Journal of Taiwan Occupational Therapy Research and Practice
目的：目前文獻已證實密集性之復健治療有助於中風病患患側手動作功能之恢復，其中，雙側動作訓練已有多份實証性研究呈現其效益。雙側動作訓練是指在復健訓練過程中讓雙手同時參予其中，執行鏡像或交替性之對稱性動作。本篇目的為分析歸納至2007年止雙側動作訓練之實證研究，並提供各實証研究之證據力層級，以供臨床與研究之參考。方法：經由PubMed、Medline、Scopus 及ProQuest 文獻搜尋引擎，鍵入關鍵字：bilateral training, stroke, hemiplegic, rehabilitation，並至2007年6月為止，以雙側動作訓練和有具體訓練過程為篩選條件。結果：回顧統整結果，共有17篇有關實證研究的文獻，依治療型式，可分為：機械性上肢協助訓練、主動－被動雙側動作訓練、雙側等運動學型態訓練、節律性聽覺指引之雙側上肢訓練、以及雙側動作合併神經肌肉刺激。治療方法之多樣化與不同嚴重程度之中風病患，其療效也會不同，但大多研究皆有顯著的效果，以節律性聽覺指引之雙側上肢訓練和雙側動作合併神經肌肉刺激最能改善中風病患之動作表現和動作控制，而雙側等運動學型態訓練之對於重度中風病患之療效較不顯著，與治療挑戰度的適切性可能有關。結論：不同的雙側動作訓練都可作為中風患者復健的有效方式，機械性上肢協助訓練，藉由機械手臂之被動協助，適合重度動作受損病患；主動－被動雙側動作治療，則由健側手主動動作，帶動患側手被動動作，雖同樣藉由儀器協助，但針對手腕之關節活動，故適合中度動作受損病患；雙側等運動學型態訓練、節律性聽覺指引之雙側上肢訓練、雙側動作合併神經肌肉刺激，則需雙手同時執行活動，適用於中、輕度動作受損病患。未來可進一步探討療效之長期效益與雙側動作之神經生理機制，作為臨床應用之參考指標。
Objective: The intensive rehabilitation protocols have been demonstrated to promote recovery of upper limb function in stroke patients. Bilateral movement training, one of the intensive rehabilitation protocols, is evidenced to be effective on motor performance. However, there is only one systematic review article on effects of bilateral movement training. The purpose of this article was to analyze the empirical studies on the effects of bilateral training dated to 2007 and provide levels of evidence with respect to these empirical findings. Methods: PubMed, Medline, Scopus and ProQuest databases dated to 2007 were searched to identify relevant studies. The criteria for inclusion of trials in this study were that trial had to include bilateral training programs. The keywords were bilateral training, stroke, hemiplegic, and rehabilitation. Results: Seventeen eligible studies were located. Five categories of bilateral movement training were identified: robot-assisted arm training; active-passive bimanual movement therapy (APBT); bilateral isokinematic training (BIT); repetitive bilateral arm training with rhythmic cueing (BATRAC); and coupled bilateral movements with active neuromuscular stimulation (coupled protocols). Results of most studies showed the beneficial effects of bilateral movement training on motor recovery post-stroke, especially the salient effects of BATRAC and coupled protocols. In contrast, the effect of BIT in patients with severe motor deficits is limited possibly because of high challenge of treatment activities administered to patients. Conclusions: Different types of the bilateral training protocols exerted a positive effect in various degrees. Robotic-assisted arm training which consists of a robotic device guides the shoulder and elbow movements was appropriate for patients with severe deficits of the affected arm. The APBT where the patient moved actively with the unaffected hand to passively drive the affected hand was beneficial for patients with moderate motor deficits. BIT, BATRAC, and coupled protocols which facilitated the affected hand performance by doing mirror movements were suitable for mild and moderate stroke patients. Further research might explore the long term effects and the neurophysiological mechanisms of bilateral training to validate the efficacy of bilateral training in patients with stroke.