acupuncture）等，試驗組則是正常針灸治療60。
六、非穴位對照法：此法試驗組在治療穴位點正常針刺，而對照組是
九、簡單的皮表針對照法：對照組用鈍頭針或其他工具，如針管、
牙籤、鑷子等，作勢拍到皮膚上，再用膠布將假針貼在穴位上 66。 十、安慰針對照法：此對照組使用Streitberger's needle 或 Park Sham
Device，此安慰針的針尖圓鈍，針身可滑入針柄而縮短，並藉由 acupuncture）71。
十二、偽灸法對照：此設計經過隨機臨床試驗研究，評估其雙盲效果
間30分鐘後會出現立即性之抗痙攣效應，但利用同樣之方法將頻率設定
小於第三週治療後之平均值。這樣的結果似乎告訴我們，當受試者在
研究中另一項次要性的結果測量，我們設計利用“生活獨立量表”
與“巴氏量表”來評估受試者經過六週之中風常規復健與電針治療後日 常生活功能獨立使用所呈現之變化，結果從數據上來分析兩組之成效 均不夠顯著，且兩組間之比較也未能達到統計上明顯之差異。這樣的 結果其實並不令人意外，早在先前的研究中就已經發表了 77，中風後 運動神經之修復是一種重新學習運動功能的過程，必須強烈地仰賴病 患接受復健療程之總量來決定恢復之成效。由此可知電針在整個中風 復健規畫中不論是運動功能或日常生活功能主要扮演的是輔助的角 色，而研究中僅針對六週後之實驗結果進行評估，就整個中風復健的 總量而言實在太短缺了， 所以我們只能建議未來相同領域的研究如果 能增加介入期間與治療頻率、延長觀察及追蹤次數，應該可以獲得正 面的應證。
研究中受到限制的就是無法發掘一部能夠將痙攣客觀評估、數據 量 化 的 測 量 儀 器 ， 目 前 雖 常 見 利 用 肌 電 圖(EMG) 或 表 面 肌 電 圖 (Surface-EMG)作為實驗室常規檢查的儀器，但與臨床評估方法較著重 在受傷後之運動與日常功能之恢復，兩者之間仍存在著相當的落差；
其二就是慢性中風病患由於行動不便需要家人或看護的貼身照顧，因 此雖然受試者有強烈的參與的意願但基於交通不便所以常會有半途而 廢的念頭，這也就是受試者不易招募與臨床試驗最困難執行的地方。
第六章 結論
透過研究結果的顯示，慢性中風病患在常規復健療程中附加六週 之電針治療，能夠有效地緩解患側上肢肘關節肌肉痙攣之現象，增加 肘關節之關節活動角度；但是對於患側上肢腕關節肌肉痙攣之現象，
以及日常生活功能獨立使用的能力並未有具體的改善，兩組間治療後 之生活獨立量表與巴式量表分數的差異檢定，經統計後均無明顯之差 異。
未來也建議能繼續執行更大型之研究計劃，提升實驗設計的嚴謹 度、擴大研究之樣本數，增加介入期間與治療頻率、延長觀察及追蹤 次數，進一步探討臨床上痙攣發作之機轉，發展針對慢性中風病患上 肢痙攣更有臨床效益之療法。
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附錄一：研究流程表(Flow Chart)： Paired (Dependent) t Test 分析
P < 0.05 為有統計之顯著 差異
附錄二：人體試驗委員會人體試驗計畫同意書
附錄三：健康調查表
*腎臟病：□否 □是，已發現_____年，
*腰圍：____________公分 *血壓：____________mmHg
*脈搏：____________下/分
附錄四：生活功能獨立程度量表(FIM)
附錄五：巴氏量表（Barthel Index）
ABSTRACT
The functional effect of electro-acupuncture on the upper-extremity spasticity in chronic stroke patients
Stroke is a leading cause of death and one of the most disabling illnesses in developed countries1-3Approximately 18.9% of stroke survivors in Taiwan have moderate levels of disability, and 26.4% have the most severe motor disability.4 Data also showed that 23% of stroke patients experienced joint tightness and soreness due to contracture.5 It is also considered a potential obstacle to improvements in motor control and functional ability of the upper- limb through different rehabilitative techniques.6 Spasticity has been defined a motor disorder characterized by velocity-dependent increase in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of stretch reflex , spasticity as one component of the upper motor neuron syndrome7, such as stroke.
Acupuncture has been used in China for more than 3000 years, some Chinese studies8-10 have indicated that acupuncture might improve stroke patients. In Oriental medicine, acupuncture11, 12 and electroacupuncture13 have been used to treat spasticity and shown effectiveness through clinical trials. According to a recent study14 showed that EA can improve upper-limb motor function for first-ever ischaemic stroke patients ,but did not result in better functional independence. Another study has demonstrated that EA could inhibit spasticity in chronic stroke patients immediately, however, there are still arguments as how long they can reduce spasticity and whether they can maintain the effect .18
In the study, we attempt to exam the following experiment hypothesis (1) EA has long term effect to inhibit the upper-extremity spasticity in chronic stroke patients, (2)EA combine with conventional rehabilitation could improve the ADL in chronic stroke patients.
Keywords: Acupuncture , Electro-Acupuncture , Stroke , Spasticity
謝辭
在這春意盎然的時節裏，終於完成了我的論文寫作！回首來時路 真的充滿了山窮水盡疑無路，柳暗花明又一村的驚喜。承蒙我的指導 老師 林教授昭庚博士及 李副教授德茂博士兩位恩師對我的提拔，特 別在學術及研究的領域上也不吝給我細心的教誨與宏觀的指點，沒有 您無私無悔的鞭策，就沒有今天的我。
在研究期間，更要特別感謝中國醫藥大學附設醫院復健科 周立偉 主治醫師，不論在研究資源的整合或受試者的收案都給我最高規格的 協助，並且我要對任職於中國醫藥大學附設醫院復健科資深職能治療 師林怡君老師致上最高的謝意，因為沒有她不計得失的支援，整個研 究就無法圓滿完成。
再者，我要對我的導師許昇峰助理教授以及所內的劉旭然先生表 示我最真誠的感謝，在我兩年的研究所日子裡不斷地給我各項協助。
最後，我要感謝我的家人，感謝他們陪我這一路走來對我的支持、
包容與協助，我願將一切喜樂與它們共享。