臺灣博碩士論文加值系統

足部可視為人類老化的現象參考，現代人由於科技發達，自行走路的機會減少，同時隨著年紀的增長，肌肉骨骼系統逐漸退化，使得肌力下降運動控制能力降低，這些也造成足部肌肉運動量不足，使得扁平足者的比例升高，而腳掌內側足弓不明顯，使得足部平衡力控制較差，這些平衡控制的問題同時隨著年齡增長也增加。
本研究目的經由步態平衡力及靜態平衡力量化指標的變化驗證平衡力改善策略：(1)正常足有規律運動及(2)扁平足著矯正鞋墊。步態平衡力指標收集4項：30秒坐站（30-sec chair-stand test, 30-sec CST）、6分鐘走路（Six minutes walk, 6MW）、起走測試（Time up & go, TUG）、單腳站立（One leg standing, OLS）。靜態平衡力是近年常用的平衡力量測方法，藉由驗證受試者靜止站立在測力板上收集到的的壓力中心點(Center of pressure, COP)訊號，將站立時身體晃動軌跡圖分解成前後(Anterior-Posterior, AP)及左右(Medio-Lateral, ML)的量化數據再進行計算分析，本研究將經由臨床常見的傳統COP指標及多尺度熵(Multi-scale entropy, MSE)方法及改良式多元多尺度熵(Multivariate Multiscale Entropy, MMSE)的複雜度指標(Complexity Index, CI)來了解靜態平衡力的變化。本研究使用常用傳統COP指標9類23個項目及複雜度多尺度熵分析MMSE、MSE_AP、MSE_ML之3個項目，共計10類26個項目進行分析。透過為期六個月以上的時間觀察，由兩種不同型態的平衡力量測方式驗證(1)正常足有無規律運動及(2)扁平足有無著矯正鞋墊的平衡力改善成效。
本研究已向管轄機關國立臺灣大學行為與社會科學審查委員會(Institutional review board, IRB)申請並獲得實驗受測者同意書的核定(編號：NTU-REC No.: 201206HS011)。針對20至50歳的成年人隨機採集足印進行實驗，最後完成實驗受試者為65人(年齡27.39±7.83)，其中22位扁平足(年齡27.59±8.32)與43位正常足(年齡27.28±7.66)。受試者接受6個月的時間觀察平衡力的變化，18名正常足者有規律運動習慣，而14位扁平足者接受著矯正鞋墊方式進行實驗，其餘對照組不進行改善策略及不改變原有生活習慣。將收集步態平衡力及靜態平衡力的變化透過統計方法配對T檢定驗證，顯著水準為0.05。
本研究針對成年人觀察6個月以上平衡力前後變化，透過靜態平衡力沒有指標顯示正常足有規律運動及扁平足著矯正鞋墊者平衡力改善，而在步態平衡力指標可見平衡力改善：(1)正常足有規律運動者在的30秒坐站(30-sec CST)平均次數實驗前(20.39±5.38)到實驗後(27.94±6.58)增加7.56次(p-vlue=0.000)及起走測試(TUG)平均時間(秒)實驗前(5.68±0.88)到實驗後(5.18±0.66)減少0.51秒(p-vlue=0.009)，(2)扁平足著矯正鞋墊者30秒坐站(30-sec CST)平均次數實驗前(15.14±3.37)到實驗後(24.86±5.52) 增加9.71次(p-vlue=0.000)及起走測試(TUG)平均時間(秒)實驗前(6.50±0.84)到實驗後(5.47±1.06) 減少1.03秒(p-vlue=0.001)。研究結果顯示(1)正常足有規律運動及(2)扁平足著矯正鞋墊平衡力改善策略有效，建議未來可以再增加扁平足的受試者數目，並建議將本研究使用的步態平衡力指標30秒坐站及起走測試應用在更多的較年青成年人平衡力改善研究中進行驗證。

