臺灣博碩士論文加值系統

妊娠婦女的身心變化相當複雜，而在日常生活中，由坐到站是不可避免之動作，本研究之主要目的即在探討妊娠婦女由於體態上之改變對於由坐到站動作之影響，著重於踝關節、膝關節與髖關節之能量消耗評估。控制之變因包括懷孕週期、座椅高度以及有無使用扶手。經由動態分析系統可得孕婦由坐到站之運動學資料，配合測力板之力學資料以及人體計測公式之計算資料，以剛體平面動力學之分析原理，可得下肢三個主要關節之運動力學參數變化。
實驗結果顯示，懷孕週期主要影響踝關節之最大屈曲角度，隨著孕期增加，踝關節之最大屈曲角度隨之加大，主因是為了穩定軀幹。座椅高度之影響主要在於膝關節，隨著座椅高度之增加，膝關節之最大輸出功率隨之降低。使用扶手可大幅降低髖關節抵抗前傾動能所必須付出之負功。以足底壓力中心的一維軌跡觀之，座椅高度越高以及有使用扶手，皆可增加由坐到站過程中軀幹之穩定性。
此外，懷孕中期孕婦於臀部離開椅子後，足底壓力中心的一維振盪範圍明顯較懷孕後期大，可能是因為懷孕中期孕婦動作還保留著未懷孕時之靈活度，卻忽略了腹部質量已日漸增加之事實，這是懷孕中期孕婦要特別要注意的，而使用扶手可顯著降低此一危險因素。最後根據本研究之分析探討，建議妊娠婦女之座椅最佳配置為與膝同高的座椅高度並且使用扶手。

There are many changes in physiological and psychological aspects for women during pregnancy. Rising from a chair is one of the essential movements in daily living. The overall goals of this research were to quantify the effects of physiological change due to pregnancy on the performance of chair-rise, and to evaluate the energy consumption at ankle, knee and hip joints. The controlled factors included three pregnancy stages, four chair heights and the removable chair arms. A video-based motion analysis system was used to measure subjects’ body movement. Two force plates were employed to measure the reaction forces of feet and arms. The information of segments was obtained in anthropometry. By kinematic and kinetic analysis, the dynamic parameters of ankle, knee and hip joints were investigated.
The results indicated that the different pregnancy stages could affect the maximum angle of ankle joint. As the pregnancy stages increased, the maximum angle of ankle joint would increase in order to balance the body. The maximum knee power decreased as the chair height increased. The arms could share the power of hip joint mainly. In the aspect of the center of pressure (COP), the stability would increase during sit-to-stand as the chair height increased or the chair had arms.
In addition, the positional range of COP for the pregnant women in the second trimester is greater than that in the last trimester during sit-to-stand. It is more dangerous to rise from chairs in this case. Using arms could improve the condition. The pregnant women in the second trimester must pay attention to this situation. Finally, it is suggested that the chair is as high as knee and with arms may be the optimal choice of pregnant women during chair-rise.

目錄

摘要(中).....................................................................i
摘要(英)....................................................................ii
誌謝.......................................................................iii
目錄........................................................................iv
表目錄......................................................................vi
圖目錄.....................................................................vii

第一章 緒論................................................................1
1.1 研究動機.................................................................1
1.2 文獻回顧.................................................................2
1.2.1 「由坐到站」之研究發展.................................................2
1.3 研究方法與目的...........................................................5
1.4 論文架構.................................................................6

第二章 實驗方法與分析學理..................................................7
2.1 主要實驗程序.............................................................7
2.2 實驗室簡介...............................................................9
2.2.1 三度空間動態分析系統..................................................10
2.2.2 測力板系統............................................................11
2.3 逆向動力學..............................................................14
2.3.1 人體計測公式..........................................................14
2.3.2 逆向動力學原理........................................................15
2.4 資料的建立與統計分析....................................................19
2.4.1 數值單位..............................................................20
2.4.2 統計學之應用..........................................................20

第三章 結果與討論.........................................................22
3.1 下肢關節角度............................................................24
3.1.1 關節角度之變化分析....................................................24
3.1.2 關節角度之極值分析....................................................24
3.2 下肢關節力矩............................................................26
3.2.1 關節力矩之變化分析....................................................26
3.2.2 關節力矩之極值分析....................................................26
3.3 下肢關節功率............................................................27
3.3.1 關節功率之變化分析....................................................27
3.3.2 關節功率之極值分析....................................................28
3.3.3 髖關節功率之區域極值分析..............................................30
3.3.4 下肢三關節所扮演之角色................................................33
3.4 下肢關節總功............................................................33
3.4.1 關節總功之變化分析....................................................33
3.4.2 關節總功之極值分析....................................................34
3.5 COP分析.................................................................36
3.6 綜合討論................................................................40
3.6.1 孕期的影響............................................................40
3.6.2椅高的影響.............................................................40
3.6.3扶手的影響.............................................................40
3.7 問卷統計結果............................................................41

第四章 結論與建議.........................................................43
4.1 主要結論................................................................43
4.2 建議最佳配置............................................................44
4.3 未來改進方向............................................................44

