Original Article / ·¡ro ´ Áª«µ¦r¢g ¢¼µ¦ 2551; 18(3): 105-108 J Thai Rehabil Med 2008; 18(3): 105-108 µ¦«¹¬µ¨´¬³ °®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê Ã¥Á Ȥ · ´ªÊ Á¸¥É ª ¦n» ·¡¥r ÃÅ¡¦· ¡.. ¨n¤» µÁª«µ¦r¢g ¢¼ æ¡¥µµ¨Á¨·· ¦¤µ¦Â¡¥r ¦³¦ªµµ¦» ABSTRACT Characteristics of motor unit action potentials (MUAPs) by monopolar needles Chokpraisin R. Rehabilitation Medicine Division, Lerdsin General Hospital, Department of Health Service, Ministry of Public Health Objectives: To determine the electromyographic characteristics of MUAPs by monopolar needles and to compare them with normal data from foreign studies. Subjects: Forty-four healthy volunteers, 22 males and 22 females with mean age of 39 years, working at Lerdsin General Hospital Methods: By using the monopolar needles, amplitudes, durations and phases of MUAPs of abductor digiti minimi (ADM), deltoid, biceps brachii, extensor digitorum communis (EDC) and tibialis anterior (TA) muscles on the right side were collected and compared with normal data from other studies. Results: Most of the subjects were non-regular exercisers and righthanded. When compared with the foreign data, the amplitudes of MUAPs in our subjects were significantly 2-3 times less in all muscles except of Correspondence to: Dr. Rungtip Chokpraisin, Rehabilitation Medicine Division, Lerdsin General Hospital, Silom road, Bangrak, Bangkok, 10500. E–mail : [email protected] biceps brachii