臺灣博碩士論文加值系統

對於腦中風的病患而言，常因為垂足的症狀而使得行動能力受到阻礙。垂足的原因是因為小腿上之肌肉無足夠的力量使足部從地面上抬，因此，行走時足部會有拖地的現象，並且容易產生絆倒的情況。除此之外，不同的中風患者皆有不同的步行缺陷，因此也需要不同的行走輔助方式予以各別矯正。而功能性電刺激已經被證實在偏癱患者的行動機能恢復上具有良好之效果。因此在本研究我們發展一套步態分析系統，即使用電子量角器量測行進間下肢關節之角度變化。我們量測正常人與各別中風患者行走時下肢關節角度變化並分析之間的差異性，以評定各別中風患者之步行缺陷並選擇出所需電刺激之肌肉位置。透過功能性電刺激使下肢肢體產生適當的動作以及使下肢關節能有較適當之角度。我們期望藉由這套系統中風患者能走得更安全、更方便、更迅速也更輕鬆，進而改善日常生活之行動能力。

本研究主要包含三個階段：系統架構、進行臨床測試實驗以及使用效果之評估與探討。在硬體部分我們建立一套步態分析系統與功能性電刺激系統。在臨床部分我們提供中風患者使用上的各項效果評估。並藉由行走測試來記錄患者使用各種行走方式之行走速率、步長步幅、下肢各關節平均角度以及心率差值，即能有效顯示出增進效果。同時亦分析訓練上之效果並在測試結束時設計一份問卷提供受測患者填寫。最後，根據以上各種的評估方法，我們即可清楚瞭解各方面的使用效果和病患的接受程度。

For the cerebral vascular accident (CVA) patients, walking ability is often hampered by a dropped foot. This occurs when the muscles of the lower leg are not strong enough to lift the foot upwards when bringing the foot forwards off the ground. As a result, the foot catches resulting in stumbling and even falling. In addition, each CVA patients have other different walking handicaps, so they need different help to reform it. The functional electrical stimulation (FES) has been demonstrated to be effective in restoring locomotion in hemiplegia. In this study, we developed a gait analysis system, and used goniometer to measure degree variety of lower joint angle during locomotion. Then we identified the variation between normal subjects and CVA patients to assess which muscle needs to be stimulated, to make lower extremities perform proper motion and lower joint perform proper angle. We expect to make CVA patients walking safer, more convenient, quicker, easier, and to improve walking abilities of daily livings by using this system.

This study has three main phases: constructing the system, collecting the clinical experiment data and evaluating objectively. In the hardware portion, we set up a gait analysis system and a FES system. In the clinical portion, we provide objective estimate of the therapy effect. Improvements are reflected in clinical trials, recording the speed of walking, step length, stride length, the average angles of the lower joint during locomotion and the effort of walking by measuring the heart rate. Carry-over of these improvements is also analyzed, indicating a training effect of stimulation, and at the end of the test period subjects were given a short questionnaire. Finally, according to these kinds of the evaluation methods, we can distinctly understand the effect and patient acceptance.

目錄
中文摘要
英文摘要
謝誌
目錄
圖表索引
第一章 緒論
1-1研究背景
1-2文顧回顧
1-3研究目的
第二章 原理
2-1腦中風
2-2腦中風的治療及復健
2-3步態
2-4功能性電刺激
2-4-1功能性電刺激之原理
2-4-2功能性電刺激之肌肉電生理
2-4-3功能性電刺激之刺激方式
2-4-4功能性電刺激之復健應用現況
第三章 材料與方法
3-1硬體設備
3-1-1電刺激器
3-1-2電子量角器
3-1-3訊號放大器與擷取控制卡
3-1-4時序控制線路
3-1-5足底開關
3-2 臨床系統組成與架構
3-2-1電子量角器角度訊號擷取系統
3-2-2電刺激系統
3-3研究方法
3-3-1電刺激方法
3-3-2實驗設計與效果評估方法
第四章 結果與討論
4-1個案報告(A)
4-1-1患者基本資料及電刺激各項參數設定
4-1-2以三種行走方式步行之結果
4-2個案報告(B)
4-2-1患者基本資料及電刺激各項參數設定
4-2-2以四種行走方式步行之結果
4-3個案報告(C)
4-3-1患者基本資料及電刺激各項參數設定
4-3-2以四種行走方式步行之結果
4-4個案報告(D)
4-4-1患者基本資料及電刺激各項參數設定
4-4-2以四種行走方式步行之結果
第五章 結論
第六章 未來展望與建議
參考文獻
附錄一 中風患者受測問卷
附錄二 受測患者(A)實驗結果圖表
附錄三 受測患者(B)實驗結果圖表
附錄四 受測患者(C)實驗結果圖表
附錄五 受測患者(D)實驗結果圖表

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