臺灣博碩士論文加值系統

研究背景與目的:肌肉無力以及動作控制能力缺損是痙攣型雙邊麻痺兒童常見的問題。研究顯示荷重坐站阻力訓練對這些兒童在肌肉力量以及粗大動作能力方面有促進的效果，但是其機轉未知。探究荷重坐站阻力訓練效果的可能機轉之前，應當先檢驗雙邊麻痺兒童對於外加荷重的立即反應。本研究的目的便是透過運動學和動力學分析來探討痙攣型雙邊麻痺兒童荷重的立即反應。受試者:13位痙攣型雙邊麻痺兒童(106.5±26.8月，6男7女)和10位一般兒童(104.3±18.9月，7男3女)參與此研究。研究流程:本研究使用Vicon 250動作分析系統以及3塊AMTI力板進行資料蒐集。實驗分為兩天進行：第一天的實驗決定各個兒童的坐站一次最大荷重重量；第二天則進行在自然狀態以及荷重狀態（負荷50%坐站一次最大荷重重量）下的坐到站動作的運動學和動力學資料蒐集。之後進行動作策略、平順度、髖以及膝關節之最大伸直力矩和功率的計算，並比較之。結果：於運動學方面，腦性麻痺兒童所使用之動作策略和一般兒童無顯著差別，且外加荷重並不影響腦性麻痺兒童的動作策略。在自然狀況下，腦性麻痺兒童之動作平順度較一般兒童差；在荷重狀態下，部分腦性麻痺兒童在前後方向的動作平順度有改善。於動力學方面，腦性麻痺兒童的膝關節最大伸直力矩和功率皆較一般兒童低；在荷重狀態下，腦性麻痺兒童的髖關節和膝關節之最大伸直力矩都有增加，其中膝關節的伸直力矩提升到與一般兒童相當的程度。結論:在坐到站動作過程當中，中度荷重可以有效增加膝關節之伸直力矩，並改善部分腦性麻痺兒童在前後方向的動作控制，故中度荷重坐站可以作為臨床肌力訓練和促進坐站動作控制的方式。

Background and Purposes: Children with spastic diplegia are characterized with muscle weakness and poor movement control ability. The loaded sit-to-stand (STS) training has demonstrated its effects in improving these children’s knee extensor strength and gross motor ability. However, mechanisms underlying the training are still unclear. Prior to probe into possible mechanisms, immediate responses of these children to externally imposed load should be examined first. The purpose of this study is to explore the immediate effects of load on children with spastic diplegia, with kinematic and kinetic analysis. Subjects: Thirteen children with spastic diplegia (106.5±26.8 months, 6 males and 7 females) and ten age-matched typical children (104.3±18.9 months, 7 males and 3 females) participated in this study. Methods: The Vicon 250 motion analysis system and 3 AMTI force platforms were used to collect data of STS movements. The experiment took two separate days to accomplish. On the first day, the STS1RM of individual children was determined. On the second day, kinematic and kinetic data of STS movements in natural and loaded (applying load of 50% STS1RM during STS movements) conditions were collected. Data of strategies, smoothness, maximal extension moment and power around hip and knee joints were then calculated. Results: In the kinematic aspect, strategies used in children with spastic diplegia and in typical children did not differ statistically. External load did not influence strategies used in children with spastic diplegia. Children with spastic diplegia demonstrated less smooth STS movements than did typical children in the natural condition and some of the former group demonstrated smoother movements alone the anterior-posterior direction in the loaded condition. In the kinetic aspect, children with spastic diplegia demonstrated smaller maximal extension moment and power of knee joints than did typical children in the natural condition. In the loaded condition, both the maximal hip and knee extension moment increased and the maximal knee extension moment increased to the level of typical children. Conclusion: Applying the load of 50% STS1RM during STS movements increased knee moment and also improve anterior-posterior movement control in some children with spastic diplegia. The loaded STS training may be clinically used for strengthening and movement proficiency enhancement.