muscles. Regarding durations and phases, results were nearly the same. Conclusion: The characteristics of MUAPs by monopolar needles in healthy Thai population were the same as those reported in foreign studies except amplitudes which were 2-3 times smaller in all muscles. Keywords: electromyography, motor unit action potentials, monopolar needles, normal data J Thai Rehabil Med 2008; 18(3): 105-108 ´¥n° ª´»¦³r: Á¡º°É «¹¬µ¨´¬³®nª¥ ¨ºÉÅ¢¢jµµ¨oµ¤ÁºÊ° (motor unit action potentials, MUAPs) ¸ÉÅoµ ¨oµ¤Áº°Ê °°µµ¤´¦¸É ·Ã¥ÄoÁ Ȥ · ´ªÊ Á¸¥É ª ¨³Á¦¸¥Á¸¥´nµ· °nµ¦³Á« ¦¼Âµ¦ª·¥´ : µ¦ª·¥´ Á·¡¦¦µ µ¸É ¶µ¦ª· ´ ¥ : ¨n» ¤ µÁª«µ¦r¢g ¢¼ æ¡¥µµ¨Á¨·· ¨n»¤¦³µ¦: °µµ¤´¦¶ª 44 ¦µ¥ Á}µ¥ 22 ¦µ¥ ¨³®· 22 ¦µ¥ ¹É Á}Áoµ®oµ¸ÃÉ ¦¡¥µµ¨Á¨··¤¸°µ¥» Á¨¸É ¥ 39 e » £µ¡Â È Â¦Â¨³Å¤n ¤¸ 浦³¦³µ ª· ¸ µ¦«¹ ¬µ: Äo°·Á¨Èæ·Á Ȥ ´Ê ª Á¸É ¥ ª «¹ ¬µ®n ª ¥¨ºÉ Å¢¢j µ µ ¨o µ ¤ÁºÊ ° µ¨o µ ¤ÁºÊ ° ¸ ªµ ° ¦nµµ¥¶ª 5 ¤´ ÅoÂn ¨oµ¤ÁºÊ° abductor digiti minimi, deltoid, biceps brachii, extensor digitorum communis ¨³ tibialis anterior Ã¥ª´Â°¤¡¨·¼ - 105 - ªµ¤ªo µ n ª ¨ºÉ ¨³¶ªÁ¢ ®µn µ Á¨¸É ¥ ¨³n µ Á¸É ¥ Á µ´Ê Á¦¸¥Á¸¥´nµ·¦¸É µ¥µµnµ ¦³Á« ¨µ¦«¹ ¬µ: °µµ¤´ ¦n ª Ä®n ´ ªµ ¶µ®´ Ân°°¶¨´µ¥ Ťn¤É¶Á¤° ¡ªnµ¨´¬³ °®nª¥ ¨ºÉÅ¢¢jµµ¨oµ¤ÁºÊ°µ¨oµ¤ÁºÊ° ´Ê 5 ¤´ ¤¸ µÂ°¤¡¨·¼Á¨Èªnµ¸É ¦µ¥µµnµ¦³Á« 2-3 Ánµ ¥Áªo µ¨oµ¤ÁºÊ° biceps brachii Ánµ´Ê n ª ªµ¤ªo µ n ª ¨ºÉ ¨³¶ª Á¢´Ê ¤¸µn ĨoÁ¸¥´ ¦»: Á¤ºÉ°Äo°·Á¨Èæ·Á Ȥ ´ÊªÁ¸É¥ª ´¹®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê ¡ªnµ °¤¡¨·¼ °¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê ° °µµ¤´¦Å¥·¤ ¸ µÁ¨Èªnµ ° nµ¦³Á« nªªµ¤ªoµnª¨ºÉ ¨³ ¶ªÁ¢´Ê ¤¸µn ĨoÁ¸¥´ °nµ¦³Á« ¶¶´ : ¨ºÉ Å¢¢j µ µ¨o µ ¤ÁºÊ ° , ®nª¥¨ºÉÅ¢¢jµµ¨oµ¤ÁºÊ°, °·Á¨Èæ·Á Ȥ ´ªÊ Á¸¥É ª, nµ· Áª«µ¦r¢g ¢¼µ¦ 2551; 18(3): 105-108 ¶ Å¢¢jµª·· ´¥ ®¦º° electrodiagnosis Á}µ¦¦³¥»r¦³µ¦¸¦ª·¥µ¤µÄo µ¨·· Á¡º°É ¦ªµ¦¶µ nª¥ª·· ´¥ Ä®o µ¦¡¥µ¦r à ¦Â¨³¡¥µ· £µ¡ ¸ÉÁ·´¦³¦³µÂ¨³/®¦º°¨oµ¤Áº°Ê (1) Ã¥´ªÉ Å µ¦¦ªµ¦¶µ ° ¦³¦³µnª¨µ¥¦ª¤´Ê ¨oµ¤Áº°Ê (lower motor neuron) ¦³°oª¥µ¦ ¦ªµ¦´¶¦³µÃ¥µ¦¦³o» Áª«µ¦r¢g ¢¼µ¦ 2551; 18(3) Áo¦³µoª¥Å¢¢jµ (nerve conduction study) ¨³µ¦Äo°Á· ¨È榴¨ºÉ Å¢¢j µ µ¨o µ ¤ÁºÊ ° (electromyography) ¹ÉÄo°·Á¨Èæ·Á Ȥ´¹ ¨ºÉ Å¢¢jµ´¨nµª ¨³Á Ȥ¸É ¥· ¤Äoµ ¨·· ·¥¤¤¸ 2 · º° 1) ·¤µ¦µ coaxial concentric ¹É¤¸ ´Êª¦´ (active electrode) ¨ºÉ Å¢¢jµ°¥n¼ ¦¨µ nª ¨µ¥ °´ªÁ Ȥ¶®oµ¸ÉÁ} ´Êª°oµ°· (reference electrode) ¨³ 2) · monopolar ®¦º°Á Ȥ· ´ªÊ Á¸¥É ª ¹É Á} Á È ¤ ´ ¶µÂÁ¨ Á¨º ° o ª ¥ Á¢¨° nª¨µ¥Á¨º°¥¶®oµ¸ÁÉ } ´Êª¦´ nª ´Êª°oµ°·Á}°·Á¨Èæ· Ân·¸É ª· ®´ Ħ³Á«Å¥´Ê ¡¥r Áª«µ¦r¢g¢¼·¥¤ÄoÁ Ȥ· ´ÊªÁ¸É¥ª ¹É ¤¸ °o ¸°º ¦µµÅ¤n¡ ¨³o¼ ¼ ¦ª ¦o¼ ¹ ÁÈo°¥ªnµ(2,3) ¸Énµ¤µ ¥´Å¤n¤¸¦µ¥µµ¦«¹¬µ ¨´¬³ °®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê ®¦º ° motor unit action potentials (MUAPs) °·Ä¦³Á«Å¥ ¶Ä®o¨·· Å¢¢jµª·· ´¥nµ Ç o°°µ«´¥ nµ·Å¸É oµnµ¦³Á« ´´Ê Á¡º°É Ä®o ¤¸ n µ · °®n ª ¥¨ºÉ Å¢¢j µ µ ¨oµ¤ÁºÊ° o¼ª·´¥¹«¹¬µ¨´¬³®nª¥ ¨ºÉÅ¢¢jµµ¨oµ¤ÁºÊ° °°µµ¤´¦ ·¹É o°¤¼¨¸ÅÉ o°µÁ}´ªÂnµ· °Å¥Â¨³µ¤µ¦ÄoÁ}Árªn ¥ ª·· ´¥Ã¦Â¨³¡¥µ·£µ¡ °¦³¦³µ ¨³¨oµ¤Áº°Ê Ä®oÅo¼ o°¥·É ¹Ê ª·¸ µ¦«¹¬µ ¨n¤» ¦³µ¦ °µµ¤´¦¹É Á}Áoµ®oµ¸ÃÉ ¦¡¥µµ¨Á¨··¸¥É · ¥°¤Á