the automatic reminder to facilitate the participation of the home exercise and to optimize the head-mounted goggle to ameliorate the comfortability so that patients can get the best treatment effects after surgery.