臺灣博碩士論文加值系統

中風是一種在老年族群中常見之中樞性神經損傷慢性疾病[1]，患者多數擁有正常行走上的困難，尤其例如單側偏癱之中風在動作上易具有不對稱性。坐式踏步機是越來越廣為使用於復健的下肢阻力式訓練機台，坐式踏步機具備例如風險性低、適用於各年齡層的特性。在許多醫院復健部裡將運動訓練機台納入為各種不同的復健訓練項目，幫助年長者或在行走上有困難的患者恢復其原本的功能[2]。目前在臨床上對於中風患者之下肢復健，經常使用下肢阻力式訓練機台以訓練下肢肌力。單側偏癱中風患者因在動作執行上可能與兩邊不對稱肌力及張力表現有關，鼓勵對稱性出力之視覺回饋或能幫助其動作執行能力[3]。故若是能夠發展一套適合多數中風疾患合適的訓練方法結合進行視覺回饋與下肢阻力式訓練機台訓練應能更產生其正向效果。過去關於各式運動機台之人因設計研究已經定義出機台之預期可調整的許多人因參數，例如：座椅距離、踩踏阻力、踩踏速度。本研究方法為利用紅外線動作擷取系統、無線肌電儀與測力板記錄受試者在兩種機台上進行的運動數據，計算運動學(關節角度、人體質量中心)、力動學(座椅反作用力、座椅壓力中心)與各項時間空間參數並進行探討。本研究目的為，研究以健康年輕族群找到於兩種坐式運動機台上最佳人因設計參數並依此提供給老年族群及中風患者運動復健時的參考依據，同時探討此三族群在運動過程中之生物力學效應。研究結果顯示適中的座椅距離(D2：90%腳長)的座椅距離有最好的下肢關節活動度。高頻率踩踏速度(S2：90 Steps/min)在三族群中均能產生較大的關節角速度峰值以及較穩定的上肢質量中心位移、座椅反作用力與左右側座椅壓力中心位移。高踩踏阻力(R2：5.3kgw)有較明顯的肌電訊號活化。然而視覺回饋在年輕族群及老年族群的作用並不明顯。但在以座椅壓力中心與上肢軀幹傾斜為視覺回饋訊號的條件下中風族群上肢質量中心位移有所減少，研判可能因年輕族群及老年族群均為健康族群，故利用視覺回饋於機台上增進運動模式或表現的程度受到限制，但是對於中風族群來說，視覺回饋應能夠起到讓受試者在完成既定任務的條件前提，維持自身穩定的動作控制。本研究已經針對三種座椅距離、兩種採踏阻力等級於不同踩踏速度下進行研究，例如關於更高強度踩踏阻力的生物力學效應仍然有待驗證。本研究建議未來在執行受試者(或是疾病患者)機台運動復健的生物力學效應之研究時，衡量實驗條件難易設定與實驗效果之間的平衡將是此類型實驗前期前驅實驗設計的關鍵。讓未來此類機台的使用者來可以更有效且明確的規劃訓練計畫內容，確認肌力訓練或復健的效果。

Stroke is a common chronic central nervous system injury in the elderly population [1], the majority of patients with the normal walking difficulties, especially for unilateral hemiplegia in the action is easy to have asymmetry. Sitting machines are increasingly used for rehabilitation of lower limb resistance training machines, such as low risk, suitable for all age. In many hospital rehabilitation departments take sports training machine into a variety of rehabilitation training, and help the elderly or patients who difficult to walk in the recovery of their original function [2]. At present in the clinical rehabilitation of the lower limb for patients with stroke, often use lower limb resistance training machine to train lower limb muscle strength. Unilateral hemiplegia stroke patients may be associated with asymmetric muscle strength and tension, encouraging visual feedback of symmetrical output may help to perform their ability [3]. It is possible to develop a set of training methods suitable for most stroke disorders combined with visual feedback and lower limb resistance training should be able to produce more positive results. In the past, people who have been working on various types of sports machines have defined many of the expected adjustments of the machine due to parameters such as seat distance, step resistance, step speed. In this study, we used the infrared ray motion capture system, the wireless EMG and the force plate to record the motion data of the subjects on the two types of machines, calculate the kinematics (joint angle, center of mass), the kinetics (seat reaction force, seat center of pressure) and the spatial parameters and to explore. The purpose of this study is to find the best human factors designed by healthy young people on the two sitting sports machines and to provide reference for the rehabilitation of the elderly and stroke patients. The results show a moderate seat distance (D2: 90% leg length) has the best lower limb joint activity. High frequency step speed (S2: 90 steps / min) can produce a large joint angular velocity peak and a more stable upper limb center of mass shift, seat reaction force and M-L seat center of pressure displacements. High step resistance (R2: 5.3kgw) has a more significant EMG activation. However, the role of visual feedback in young and old age groups is not obvious. It may be due to young group and elderly group are healthy groups, so the use of visual feedback on the machine to enhance the pattern of movement or the degree of performance is limited. But for the stroke group, the visual feedback should be able to make subjects maintain their own stable action control. This study provides that the future of such machine users can be more effective and clear planning training program content to confirm the effect of muscle training or rehabilitation.

中文摘要 I
ABSTRACT II
誌謝 III
目錄 IV
圖目錄 VI
表目錄 XI
第一章 緒論 1
1.1 研究背景 1
1.2 文獻回顧 2
1.2.1 運動機台人因設計之生物力學研究 2
1.2.2運動機台訓練於老年族群之生物力學研究 7
1.2.3 運動機台訓練於中風族群之復健醫學或生物力學研究 9
1.3 研究目的 14
1.4 研究假設 15
第二章 實驗設計及方法 16
2.1 受試者 17
2.2 實驗設備 18
2.2.1 動作分析軟硬體設備 18
2.2.2 視覺回饋軟硬體設備 19
2.2.3 坐式踩踏復健機台(Seated Stepper) 21
2.2.4 完整實驗硬體架構圖 22
2.3 實驗流程 23
2.3.1 實驗室硬體校正 23
2.3.2 受試者準備及最大自主收縮測試 26
2.3.3 受試者靜態校正 28
2.3.4 實驗動作周期定義(水平行走/坐臥式踩踏動作) 29
2.4 資料分析 30
2.4.1 運動學分析 30
2.4.2 力動學分析 31
2.4.3 肌電訊號分析 32
2.5 統計分析 33
第三章 結果與討論 35
3.1 運動機台人因設計生物力學研究 35
3.1.1阻力(2)/距離(3)/速度(2)之影響 35
3.1.2視覺回饋之影響in R2D2S2 53
3.1.3作用力與各關節旋轉中心對肌電之影響in V1R2D2S2 59
3.2 運動機台訓練於老年族群之生物力學研究 60
3.2.1阻力(2)/距離(2)/速度(2)之影響 60
3.2.2視覺回饋之影響in R2D2S2 78
3.2.3作用力與各關節旋轉中心對肌電之影響in V1R2D2S2 84
3.2.4年齡之效應in V1R2D2S2 85
3.3 運動訓練機台於中風族群之復健醫學或生物力學研究 91
3.2.1阻力(2)/距離(1)/速度(2)之影響 91
3.2.2視覺回饋之影響in R2D2S2 109
3.2.3作用力與各關節旋轉中心對肌電之影響in V1R2D2S2 115
3.2.4中風之效應(Stroke Effect) in V1R2D2S2 116
第四章 結論 122
參考文獻 123

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