oµ¦nª¤µ¦ª·¥´ ¶ª 44 ¦µ¥ Á}µ¥ 22 ¦µ¥ ®· 22 ¦µ¥ Árµ¦´Á oµ - Ťn¤Ã¸ ¦¦³¶´ªµ¦³¦³µ - ¶¨´¨oµ¤Áº°Ê °¥nļ Ár· Árµ¦´°° - ¤¸¦³ª´Å· o¦´ µ¦µÁȦ·Áª  µ ªµ J Thai Rehabil Med 2008; 18(3) - ¤¸£µª³Á¨º°°°Å¤n®¥»®¨´¤¸ µÂ¨ Ár¥»·µ¦«¹¬µ - °°´ª ³¶µ¦«¹¬µ Á¦º°É ¤º°Â¨³°»¦r - Á¦º°É ¦ª¨oµ¤Áº°Ê ¨³Áo¦³µ oª¥Å¢¢jµ ¥¸®É °o Medelec ¦n» Synergy T5EP - °· Á ¨È æÂÁ È ¤ · ´Ê ª Á¸É ¥ ª ¶®¦´¦ª¨ºÉÅ¢¢jµµ¨oµ¤ÁºÊ° ¥¸®É °o TECA ¡ºÊ ·ª¦´´µÅ¢¢jµ 500 µ¦µÅ¤Ã¦¤·¨¨·Á¤¦ ªµ¤¥µª 27 ¨³ 35 ¤·¨¨·Á¤¦ ´Ê °µ¦ª·¥´ - ´¹ o°¤¼¨¦³ª´· o°¤¼¨´ÉªÅ ° °µµ¤´¦ ÅoÂn°µ¥» Á¡« °µ¸¡ µ¦°°¶¨´ ¤º°´ - Äo榤 Multi MUP ´¹®nª¥ ¨ºÉÅ¢¢jµµ¨oµ¤ÁºÊ° Ã¥´Ênµ band pass filter Á} 20 Hz – 10 KHz(4) - {Á Ȥ¸É ¨oµ¤Áº°Ê 5 ¤´º° abductor digiti minimi (ADM), deltoid, biceps brachii, extensor digitorum communis (EDC) ¨³¨oµ¤Áº°Ê tibialis anterior (TA) ¦·Áªoµ ªµ ° °µµ¤´ ¦ Ã¥°µ«´ ¥ ¶Â®n ¸É °oµ°·Ä®´º°n¼¤º° Anatomical Guide for The Electromyographer(5) ¨³· ´Êª°·Á¨Èæ°oµ°·®nµµ Á Ȥ 1 Á·Á¤¦ - Ä®o°µµ¤´¦°°Â¦Á¦È¨oµ¤ÁºÊ° Áµ Ç (minimal voluntary contraction) ¨oª´¹ MUAPs¶ª 2-6 ´ªn°¨oµ¤ÁºÊ° 1 ¤´ ¨oª¦ª¦ª¤ o°¤¼¨¡µ¦µ¤·Á°¦rµn Ç ° MUAP (6,7,8) (¼¦¼¸É 1) ÅoÂn °¤¡¨·¼ (amplitude) ¹É ª´µ»¼»¹» ɶ » °¨ºÉ ¤¸ ® n ª ¥Á} Ťæ ê¨r®¦º°¤·¨¨·Ãª¨r, ªµ¤ªoµnª ¨ºÉ (duration) ¹É ª´µ»Á¦·¤É o ¹ » ·Ê » °¨ºÉ ¤¸ ® n ª ¥Á} ¤·¨¨·ª· µ¸ ¶ªÁ¢ (phases) ¨³ ¦o°¥¨³ °¶ª®nª¥¨ºÉÅ¢¢jµ µ¨oµ¤ÁºÊ°·Ã¡¨¸Á¢· (polyphasic potentials) ¹É ¤¸¶ªÁ¢ ¤µªnµ 4 Á¢ ¹Ê Å µ¦ª·Á¦µ³®r °o ¤¼¨µ·· - ®µnµÁ¨¸¥É (mean) ¨³nµÁ¸¥É Á (standard deviation) °¡µ¦µ¤·Á°¦r´ ¨nµª - Á¦¸ ¥ Á¸ ¥ n µ ¡µ¦µ¤· Á °¦r ° ¨oµ¤ÁºÊ°¤´nµ Ç ¸ÉÅoµ°µµ ¤´ ¦Å¥´ ¸É ¦ µ¥µµn µ ¦³Á«(3,10-13) ¨µ¦«¹¬µ °µµ¤´¦¤¸°µ¥»Á¨¸¥É 39 e (21-56 e) nªÄ®n¶µ®´Ân°°¶¨´Å¤n ¤É¶Á¤° ¤¸ªn o°¥¸É ´oµ¥ nµÁ¨¸¥É ¡µ¦µ¤·Á°¦r °®nª¥¨ºÉÅ¢¢jµ¨oµ¤ÁºÊ° °¨oµ¤ÁºÊ°Ân¨³¤´ ³°°Â¦ Á¦ÈÁµ Ç ´Âĵ¦µ¸É 1-5 ¦¼¸É 1  Motor unit action potential (MUAP) ¦¼£µ¡´Â¨¤µµ®´º° Electrodiagnosis Medicine ° Dumitru(6) - 106 - µ¦«¹¬µ¸Ê Nelson(9) nµÁ¨¸É¥ +/- nµÁ¸É¥Á µ ªµ¤ªoµnª¨ºÉ εª (¤·¨¨·Ãª¨r) (¤·¨¨·ª·µ¸) Á¢ 0.61±0.42 11.07±2.43 3.46±0.79 1.76±0.90 7.80±0.24 3.11±0.09 ¦o°¥¨³ polyphasic potentials 8.06 Ťn¤¸ o°¤¼¨ µ¦µ¸É 1 ¡µ¦µ¤·Á°¦r °®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê abductor digiti minimi (ADM) µ¦«¹¬µ¸Ê Chu-Andrews(3) Nelson(9) µ (¤·¨¨·Ãª¨r) 0.42±0.28 0.9 ±0.5 1.5±0.6 nµÁ¨¸É¥ +/-nµÁ¸É¥Á ªµ¤ªoµnª¨ºÉ (¤·¨¨·ª·µ¸) 13.81±4.07 12.7±1.9 6.2±2.2 εª Á¢ 3.35±0.90 3.4 ±1.4 2.9±0.8 ¦o°¥¨³ polyphasic potentials 7.40 19.0 Ťn¤¸ o°¤¼¨ µ¦µ¸É 2 ¡µ¦µ¤·Á°¦r °®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê deltoid µ¦«¹¬µ¸Ê Chu-Andrews(3) Howard(10) µ (¤·¨¨·Ãª¨r) 0.49±0.35 0.7±0.4 0.8±0.2 nµÁ¨¸É¥ +/-nµÁ¸É¥Á ªµ¤ªoµnª¨ºÉ (¤·¨¨·ª·µ¸) 14.39±4.21 14.9±3.9 9.5±1.4 εª Á¢ 3.60±0.91 3.3 ±1.0 Ťn¤¸ o°¤¼¨ ¦o°¥¨³ polyphasic potentials 8.30 14.2 Ťn¤¸ o°¤¼¨ µ¦µ¸É 3 ¡µ¦µ¤·Á°¦r °®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê biceps brachii µ¦«¹¬µ¸Ê Chu-Andrews(3) Pease (11) µ (¤·¨¨·Ãª¨r) 0.47±0.24 1.0± 0.6 1.0±0.4 nµÁ¨¸É¥ +/-nµÁ¸É¥Á ªµ¤ªoµnª¨ºÉ (¤·¨¨·ª·µ¸) 12.50±3.18 14.5 ±4.9 10.8±2.0 εª Á¢ 3.74±0.96 3.6±1.1 Ťn¤¸ o°¤¼¨ ¦o°¥¨³ polyphasic