背景與目的：利用經顱磁刺激(transcranial magnetic stimulation, TMS)探討運動訓練促使中風患者動作功能恢復的神經塑性與機制，有利於尋找安全、有效的治療參數。肌電生物回饋儀(EMG biofeedback, EMGBFB)是學習脛前肌(tibialis anterior)出力程度控制經常被建議使用的有利工具，但是目前研究對其療效及訓練參數尚缺乏有利的證據。本個案報吿利用簡易攜帶型肌電生物回饋儀輔助脛前肌出力控制訓練，探討固定與變異練習模式對慢性腦中風患者經顱磁刺激誘發之脛前肌神經興奮性及行走相關之動作功能恢復的短期及長期療效。方法：三位腦中風受試者(個案A、B、C)，分別隨機分配於固定練習運動(constant practice)、變異練習運動(variable practice)或對照運動(為期六週、每週三次、每次60分鐘)。固定練習以當次最大肌電量為訓練目標、變異練習分別以當次最大肌電量的100%、75%、50%及25%為隨機訓練目標、對照運動為上肢訓練。分別於訓練前、後、訓練後二週和六週接受包括患側脛前肌肌力、行走速度、計時起走測驗(Timed Upand Gotest, TUGT)及六分鐘行走測驗(Six-minute Walking test, 6MWT)與經顱磁刺激誘發之腔前肌運動閾值(motor threshold, MT)等項目的評估。以SPSS17.0進行統計分析。結果：受試者在接受六週的肌電生物回饋儀訓練後，脛前肌最大肌力皆有立即的進步，固定練習個案有進步較多的趨勢。然而，只有固定錬習個案在訓練後脛前肌肌力及神經興奮性有明顯長期增加的趨勢》在行走相關之動作功能恢復的短期及長期效果並無明顯的變化。結論：固定練習模式的簡易型肌電生物回饋儀輔助脛前肌出力控制訓練似乎較變異練習模式對慢性腦中風患者之脛前肌最大肌力及經顱磁刺激誘發之脛前肌神經興奮性有短期及長期療效。未來將徵召更多受試者進行隨機分組控制研究進一步探討。(物理治療2014;39(1):50-58)

Background: Using transcranial magnetic stimulation (TMS), we could investigate neural plasticity accompanying motor function changes induced by physical training, and hence may help to develop safer and more effective training parameters. Impaired force control of the tibialis anterior (TA) is a major deficit during gait in people with stroke. Electromyograghic biofeedback (EMGBFB) has been used for TA muscle training to improve gait in stroke rehabilitation, but benefit of such therapy is weak in the literature. Purpose: This study measured the changes in TA strength, gait function and cortical excitability after EMGBFB-assisted TA exercise training in people with chronic stroke. Methods: Three participants were randomly assigned to one of the three exercise programs: constant, variable or control. Each program was 6-week in length, 60 minutes/section, three sections per week. For the constant program, the goal was to maintain a force exertion level of 100% for each repetition. For the variable program, the goal was to maintain a force exertion level of 100%, 75%, 50%, and 25% for each repetition. The control participant practiced upper extremity exercises. Affected TA muscle strength, Timed Up and Go test (TUGT), Six-minute Walking test (6MWT), and motor threshold (MT) of TA were evaluated at baseline, post-training, 2-week and 6-week after training. Results: Both participants of the EMGBFB -assisted TA exercise program showed immediate improvement in TA strength after training. The constant program demonstrated more prominent increase in TA strength than the variable program. Only the constant program participant appeared to show lasting effects in TA strength and MT at 6-week after training. There were no significant improvement in walking speed, TUGT and 6MWT. Conclusion: Six-week of EMGBFB-assisted TA exercise training helped to improve TA strength immediately after training. The constant EMGBFB program also enhanced cortical excitability lasting for 6 weeks after training in stroke patients. The EMGBFB is a feasible and potentially effective adjunct therapy for improving TA control after stroke. Its effect on gait remains unclear. (FJPT 2014;39(1):50-58)