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題名：給予感覺刺激的肌力訓練對慢性前十字韌帶損傷患者神經調控與功能性表現之影響
作者：黃奕銘
作者(外文)：Yi-Ming Huang
校院名稱：國立體育大學
系所名稱：教練研究所
指導教授：湯文慈
張雅如
學位類別：博士
出版日期：2009
主題關鍵詞：前十字韌帶；肌力訓練；電刺激；anterior cruciate ligament；strength training；electrical stimulation
原始連結：連回原系統網址new window
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前十字韌帶斷裂後，透過周邊感覺缺損改變人體中樞神經系統，造成股四頭肌的中樞驅動失敗，並影響股四頭肌的活化。短期的微量電刺激介入可以改善前十字韌帶損傷患者股四頭肌的自主活化程度並改善大腦皮質內的調節，對於想積極復健股四頭肌肌力者，應可提供更多的助益。本研究目的想探討給予感覺刺激的肌力訓練對於前十字韌帶損傷患者神經調控與功能性表現的影響。19名自主活化程度低於90%的前十字韌帶損傷患者隨機分成感覺刺激組(SS組)與非感覺刺激組(NSS組)，分別進行每次30分鐘，每週三次，共4週的訓練。訓練前、後，兩組均接受股四頭肌最大等長與等速肌力測試、單腳跳遠距離、單腳落地與神經測試。訓練後的結果顯示，兩組的等長、等速肌力、單腳跳遠距離、自主活化程度、落地垂直地面反作用力皆顯著提升；SS組落地前、後，股內斜肌與股二頭肌的共同收縮比顯著降低，NSS組則無顯著改變；NSS組股外側肌動作誘發電位顯著降低，SS組股內斜肌、股直肌與股外斜肌則無顯著改變；SS組股內斜肌與股外側肌的大腦皮質內抑制與興奮曲線正常化，NSS組皆無顯著改變；兩組落地後最大膝彎曲角度、壓力中心最大前後與內外方向偏移量在訓練後皆無顯著改變。根據結果，長期輔以感覺刺激的肌力訓練可改善前十字韌帶損傷患者單腳落地時的神經肌肉控制，並使大腦皮質內抑制與興奮調控正常化。慢性前十字韌帶損傷患者大腦皮質內存在重塑反應，可能是為了因應受傷或重建後的功能性動作控制改變而產生。單純的肌力訓練無法改善此反應，建議加入微量電刺激以提供額外的感覺輸入來解決中樞的問題。
The changes of Central Nerve System (CNS) in human bodies due to ACL deficient subject results in failure voluntary activation (VA) and inactive quadriceps muscle firing. A mild electrical stimulation (ES) alleviates the aforementioned VA issue and, meanwhile, helps the motor cortex adjustment. Consequently, such a mild ES may benefit people who want to recover/improve strength of quadriceps muscle more efficiently. The present study aims to investigate the effect of strength training with sensory stimulation on neural adjustment, as well as the function outcome in chronic ACL injured subject. Nineteen ACL injured subjects with VA below 90% were randomly divided into sensory stimulation (SS) and non-sensory stimulation (NSS) groups. An isokinetic training program consisting of 3 sessions per week on a 4 week period was conducted. Tests performed include quadriceps isokinetic and isometric strength, single leg hop distance, single leg landing and neural tests. It was observed that isometric and isokinetic knee extensor torque, hop distance, VA and maximal vertical ground reaction force increased significantly after training. Co-contraction ratios of vastus medialis oblique (VMO) and biceps femoris decreased in the SS group while no evident change was detected in the NSS group. Motor-evoked potential amplitudes resulting from vatus lateralis (VL) were seen to decrease in the NSS group. The changes in the SS group, however, were not statistically significant. It was also only observed in the SS group that intracortical inhibition (ICI) and facilitation (ICF) curves of VMO and VL shifted toward the normal state. Furthermore, maximal knee flexion angle, maximal displacement of anterior-posterior and medial-lateral of center of pressure after landing remained essentially unchanged in both groups. The strength training with sensory simulation may improve neuromuscular control during landing and simultaneously normalize the ICI-ICF curve to the healthy state. Remodeling of motor cortex in the ACL injured subject may be responsible for the changes of functional motor control after injury or reconstruction. While strength training alone may not be sufficient to resolve this problem, additional mild ES as sensory input to the CNS is suggested.
黃奕銘、詹智能、湯文慈 ：自主活化程度評估與其影響因素之探討。中華體育季刊，第20卷，第4期，27-31。new window
謝昌運(2002)：前十字韌帶斷裂後其本體自覺性平衡感之調查.國立體育學院運動科學研究所碩士論文。未出版之碩士論文，桃園，台灣。
徐育廷(2008)：增加感覺輸入訓練對慢性前十字韌帶斷裂患者自主活化程度與神經調控的影響。長庚大學復健科學研究所碩士論文。未出版之碩士論文，桃園，台灣。
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