致謝…………….. I
中文摘要……….. …….IX
ABSTRACT………………………………………………………………….………XI
CHAPTER 1 INTRODUCTION 1
1.1 BACKGROUND 1
1.2 QUESTIONS 3
1.2.1 Between groups 3
1.2.2 Between conditions 4
1.3 PURPOSES 4
1.4 HYPOTHESES 4
1.4.1 Hypotheses 1 4
1.4.2 Hypotheses 2 5
1.5 DEFINITIONS 6
1.5.1 Strategies of STS movements 6
1.5.2 Smoothness 6
1.5.3 Maximal extension moment 7
1.5.4 Maximal extension power 7
1.5.5 STS movements 7
1.5.6 STS1RM 7
1.5.7 Natural condition 8
1.5.8 Loaded condition 8
CHAPTER 2 LITERATURE REVIEW 9
2.1 CEREBRAL PALSY 9
2.1.1 Definition and clinical classification 9
2.1.2 Control of voluntary movements in children with CP 10
2.1.3 Muscle functions in children with CP 12
2.1.4 Summary 14
2.2 STRENGTHENING FOR CHILDREN WITH SPASTIC DIPLEGIA 14
2.2.1 Progressive resistive exercises 14
2.2.2 Functional strength training with external load 15
2.2.3 Summary 18
2.3 MOTION ANALYSIS IN CHILDREN WITH SPASTIC DIPLEGIA 19
2.3.1 Study 1 19
2.3.2 Study 2 20
2.3.3 Summary 21
2.4 EFFECTS OF RESISTANCE ON MOVEMENT CONTROL 22
2.4.1 Elbow tracking task 22
2.4.2 Gait 24
2.4.3 Summary 25
2.5 FACTORS INFLUENCING THE STS BIOMECHANICAL CHARACTERISTICS 25
2.5.1 STS biomechanical characteristics in healthy adults 25
2.5.2 The individual 26
2.5.3 The Task 28
2.5.4 The Environment 29
2.5.5 Summary 30
2.6 INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH 31
2.6.1 Introduction 31
2.6.2 Activities and participations 32
2.6.3 Environmental factors 32
2.6.4 Body functions and structures 34
2.6.5 Summary 35
2.7 RELIABILITY OF MEASUREMENTS 36
2.7.1 Loaded sit-to-stand test (LSTST) 36
2.7.2 Motion analysis system 36
2.7.3 Summary 37
CHAPTER 3 METHODS 38
3.1 PARTICIPANTS 38
3.1.1 The CP group 38
3.1.2 The reference group 39
3.2 EQUIPMENT AND SET-UP 39
3.2.1 Vicon motion analysis system 39
3.2.2 AMTI force platforms 41
3.2.3 Weight jacket and weights 41
3.2.4 Chair 41
3.3 MEASUREMENTS 42
3.3.1 Anthropometric data 42
3.3.2 GMFCS 42
3.3.3 STS1RM 43
3.3.4 STS movements 44
3.4 PROCEDURES 46
3.4.1 The first day 47
3.4.2 The second day 47
3.5 DATA REDUCTION 47
3.5.1 NSTS1RM 47
3.5.2 Kinematic and Kinetic data 48
3.6 STATISTICAL ANALYSIS 56
CHAPTER 4 RESULTS 58
4.1 BASIC DATA 58
4.2 COMPARISON OF STS KINEMATIC AND KINETIC PERFORMANCE BETWEEN TWO GROUPS IN THE NATURAL CONDITION 59
4.2.1 Strategies of STS movements 60
4.2.2 Smoothness of movement control 62
4.2.3 Maximal extension moment 63
4.2.4 Maximal extension power 65
4.3 COMPARISON OF STS KINEMATIC AND KINETIC PERFORMANCE BETWEEN TWO CONDITIONS IN THE CP GROUP 66
4.3.1 Strategies of STS movements 66
4.3.2 Smoothness of movement control 69
4.3.3 Maximal extension moment 70
4.3.4 Maximal extension power 72
CHAPTER 5 DISCUSSION 73
5.1 MOVEMENT STRATEGIES BETWEEN GROUPS AND BETWEEN CONDITIONS 74
5.2 POORER SMOOTHNESS IN THE CP GROUP 77
5.3 CHANGES OF SMOOTHNESS BETWEEN CONDITIONS IN THE CP GROUP 79
5.4 KINETIC VARIABLES IN STS MOVEMENTS BETWEEN TWO GROUPS 80
5.5 CHANGES OF KINETIC VARIABLES IN LOADED CONDITION IN CHILDREN WITH CP 81
5.6 CLINICAL IMPLICATION 82
5.7 LIMITATIONS OF THIS STUDY 82
CHAPTER 6 CONCLUSION 84
REFERENCES. 86
APPENDICES……………………………………………………………………96

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