臺灣博碩士論文加值系統

多數的脊髓損傷病患在受傷之後，很難再恢復到以往獨立行走的狀態，需要穿戴特定的行動輔具以支撐身體以協助步行。在傳統上，大多使用長腿支架(Long Leg Brace; LLB)來訓練病患行走，但效果並不令人滿意；在本研究中，採用目前新型的交替式步行支架(Reciprocating Gait Orthosis; RGO)，且結合功能性電刺激器(Functional Electrical Stimulation; FES)，除具備了支撐範圍加大、運用機械構造輔助行走等特點外，功能性電刺激的配合使用更能有助於重建癱瘓患者所失去的步行運動功能。
本研究係研製一具功能性電刺激裝置之步行輔助器，藉由此功能性電刺激裝置對下半身癱瘓病患的下肢特定肌群(股四頭肌、膕旁肌)進行電刺激，一方面可達到復健物理治療的效益，另一方面亦可藉由該步行輔助器幫助下肢癱瘓病患達到步行移動身體的目的。而該功能性電刺激裝置可由設計於步行輔助器上的按鍵控制，由該患者自行控制所要步行移動的左或右下肢，達到自行控制步行及步行速度之目的。
本研究於系統研製完成及實際測試後，針對一位T12與L2完全脊髓損傷的25歲下半身癱瘓的女性病患，在分別時使用傳統長腿支架、新型交替式步行支架及新型交替式步行支架合併功能性電刺激等三種方式下，來進行步行的復健訓練與臨床評估。結果顯示在步行前後的心率差值、平均血壓差值、步行速度、步長、步數及單位耗氧量上，RGO與RGO＆FES都優於LLB，但前三項參數在RGO與RGO＆FES之間的差異度並不大，主因於患者右腿對於電刺激的反應程度較低。總而言之，RGO能使患者產生較快、較獨立且低耗能的步行方式，而RGO加入FES則能再提升RGO使用上的功效。而這兩種行動輔具在各方面上都優於傳統的長腿支架，提供脊髓損傷患者更佳的步行輔具選擇。

Patients suffered from spinal cord injury with paraplegia can hardly recover to walk independently. They would need to use some special walking orthoses to support the body to walk properly. Traditionally, Long Leg Braces (LLB) are mostly used to train the patients to walk. Unfortunately, the results are not satisfied. In this study, we used latest Reciprocating Gait Orthosis (RGO) and combined the use of Functional Electrical Stimulation (FES). The combination provides larger support range and applies features of mechanical structures in walking assistant. The coordination of FES especially helps to restore the walking abilities that paralyzed patients lost.
This study is to develop a walking orthosis with a FES, using a FES to stimulate specific muscles (quadriceps, hamstring) of paralyzed patients' lower limbs. It can achieve the benefits of physical therapeutics; on the other hand, paralyzed patients can achieve the purpose of walking. The FES is designed with control buttons on the walking orthosis. A patient can decide and control left or right leg that he desires to move to walk, and consequently accomplishes the purposes of walking control and speed via the control buttons.
After the completion of the development and several practical tests of the new walking orthosis. A 25-years-old female paralyzed patient (T12 and L2 complete spinal cord injury) separately used traditional LLB, RGO, and RGO with FES to proceed with the training of walking rehabilitation and clinical assessment. After comparisons with heart rate difference (HRdifference), mean blood pressure difference (MBPdifference), walking speed, length of steps, number of steps and oxygen consumption before and after walking, the results show that usage of RGO and RGO with FES are both better than LLB. But, the differences between RGO and RGO with FES in HRdifference, MBPdifference, and walking speed are not significant, due to that the reaction of patient's right leg to electrical stimulation is relatively lower. In general, RGO can help the patient to achieve quicker and more independent walking; while the combination of RGO and FES can raise the effectiveness of RGO. These two walking orthoses are better than traditional LLB, they provide patients suffered from paraplegia with better choices.

摘要…………………………………………………………………Ⅰ
ABSTRACT……………………………………………………………Ⅱ
謝誌…………………………………………………………………Ⅲ
目錄…………………………………………………………………Ⅳ
圖表索引……………………………………………………………Ⅵ
第一章緒論…………………………………………………………01
1─1研究背景……………………………………………………01
1─2文獻回顧……………………………………………………03
1─3研究目的……………………………………………………05
第二章原理…………………………………………………………08
2─1中樞神經系統………………………………………………08
2─2脊髓神經的構造與功能……………………………………09
2─3脊髓損傷……………………………………………………10
2─3─1 脊髓損傷的原因……………………………………………10
2─3─2 脊髓損傷的症狀……………………………………………11
2─4步態…………………………………………………………13
2─5功能性電刺激………………………………………………13
2─5─1 電刺激與骨骼肌反應………………………………………14
2─5─2 功能性電刺激的種類與參數………………………………15
第三章材料與方法…………………………………………………24
3─1長腿支架……………………………………………………24
3─2交替式步行支架……………………………………………24
3─3電刺激系統功能性電刺激裝置之步行輔助器……………26
3─4實驗方法……………………………………………………28
3─4─1 實驗設計……………………………………………………29
3─4─2 訓練步驟……………………………………………………30
3─4─3 量測步驟……………………………………………………31
3─4─4 統計分析方法………………………………………………32
第四章結果…………………………………………………………42
4─1使用三種步行輔具行走之結果……………………………42
4─2各組實驗結果的統計分析…………………………………46
第五章討論…………………………………………………………64
第六章 結論與展望…………………………………………………69
參考文獻………………………………………………………………72

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