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研究生:陳建勳
研究生(外文):Chien-Hsun Chen
論文名稱:外側楔型鞋墊對中風患者步態之影響
論文名稱(外文):Effect of Lateral Wedged Insole on the Gait Pattern in Stroke individuals
指導教授:林光華林光華引用關係
指導教授(外文):Kwan-Hwa Lin
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:物理治療學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:英文
論文頁數:70
中文關鍵詞:外側楔型鞋墊偏癱步態腦中風
外文關鍵詞:cerebrovascular accidentgaithemiplegialateral wedged insole
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中文摘要
目的:本研究的目的,在探討可獨立行走的初次中風患者,健側下肢穿戴一個斜度5度的外楔型鞋墊後,於站立和行走時之生物力學改變。
方法: 16位來自臺大醫院復健部門診及住院的男性受試者均符合下列條件:(1)首次中風合併單側偏癱;(2)可獨立站立3分鐘以上,並能不用行走輔具,在平地獨立連續行走5公尺;(3)患側下肢行走時能將足部完全提離地面;(4)意識清楚,病情穩定,能了解並配合實驗指示者。沒有動作協調上的問題;排除合併有其他任何可能影響行走功能的嚴重骨骼、週邊神經、心肺系統方面問題者。利用三度空間動作分析系統與測力板,分析穿著外楔型鞋墊是否增加偏癱患者其站立與行走時患側腳承重,和姿勢的對稱性。
結果:健側腳穿戴5度外楔型鞋墊,其主要作用:(1)站立時增加患側下肢承重從體重的34.80%到38.00% (p=0.007);(2)垂直方向的地面反作用力,其對稱性指標(SI) 有明顯改善,從60.82%到48.02% (p=0.005);(3)走路時,整體站立期的SI有明顯改善,從18.55%到11.47% (p=0.033);(4)在健側下肢,單獨支撐期的垂直地面反作用力總和明顯下降,從5.49 ± 0.34 N/kg/sec到4.86 ± 0.26 N/kg/sec (p=0.026);以及整體站立期的反作用力平均值明顯下降,從7.21 ± 0.13N/kg 到6.94 ± 0.11 N/kg ( p=0.039);(5)在健側下肢整個走路的周期中,對側腳離地發生時間的百分比明顯上升(26.80% to 29.85%, p=0.039)和單腳支撐期的時間(0.57 second to 0.52 second, p=0.058)有明顯下降;(6)身體軀幹在走路周期中,側向位移角度的總和有明顯下降(p=0.020)。
結論:可獨立行走的中風患者於健側腳穿戴五度的外楔型鞋墊,在靜止站立時可增加患側下肢承重與兩腳對稱性。但是在走路時,外楔型鞋墊對於步態的影響並效果不一致。



關鍵字:步態、腦中風、偏癱、外楔型鞋墊
Abstract
Objective: To assess the biomechanical changes in ambulatory first stroke patients during stance and ambulation with and without wearing a 5° laterally wedged insole on the non-paretic side
Method: Randomized cross-sectional design to compare the static standing and self-selected speed walking with and without the wedge under the non-paretic foot. The setting was in Department of Rehabilitation Medicine, National Taiwan University Hospital (NTUH) in Taiwan. The inclusive criteria of sixteen participants were unilateral cerebrovascular accident (CVA) males with hemiparesis, who were asymmetry (symmetry index>10%) in standing, being able to stand independently for up to 3 minutes without rest, to walk on the ground over 5 meters without assistive device, and to understand and follow instructions, as well as without other neurological, and musculoskeletal and disease. Three dimensional motion analysis system and force plates were used for the kinematic and kinetic parameters of gait.
Results: The effect of wearing 5° lateral wedged insole on the non-paretic limb in hemiparetic patients were as follows. (1) It increased the paretic limb weight bearing from 34.80% to 38.00% of body weight. (2) The symmetry index (SI) of vertical ground reaction force (GRF) had been significantly improved after wearing 5° lateral wedged insole in static standing (60.82% to 48.02%, p=0.005). (3) During walking, there were significant improvement in the SI of stance time (18.55% to 11.47%, p=0.033). (4) On the non-paretic limb, the impulse of single support phase and the mean vertical GRF of stance phase decreased significantly (5.49 ± 0.34 N/kg/sec to 4.86 ± 0.26 N/kg/sec, p=0.026; 7.21 ± 0.13N/kg to 6.94 ± 0.11 N/kg,, p=0.039, respectively), but the changes in the paretic limb were not significant. (5) In one gait cycle, there were significant changes in the increase of the percentage of opposite foot off, and the decrease in the time of single support on non-paretic side limb. (26.80% to 29.85% gait cycle, p=0.039 and 0.57 second to 0.52 second, p=0.043, respectively). (6) The integrated area of the thorax lateral sway angle during one gait cycle showed significant decrease (p=0.02).
Conclusion: The simple mechanical device like 5° lateral wedged insole on the non-paretic side would improve the weight bearing and symmetry in hemiparetic patients during stance, but the changes during ambulation were variable.


Keyword: gait, cerebrovascular accident, hemiplegia, lateral wedged insole
目錄 1
中文摘要 3
Abstract 5
Chapter 1. Introduction 7
1.1 Background 7
1.2 Project Motivation 8
1.3 Aims and Hypothesis 9
1.4 Operational Definition 10
1.4.1 Gait cycle 11
1.4.2 Kinematic parameters—Temporal-distance parameters 12
1.4.3 Kinematic parameters—Postural changes 13
1.4.4 Kinetic parameters 13
1.4.5 Symmetry indices (SI) 14
Chapter 2. Literature Review 15
2.1 Hemiplegic gait 15
2.2 Symmetry and gait parameters 16
2.3 Forced use 19
2.4 Load receptor 21
2.5 Lateral wedged insole 22
Chapter 3. Research Methods 25
3.1 Participants 25
3.2 Study Design 26
3.3 Experimental Equipment 26
3.4 Wedge Fabrication 28
3.5 Experimental Protocol 29
3.5.1 Clinical Assessment 30
3.5.2 Motion Assessment 31
3.6 Data Reduction and Statistical Analysis 34
Chapter 4. Results 35
4.1 Demographic Data 35
4.2 Quiet Standing 35
4.3 Comfortable Speed Walking 36
4.3.1 Kinetic parameters 37
4.3.2 Kinematic parameters 39
Chapter 5. Discussion 53
5.1 Wedge Effect 53
5.1.1 Static Standing 53
5.1.2 Comfortable Speed Ambulation 54
5.2 Proposed Underlying Mechanisms 56
5.3 Research Limitation 58
5.4 Further Work 58
5.5 Conclusion 59
Reference 60
Appendix 64
Reference
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