potentials 9.20 19.2 Ťn¤¸ o°¤¼¨ µ¦µ¸É 4 ¡µ¦µ¤·Á°¦r °®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê extensor digitorum communis µ¦«¹¬µ¸Ê Chu-Andrews(3) Howard (10) Chan(12) µ (¤·¨¨·Ãª¨r) 0.63±0.45 1.2±0.7 1.1±0.3 0.83±0.44 nµÁ¨¸É¥ +/-nµÁ¸É¥Á ªµ¤ªoµnª¨ºÉ (¤·¨¨·ª·µ¸) 14.01±3.44 16.2±5.2 11.2±1.7 14.7±4.02 εª Á¢ 3.65±1.15 3.6±1.1 Ťn¤¸ o°¤¼¨ 3.8±1.45 µ¦µ¸É 5 ¡µ¦µ¤·Á°¦r °®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê tibialis anterior - 107 - ¦o°¥¨³ polyphasic potentials 10.20 18.6 Ťn¤¸ o°¤¼¨ Ťn¤¸ o°¤¼¨ ª·µ¦r µµ¦ª·Á¦µ³®rnµÁ¨¸É¥ °¡µ¦µ¤·Á°¦rnµ Ç °®nª¥¨ºÉÅ¢¢jµµ ¨oµ¤Áº°Ê ´Ê 5 ¤´ °Å¥·¡ªnµ nµÂ°¤¡¨·¼Á¨¸É¥°¥n¼¦³®ªnµ 0.4-0.6 ¤·¨¨·Ãª¨r nµªµ¤ªoµnª¨ºÉÁ¨¸É¥ ¤µªnµ 10 ¤·¨¨·ª· µ¸ Ân°o ¥ªnµ 15 ¤·¨¨·ª·µ¸ ¶ªÁ¢¦³¤µ 3 Á¢ ¨³¡®nª¥¨ºÉÅ¢¢jµµ¨oµ¤ÁºÊ° ·Ã¡¨¸Á¢·o°¥ªnµ¦o°¥¨³ 10 Á¤ºÉ°Á¦¸¥Á¸¥¡µ¦µ¤·Á°¦r¦³®ªnµ ¨oµ¤Áº°Ê nªo¨³¨oµ¤Áº°Ê nª¨µ¥ ¦¥µr ¡ªnµ MUAPs °¨oµ¤Áº°Ê Ä Áoµ¹É ¤¸Â°¤¡¨·¼ µÁ¨Èªnµ¨oµ¤Áº°Ê ®o µ  o Ân ¨o µ ¤ÁºÊ ° £µ¥Ä¤º ° ¹É ¤¸ µÁ¨È¨´¤¸µn °¤¡¨·¼ Á¨¸¥É ¼ªnµ °¨oµ¤Áº°Ê o ¹É ¤¸ µÄ®n ¹É nµµnµ¸ÅÉ oµµ¦«¹¬µ °nµ¦³Á« ¸¤É ´ ¡ªnµ¨oµ¤Áº°Ê ¤´Á¨ÈĦ¥µrªn ¨µ¥¤´¤¸µn °¤¡¨·¼ Á¨Èªnµ¨oµ¤Áº°Ê ¤´Ä®nĦ¥µrªn o ´Ê ¸ÁÊ }Á¡¦µ³ °¤¡¨·¼ ° MUAPs ¹Ê´¶ª ªµ¤®µÂn °Ä¥¨oµ¤Áº°Ê n°®nª¥ ¦³µ´É µ¦ (motor unit) ¨³ ¶ª motor end plate °Ä¥¨oµ¤Áº°Ê ¸°É ¥nļ ¦³¥³¸ÁÉ È¤°·Á¨È浤µ¦¦´«´¥rÅ¢¢jµ Åo(13,14) ¨³Á¤ºÉ°Á¦¸¥Á¸¥´nµ· °nµ¦³Á«¡ªnµ °¤¡¨·¼ ° MUAPs ¸ÅÉ oµµ¦«¹¬µ¸¤Ê ¸ µÁ¨È ªnµ °nµ¦³Á« ®¦º° MUAPs ¸É ¦µ¥µµnµ¦³Á«¤¸Â°¤¡¨·¼ Ä®n ªnµÁnµ´ª ´Ê ¸Ê °µ¤¸µÁ®»µ¦¼¦nµÂ¨³ µ¨oµ¤Áº°Ê °µ¸Ã¨³ª´¤¸ µÄ®nªnµÅ¥ nª{´¥ ¸É ¤¸ ¨n ° ªµ¤ªo µ n ª ¨ºÉ Åo  n °´¦µªµ¤Á¦Èªµ¦´¶¦³Â¦³µ ´Éµ¦ °Áo¦³µ(13,15) Ã¥´ÉªÅ ªµ¤ªoµnª¨ºÉ ° MUAPs · µ¦µ¥µ °nµµ·¤¸ µn Á¨¸¥É ¦³®ªnµ 7-16 ¤· ¨ ¨· ª· µ¸ ¨³Â¸É » º ° MUAPs °¨oµ¤Áº°Ê ADM(9) ¹É ¨µ µ¦«¹ ¬µ¦´Ê ¸Ê È °¨o ° ´ ° nµ¦³Á« Áª«µ¦r¢g ¢¼µ¦ 2551; 18(3) °¹É ªµ¤Ân µ ¸É Á · µµ¦ «¹ ¬µÂn ¨ ³Â®n ´Ê °µ¶¤µÁ¦¸ ¥ Á¸¥´Å¤nÅo Á¡¦µ³¤¸µ¦ÄoÁ¦ºÉ°¥¸É®o° nµ´ ¹É°µ´Ênµªµ¤¸Éµ¦¦° ´µ (band pass filter) nµ´ Án Chu-Andrews(3)1986 ÅoÄoÁ¦ºÉ° ° TECA Corporation ¨³ª·Á¦µ³®rÃ¥ Swedish Electrophysiologic Software °µ¸Ê Á·µ¦ª·Á¦µ³®r¨ºÉ Å¢¢jµ µ¨oµ¤ÁºÊ°¤´nµ´ Án µ¼ oª¥µ¥µ¹É ¹Ê´ªµ¤¶µ °o¼ ¦ª ¨³µ¦ª·Á¦µ³®rªo ¥Ã¦Â¦¤¸É Á¦ºÉ°´ÊŪo µ¦«¹¬µ¦´Ê¸ÊÅo¡¥µ¥µ¤ ¨ªµ¤¨¶Á°¸¥¸°É µÁ·µµ¦ª·Á¦µ³®r oª¥µ¥µ oª¥µ¦Äo榤 MultiMUP ¸ÁÉ ¦º°É ´¹Ä®o ÂnÃ¥´ªÉ Ũoª Ä®o Å o ° ¥n µ o ° ¥ 20 ´ ª Á¨º ° ´ ª ¸É n µ ÁºÉ°º°Åªo ¨³¨´ª¸ÉŤnnµÁºÉ°º°°° °¸´Ê¦´Á¦ºÉ°®¤µ¥¸Éª´¦³¥³nµ Ç n°¶nµ¡µ¦µ¤·Á°¦rÁ¸É ¦º°É ¶ªÅªo¤µ Á¨¸É ¥ ¹É µ¦«¹ ¬µ¦´Ê ¸Ê ¤¸ o ° o ° ¥º ° ´¹¶ª MUAPs µ¨oµ¤Áº°Ê Ân ¨³¤´o°¥Á·Å ¹°µn¨¶Ä®onµ ¸É Å o ° µÅ¤n Á } ´ ª  ° MUAPs ¸É  o ¦· ®¦º ° ¶Ä®o n µ · ¸É Å o ¦´Ê ¸Ê ¤¸ ªµ¤nµÁºÉ°º°¨¨ ´´Ê oµ¤¸µ¦ «¹¬µ¦´Ên°Å ª¦¤¸µ¦´¹¶ª MUAPs Ä®o ¤ µÁ¡¸ ¥ ¡° ¨³¶¤µ Á¦¸¥Á¸¥´µ¦«¹¬µ¦´Ê ¸Ê ¦» µ¦«¹¬µ¨´¬³®nª¥¨ºÉ Å¢¢jµµ¨oµ¤Áº°Ê °°µµ¤´¦Å¥ ·Ã¥Äo°·Á¨Èæ·Á Ȥ ´ÊªÁ¸É¥ª ¡ªnµÂ°¤¡¨·¼ ¤¸ µÉ¶ªnµ 1 ¤·¨¨·Ãª¨r ªµ¤ªoµnª¨ºÉo°¥ªnµ 15 ¤·¨¨·ª· µ¸ ¤¸¶ª 3-4 Á¢ ¨³®nª¥ ¨ºÉÅ¢¢jµµ¨oµ¤ÁºÊ°·Ã¢¨¸Á¢· ¡o°¥ªnµ¦o°¥¨³ 10 ¹É¡µ¦µ¤·Á°¦r ´¨nµªnªÄ®n¨oµ¥¨¹´¦µ¥µ ° nµ¦³Á«¥Áªo°¤¡¨·¼ ¹É °Å¥ ¤¸ µÁ¨Èªnµ J Thai Rehabil Med 2008; 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