參考文獻....................................................................46

附錄A 受測者之基本資料表.................................................49
附錄B 實驗結束時之問卷調查表.............................................51
附錄C 無使用扶手時各探討參數於STS cycle中之變化曲線......................55
附錄D 有使用扶手時各探討參數於STS cycle中之變化曲線......................72
附錄E 探討參數極值之變異數分析初步統計顯著摘要...........................89
附錄F 探討參數極值之變異數分析單純主要效果統計顯著摘要...................94
附錄G 膝關節總功最大值之變異數分析統計顯著摘要...........................99
附錄H 受測者基本資料之統計結果..........................................103
附錄I 受測者問卷做答之統計結果..........................................105

表目錄
表2-1 孕婦懷孕分期分組詳目................................................7
表2-2 力板內各Channel所對應之參數........................................12
表2-3 本實驗所量測之人體計測資料.........................................15
表2-4 人體計測經驗公式(肢段質量與肢段質心位置)...........................15
表2-5 人體計測經驗公式(肢段之轉動慣量)...................................15
表3-1 下肢三關節在STS過程中所扮演之角色..................................33

表C-1 圖C-1~C-15之各子圖座標說明.........................................56
表D-1 圖D-1~D-15之各子圖座標說明.........................................73
表E-1 各下肢關節探討參數最大值之變異數分析初步統計顯著
(P值)摘要一........................................................90
表E-2 各下肢關節探討參數最大值之變異數分析初步統計顯著
(P值)摘要二........................................................91
表E-3 下肢髖關節功率區域極值之變異數分析初步統計顯著
(p值)摘要..........................................................92
表E-4 COP之變異數分析初步統計顯著(p值)摘要...............................93
表F-1 各下肢關節探討參數最大值之變異數分析單純主要效果
統計顯著(P值)摘要一................................................95
表F-2 各下肢關節探討參數最大值之變異數分析單純主要效果
統計顯著(P值)摘要二................................................96
表F-3 下肢髖關節功率區域極值之變異數分析單純主要效果
統計顯著(p值)摘要..................................................97
表F-4 其他探討參數值之變異數分析單純主要效果統計顯著
(p值)摘要..........................................................98
表G-1 膝關節總功最大值之變異數分析單純交互作用效果
統計顯著(P值)摘要.................................................100
表G-2 膝關節總功最大值之變異數分析單純單純主要效果
統計顯著(P值)摘要.................................................101
表G-3 膝關節總功最大值之變異數分析交互作用不顯著因子之
單純主要效果統計顯著(P值)摘要.....................................102
表H-1 懷孕初期受測者基本資料............................................104
表H-2 懷孕中期受測者基本資料............................................104
表H-3 懷孕後期受測者基本資料............................................104

