臺灣博碩士論文加值系統

中文摘要
截肢者的復健最終目標是要能夠獨立穿戴義肢行走，而承重能力是一項很好的評估指標。有好的承重能力，才能有好的義肢控制力以及平衡能力，才可能進行獨立行走，但臨床目前仍未有針對義肢殘肢承重能力評估與訓練的整合系統出現。
目的: 研發一套專為小腿截肢者設計之電腦輔助站立承重能力檢測及訓練整合系統，並使用本系統來評估是否可提升使用義肢之承重及控制能力。
方法: 使用特製、可即時量測重量的測力板、個人電腦，利用LabVIEW軟體程式來撰寫專為承重能力評估與訓練的軟體，組成完整的電腦輔助站立承重能力檢測及訓練系統。此系統可以即時分析兩腳站立承重力量的變化，並在訓練系統中提供病患立即的視覺與聽覺回饋。系統開發完成後進行信效度的驗證，效度驗證利用砝碼當黃金標準值，信度驗證招募健康受試者26人，有經驗義肢使用者15人，進行測試-再測試驗證。此外並進行承重能力訓練之初步試驗，實驗組及對照組各招募3人及2人，實驗組由專任治療師使用本系統進行小腿義肢承重站立及踏步訓練系統；對照組則由專任治療師負責傳統義肢承重及踏步訓練。兩組訓練時間皆為每週三次，每次30~40分鐘，總共四週訓練。信效度統計採用重複兩次量測相同參數的相關係數值來檢驗系統穩定度；評估訓練前後義肢承重與義肢控制能力的參數值是否進步提升來判斷系統訓練成效。
結果: 效度相關係數值(ICC)達到0.999，且p皆小於0.01；信度驗證以有經驗義肢使用者及健康受試者的測試-再測試驗證，除了健康受試者的站立期站立時間百分比的ICC值是0.612，其他參數的ICC值都達到0.892~0.979之間，且p皆小於0.011；初步試驗結果為實驗組與對照組經過四週的系統訓練介入後，在承重能力:實驗組的三位受試者義肢邊增加體重的11.27%、9.30%及19.85%，而對照組的兩位受試者增加5.39%及4.95%；在控制能力:實驗組的的三位受試者義肢邊踏步最高承重量可達體重的94.69%、102.7%及63.37%，而對照組的兩位受試者為33.32%及79.67%。且四週後實驗組有兩位原本需攙扶平行桿的受測者不須依靠手扶平行桿即可完成檢測。
結論: 系統信效度相關係數很高，證明確實可以當作小腿截肢者站立承重檢測系統。在系統介入訓練後，實驗組受試者兩腳的承重能力平均差距3.01%，優於對照組的7.24%，實驗組兩腳踏步的平均時間差(4.1%)也優於對照組(18.9%)，能證明介入訓練後有較好的承重能力及義肢控制能力。因此本系統應可在臨床上能可為小腿截肢者的義肢承重能力提供一個客觀、有效的檢測及訓練方法。

Abstract
The ultimate goal of prosthesis training for amputees is to regain independent walking ability. Static weight-bearing ability is a very good predictor of whether subject can walk independently. Good weight-bearing ability is a prerequisite for proper prosthetic control and balance ability, so it may be to walk independently. There is no objective measurement or device to evaluate and train weight-bearing ability and control ability for transtibial amputees in clinical.
Purpose: Our study was to develop a computer-aided standing weight-bearing ability assessment and training system for transtibial amputees and to evaluate effects of system functions for improving weight-bearing and control ability.
Methods: This system was composed of specific-designed force plates, PC and using LabVIEW to write specifically for weight-bearing assessment and training software. The system can instantly analyze two feet force changing and provide immediately visual and auditory feedback. System validity verification used the weights for the gold standard values. Twenty-six healthy subjects and fifteen experienced prosthetic users were recruited for reliability verification. In addition, we also executed clinical trial for weight-bearing training preliminary test. Three subjects in the intervention group and two subjects in the control group were recruited respectively. The intervention group received the system training for weight-bearing and stepping. The control group received traditional training. The intervention included three days in a week for four weeks and each session lasted about 30-40 minutes. Intraclass correlation coefficient(ICC) was used to estimate the validity and reliability. The comparable parameters between pre-training and post-training were assessed whether the progressive training effect.
Results: ICC was 0.99 on validity verification, and p<0.01. Reliability verification, ICC values only on ND ST% and D ST% were 0.612 in healthy subjects, ICC values of other parameters were between 0.892 and 0.979, and p<0.011.After four weeks of system training intervention, weight-bearing ability--Intervention group, three subjects increased 11.27%, 9.30% and 19.85% in Ps%,--Control group, two subjects increased 5.39% and 4.95% in Ps%. Control ability--Intervention group, subjects increased 94.69%, 102.7% and 63.37% in Ps max%. Control group, subjects increased 33.32% and 79.67% in Ps max%. And two subjects did not touch parallel bar by hand in intervention group.
Conclusion: ICC values are very high in reliability and validity, and we can use this system to evaluate standing weight-bearing ability for transtibial amputation patients. After training, the average of (S%-Ps%) is 3.01% in intervention group, better than in control group(7.24%). The average of (S ST%-Ps ST%) is 4.1% in intervention group, also superior to the control group (18.9%). Therefore, our system provides an objective and effective assessment and training method for transtibial amputation patients.

目錄
誌謝 I
中文摘要 II
Abstract III
目錄 V
圖目錄 VII
表目錄 VIII
第一章 緒論 1
第一節 研究背景 1
一、 截肢衍生的問題 1
二、 小腿截肢的復健訓練現況 2
三、 現況的不足 2
四、 研究構想 3
第二節 研究目的 3
第三節 研究假設 3
第二章 文獻回顧 4
第一節 小腿義肢復健 4
第二節 承重能力的檢測方法 6
一、 臨床測量方法 6
二、 實驗室測量方法 6
第三節 承重能力的訓練方法 8
第四節 文獻回顧結論 8
第三章 研究方法 9
第一節 系統研發 9
一、 系統組成項目 9
二、 硬體介紹 11
三、 軟體程式開發設計 13
四、 軟體介紹 15
五、 評估參數 18
第二節 臨床試驗計畫 18
一、 系統效度驗證 19
二、 系統信度驗證 19
三、 系統效果評價 20
第三節 資料分析 24
第四章 研究結果 25
第一節 系統效度檢驗結果 25
第二節 系統信度檢驗結果 26
第三節 系統效果評價結果 28
一、 受試者基本資料 28
二、 義肢側承重訓練結果 29
三、 義肢側控制能力訓練結果 31
四、 實驗組與控制組的比較 34
五、 參數比較 35
第五章 討論 39
第一節 系統信度效度的探討 39
第二節 參數比較探討 39
第三節 系統效果評價探討 40
第四節 研究限制與未來發展建議 42
第六章 結論 43
參考文獻 44
附錄一 IRB通過證明 47
附錄二 AMP量表 48
附錄三 K-LEVEL 53

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