臺灣博碩士論文加值系統

本研究針對中風病患設計一套可以讓患者自行操作的膝關節控制器並且合併功能性電刺激，來改善病患膝無力以及懸垂足的情形，病患在行進間使用患側站立時，利用膝關節控制器的輔助，協助病患站立穩定，而在行走時，利用足底開關控制，解除膝關節控制器的控制，並且配合功能性電刺激同時刺激髖關節屈肌以及脛骨前肌來改善病患行走步態，並與其他復健條件：無輔助行走、功能性電刺激、膝關節控制器做復健之情況記錄病患行走時的步距（step length）、步幅（stride length）、步行速度（walking velocity）以及下肢各關節角度來做比較。
四位腦中風病患參與本實驗進行，並完成五週訓練，結果測出，其中三位使用電刺激加上膝關節控制器這一組，其左右腳步距在左右腳比較T-檢定下，並無顯著差異，而在步行速度的改進方面其中三位也有顯著進步，而關節角度也藉由電刺激的輔助有一定程度的改進，尤其是針對懸垂足改進的部分，這都表示經過這樣的訓練之後，患者可改善其行走步態，增進步態美觀，但也需更多病患來證明此法的效用，並且最終目的希望能做成可方便攜帶的輔具，希望能夠為病患縮短治療時間，以及提供病患便利的復健方式。

Abstract

This study proposed a integrated system of knee lock controller and functional electrical stimulation (FES) for cerebral vascular accident (CVA) patients showed the symptoms of drop foot and kneeback during locomotion. The knee lock controller unlocked the knee electrically and allowed knee joint flexion during the swing phase of the gait. When the knee was extended by electrical stimulation of the hip flexor, the knee was automatically locked by the weight of the locking bar, and the stimulation of the hip flexor stopped.
We compared this device with the FES, knee lock controller and assistance. In each of these four trainings, we measured and recorded step length, stride length, walking velocity and various angles of lower limbs respectively.
Four patients were recruited in this study and trained for four weeks. After four weeks of training with this system, three of them have abetter improvement on the symptoms of drop foot and kneeback.
This system is advantageous because it is easy to put on and take off and has a good cosmetic appearance. In the near future, we hope to make this device into a portable type. However, we still need more patients for clinical evaluation to verify these results.

目 錄
中文摘要…………………………………………………………………Ⅰ
英文摘要…………………………………………………………………Ⅱ
謝 誌…………………………………………………………………Ⅲ
目 錄…………………………………………………………………Ⅳ
圖表索引…………………………………………………………………Ⅵ

第 一 章緒 論
1 — 1 研究背景 ………………………………………01
1 — 2 文獻回顧 ………………………………………03
1 — 3 研究目的 ………………………………………06

第 二 章原 理
2 — 1 腦的血液供應 …………………………………09
2 — 2 腦中風 …………………………………………10
2 — 3 腦中風的治療 …………………………………11
2 — 4 下肢組成 ………………………………………11
2 — 4 — 1 髖部的組成 ……………………………………12
2 — 4 — 2 膝部的組成 ……………………………………12
2 — 4 — 3 踝和足部的組成 ………………………………13
2 — 5 行走步態 ………………………………………13
2 — 6 肌肉活動 ………………………………………15
2 — 7 功能性電刺激 …………………………………15
2 — 8 功能性電刺激的復健應用 ……………………17
2 — 9 功能性電刺激刺激的方式 ……………………18

第 三 章材料與方法
3 — 1 硬體設備 ………………………………………30
3 — 1 — 1 電刺激器 ………………………………………30
3 — 1 — 2 膝關節控制器 …………………………………31
3 — 1 — 3 電子量角器 ……………………………………32
3 — 1 — 4 訊號放大器與擷取控制卡 ……………………33
3 — 2 系統組成及刺激位置 …………………………33
3 — 3 實驗方法 ………………………………………34
3 — 3 — 1 實驗設計 ………………………………………36
3 — 3 — 2 訓練步驟 ………………………………………36


3 — 3 — 3 量測方法 ………………………………………37

第 四 章結果與討論
4 — 1 病患A實驗結果 ………………………………52
4 — 2 病患B實驗結果 ………………………………52
4 — 3 病患C實驗結果 ………………………………54
4 — 4 病患D實驗結果 ………………………………55

第 五 章結 論………………………………………………………71

第 六 章未來展望………………………………………………………73

第 七 章參考文獻………………………………………………………75

作者自述…………………………………………………………………78

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