圖目錄
圖2-1 調整椅高之依據......................................................8
圖2-2 反光球貼的解剖位置..................................................8
圖2-3 主體配置俯視圖......................................................9
圖2-4 三度空間動態分析系統...............................................10
圖2-5 Cube示意圖.........................................................11
圖2-6 力學數位資料的取得.................................................12
圖2-7 力板受力示意圖.....................................................12
圖2-8 力動學模型.........................................................16
圖2-9 資料處理之主要流程.................................................19
圖2-10 三因子變異數分析流程圖.............................................21
圖3-1 由坐到站的三個階段.................................................22
圖3-2 下肢關節角度與力矩之正負號與臨床上之定義...........................23
圖3-3 不同孕期對踝關節最大屈曲角度的影響.................................25
圖3-4 不同椅高與有無扶手對下肢三關節最大屈曲角度的影響...................25
圖3-5 不同椅高與有無扶手對膝關節與髖關節之最大伸展力矩的影響.............27
圖3-6 不同椅高對踝關節最大輸出功率的影響.................................29
圖3-7 不同椅高與有無扶手對膝關節與髖關節之最大輸出功率的影響.............29
圖3-8 髖關節功率之區域極值...............................................31
圖3-9 不同椅高與有無扶手對Hpp1、Hnp1、Hpp2的影響.........................32
圖3-10 不同椅高對踝關節最大總功的影響.....................................34
圖3-11 不同椅高與有無扶手對髖關節之最大總功的影響.........................35
圖3-12 三因子對膝關節之最大總功的影響.....................................36
圖3-13 COP變化之探討值....................................................37
圖3-14 有無使用扶手對Copm的影響...........................................38
圖3-15 不同椅高對Copm、Copr1、Copr2的影響.................................38
圖3-16 不同孕期對Copr2的影響..............................................39
圖3-17 不同孕期與不同座椅高度下扶手分攤體重之最大比例.....................41
圖C-1 懷孕初期無使用扶手四種椅高狀況下之下肢三關節角度變化...............57
圖C-2 懷孕中期無使用扶手四種椅高狀況下之下肢三關節角度變化...............58
圖C-3 懷孕後期無使用扶手四種椅高狀況下之下肢三關節角度變化...............59
圖C-4 懷孕初期無使用扶手四種椅高狀況下之下肢三關節力矩變化...............60
圖C-5 懷孕中期無使用扶手四種椅高狀況下之下肢三關節力矩變化...............61
圖C-6 懷孕後期無使用扶手四種椅高狀況下之下肢三關節力矩變化...............62
圖C-7 懷孕初期無使用扶手四種椅高狀況下之下肢三關節功率變化...............63
圖C-8 懷孕中期無使用扶手四種椅高狀況下之下肢三關節功率變化...............64
圖C-9 懷孕後期無使用扶手四種椅高狀況下之下肢三關節功率變化...............65
圖C-10 懷孕初期無使用扶手四種椅高狀況下之下肢三關節總功變化...............66
圖C-11 懷孕中期無使用扶手四種椅高狀況下之下肢三關節總功變化...............67
圖C-12 懷孕後期無使用扶手四種椅高狀況下之下肢三關節總功變化...............68
圖C-13 懷孕初期無使用扶手四種椅高狀況下之足部力板垂直向
反作用力與縱向COP變化..............................................69
圖C-14 懷孕中期無使用扶手四種椅高狀況下之足部力板垂直向
反作用力與縱向COP變化..............................................70
圖C-15 懷孕後期無使用扶手四種椅高狀況下之足部力板垂直向
反作用力與縱向COP變化..............................................71
圖D-1 懷孕初期有使用扶手四種椅高狀況下之下肢三關節角度變化...............74
圖D-2 懷孕中期有使用扶手四種椅高狀況下之下肢三關節角度變化...............75
圖D-3 懷孕後期有使用扶手四種椅高狀況下之下肢三關節角度變化...............76
圖D-4 懷孕初期有使用扶手四種椅高狀況下之下肢三關節力矩變化...............77
圖D-5 懷孕中期有使用扶手四種椅高狀況下之下肢三關節力矩變化...............78
圖D-6 懷孕後期有使用扶手四種椅高狀況下之下肢三關節力矩變化...............79
圖D-7 懷孕初期有使用扶手四種椅高狀況下之下肢三關節功率變化...............80
圖D-8 懷孕中期有使用扶手四種椅高狀況下之下肢三關節功率變化...............81
圖D-9 懷孕後期有使用扶手四種椅高狀況下之下肢三關節功率變化...............82
圖D-10 懷孕初期有使用扶手四種椅高狀況下之下肢三關節總功變化...............83
圖D-11 懷孕中期有使用扶手四種椅高狀況下之下肢三關節總功變化...............84
圖D-12 懷孕後期有使用扶手四種椅高狀況下之下肢三關節總功變化...............85
圖D-13 懷孕初期有使用扶手四種椅高狀況下之足部力板和扶手
(單側受力*2)垂直向反作用力與縱向COP變化............................86
圖D-14 懷孕中期有使用扶手四種椅高狀況下之足部力板和扶手
(單側受力*2)垂直向反作用力與縱向COP變化............................87
圖D-15 懷孕後期有使用扶手四種椅高狀況下之足部力板和扶手
(單側受力*2)垂直向反作用力與縱向COP變化............................88
圖I-1 日常生活中坐站之難易(懷孕初期)....................................106
圖I-2 日常生活中坐站之難易(懷孕中期)....................................106
圖I-3 日常生活中坐站之難易(懷孕後期)....................................106
圖I-4 日常生活中上下樓梯之難易(懷孕初期)................................107
圖I-5 日常生活中上下樓梯之難易(懷孕中期)................................107
圖I-6 日常生活中上下樓梯之難易(懷孕後期)................................107
圖I-7 日常生活中上下斜坡之難易(懷孕初期)................................108
圖I-8 日常生活中上下斜坡之難易(懷孕中期)................................108
圖I-9 日常生活中上下斜坡之難易(懷孕後期)................................108
圖I-10 日常生活中彎腰拾物之難易..........................................109
圖I-11 日常生活中由坐到站有無以手撐他物之習慣............................109
圖I-12 本實驗中無使用扶手以各椅高由坐到站之難易(懷孕初期)................110
圖I-13 本實驗中無使用扶手以各椅高由坐到站之難易(懷孕中期)................110
圖I-14 本實驗中無使用扶手以各椅高由坐到站之難易(懷孕後期)................110
圖I-15 本實驗中有使用扶手以各椅高由坐到站之難易(懷孕初期)................111
圖I-16 本實驗中有使用扶手以各椅高由坐到站之難易(懷孕中期)................111
圖I-17 本實驗中有使用扶手以各椅高由坐到站之難易(懷孕後期)................111
圖I-18 本實驗結束時下肢三關節之不舒服程度(懷孕初期)......................112
圖I-19 本實驗結束時下肢三關節之不舒服程度(懷孕中期)......................112
圖I-20 本實驗結束時下肢三關節之不舒服程度(懷孕後期)......................112
圖I-21 本實驗結束時由坐到站三階段之總體感覺(懷孕初期)....................113
圖I-22 本實驗結束時由坐到站三階段之總體感覺(懷孕中期)....................113
圖I-23 本實驗結束時由坐到站三階段之總體感覺(懷孕後期)....................113
圖I-24 本實驗結束時描述不舒服之生理狀況..................................114

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