Foot can be regarded as a sign of human aging process. Due to modern technological development, decreasing chances of walking and exercise resulted in degenerative development of foot muscles that easily leads to falls, also making the increase in the percentage of population with flatfeet. The longitudinal arch of a flatfoot is not obvious, causing poor foot balance control during aging.
The purpose of this study was to verify the balance-improvement strategy through changes in gait balance and static balance indicators: (1) normal foot with regular exercise and (2) flat foot with correction insoles. This study involved four commonly-used gait function test items used for balance measurement in relevant clinical research: 30 second seat test (30-sec CST), six-minute walk (6MW), time up and go (TUG) and one-leg standing (OLS) test with eyes closed. Static balance has been commonly used in recent years as a verification method by examining center of pressure (COP) data collected from the subject while standing upright on a force plate. The analyzed COP sway time-series in the anterior (AP) and mediallateral (ML) directions were derived from signals that were used to investigate the quantitative postural stability of the subjects when standing upright in each trial. These time-series signals of COP were quantized with the use of traditional measures and entropy-based measures used to assess postural stability. A total of 26 measure indicators include 23 items of traditional COP indicators and 3 items of complexity multi-scale entropy analysis MMSE, MSE_AP, MSE_ML. To verify the effect of improving postural stability through the observation for more than six months with two strategies by two different types of balance indicators: (1) regular exercise with normal feet and (2) orthopedic insole with flatfeet.
All patients in this study signed institutional review board (IRB) agreements before participation (IRB approval no.: NTU-REC 201206HS011).Sixty-five (mean age: 27.39±7.83 years) healthy adults aged 20–50 years participated in this study. These were categorized into two groups: normal (43 subjects, mean age: 27.28±7.66 years) and flatfooted (22 subjects, mean age: 27.59±8.32 years). Eighteen subjects with normal feet were tested in a regular exercise mode, while 14 subjects with flat feet were tested with orthopedic insole, in other control groups did not change their living habits. Six-month observation was conducted to monitor the changes in balance of the subjects. The changes in collection gait balance and static balance force were verified by the statistical method paired-t test, with a significant level of 0.05.
This study observes changes in balance of adults over six months. Through the static balance observed, no indicators show improvement of the balance for normal foot with regular exercise and flat foot with correction insoles. The improvement was seen in the gait balance indicators: (1) normal feet with regular exerciser: average number of pre-test (20.39±5.38) to post-test (27.94±6.58) increase of 7.56 (p-vlue=0.000) of 30-sec CST mean time (seconds) before the experiment (5.68± 0.88) 0.51 second (5.18±0.66) reduction (p-vlue=0.009) after the experiment of TUG, (2) flat feett with correction insoles: average number of pre-test (15.14±3.37) to post-test (24.86±5.52) increase of 9.71 times (p-vlue=0.000) of 30-sec CST and mean time (seconds) before the experiment (6.50±0.84) to post-experimental (5.47±1.06) decrease of 1.03 seconds (p-vlue =0.001) of TUG. The results of the study showed that the balance improvement strategies for normal foot with regular exercise and flat foot with correction insoles are effective. The results of the study suggest that further research might include more samples. The 30-sec CST and TUG test adopted in this study can be used to validate more studies on balance improvement of young adults.

中文摘要 ii
Abstract iv
目錄 viii
圖目錄 x
表目錄 xii
符號表 xiv
第一章 緒論 1
1.1. 研究背景 1
1.2. 研究動機 1
1.3. 研究目的 3
1.4. 研究架構 4
第二章 文獻探討 6
2.1. 扁平足與分類 6
2.1.1. 足部的構造 6
2.1.2. 扁平足的形成 8
2.1.3. 扁平足的分類 8
2.2. 平衡力控制 11
2.3. 平衡力的量化指標 12
2.3.1. 步態平衡力指標 12
2.3.1.1. 30秒坐站（30-sec chair-stand test, 30-sec CST） 13
2.3.1.2. 6分鐘走路（Six minute walk, 6MW） 14
2.3.1.3. 起走測試（Time up & go, TUG） 14
2.3.1.4. 單腳站立（One leg standing, OLS） 15
2.3.2. 靜態平衡力指標 16
2.3.2.1. 傳統COP指標 18
2.3.2.2. 熵-多尺度熵與多元多尺度熵(MSE & MMSE) 23
2.4. 平衡力改善策略 30
2.4.1. 規律運動 30
2.4.2. 矯正鞋墊 31
2.5. 文獻探討總結 32
第三章 研究方法 36
3.1. 實驗介紹 36
3.1.1. 實驗對象 36
3.1.2. 儀器設備 38
3.1.3. 實驗規範 40
3.1.3.1. 步態規範 40
3.1.3.2. 靜態平衡力COP訊號收集使用AMTI規範 41
3.1.3.3. 運動規範 43
3.1.3.4. 鞋墊規範 43
3.1.4. 實驗流程 45
3.2. COP數據處理 47
3.2.1. COP數據前處理 47
3.2.2. 數據分解方法與計算說明 48
3.3. 研究假說及分析工具 58
第四章 受試者實驗結果綜合說明 60
4.1. 實驗對象基本屬性 60
4.2. 步態平衡力量測結果比較 61
4.3. 靜態平衡力量測結果比較 73
4.4. 小結 107
第五章 正常足運動改善平衡策略實驗結果與討論 109
5.1. 步態平衡力量測結果比較 109
5.2. 靜態平衡力量測結果比較 114
5.3. 小結 123
第六章 扁平足著鞋墊改善平衡策略實驗結果與討論 124
6.1. 步態平衡力量測結果比較 124
6.2. 靜態平衡力量測結果比較 129
6.3. 扁平足X光量測參考 138
6.4. 小結 139
第七章 結論與未來研究方向 140
7.1. 討論 140
7.2. 結論 142
7.2.1. 正常足平衡力改善策略-規律運動 146
7.2.2. 扁平足平衡力改善策略-矯正鞋墊 147
7.3. 未來研究方向 148
參考文獻 150
附件一：人體試驗委員會(IRB)說明及同意書 161
附件二：受試者資料收集表單 166
附件三：人體試驗委員會(IRB)審查同意試驗證明書 167

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