臺灣博碩士論文加值系統

背景 : 人類於休息時使用枕頭以提供頭頸部的支撐，近年來枕頭的發展於形狀的設計為重點之一，以提供休息時的舒適度甚至睡眠的品質與頭頸部問題的改善。相關研究的探討以問卷型式探討舒適性外，另以肌電圖探討枕頭型式於不同頭頸問題病患其肌肉活動的影響，但尚未探討使用時間對於一般人使用枕頭時頭頸部姿勢與肌肉活動的影響。因此本研究的目的在於探討短時間使用頸部支撐型枕頭對頭頸姿勢與頸部肌肉活動的影響。方法：30位過去未有頸部傷害經驗的年輕成年自願受測者，以隨機方式決定實驗進行順序，一為使用頸部支撐枕頭、二為普通枕頭、三則不使用枕頭等三組。以肌電圖量測頸部胸鎖乳突肌以及上斜方肌於不同姿勢（坐姿與仰躺）情況下肌肉的活動變化，並以坐姿為標準化的相對參考值，過程中同步以量角器測量頭頸角度作為觀測頭頸姿勢的依據，實驗數據皆以SPSS for Windows 10.0版進行統計分析。結果：30位未有頸部障礙 (頸部疼痛指標<1.73分)的健康受測對象，使用不同支撐型態枕頭的過程中，胸鎖乳突肌肉活動都顯著的隨時間增加而下降 (p<0.001)。使用頸部支撐枕頭時胸鎖乳突肌肉活動下降量最多，而上斜方肌肉活動的表現沒有因為枕頭支撐而有下降的趨勢產生，且參數也不受支撐型態的影響 (p>0.05)。矢狀面之頭頸姿勢角度値於不同支撐型態的枕頭之間有顯著差異 (p<0.05)，額狀面和水平面之頭頸姿勢角度則不會隨時間和枕頭型態而有顯著差異產生 (p>0.05)。結論：就整個使用不同支撐型態枕頭的三十分鐘仰躺時間中，主要的差異發現在頸部肌肉活動的變化，使用頸部支撐枕頭使頸部的胸鎖乳突肌肉活動量下降最多，讓頸部肌肉放鬆的效果最為顯著；而不使用枕頭的情況則相對的胸鎖乳突肌肉活動量下降最少。三平面的頭頸姿勢角度以及頸部上斜方肌之肌肉活動值，除了使用不同枕頭狀態時矢狀面之頭頸姿勢角度有差異，其餘參數皆不受支撐形式和時間的影響。臨床意義：由實驗結果可知，支撐式的枕頭使用，對於頸部前側肌肉於短時間即具適當的放鬆效果，同時提供客觀的參考意義。

Background and purpose：People often use pillows when take a rest to provide a proper cervical posture and support. Researches have been done with regards to muscles activities and comfort of neck regions when using different shape, materials of pillows. There is not sufficient evidence about the changes of muscular activity of neck muscles and craniocervical postures through a period of time. Therefore, the purpose of this study is to examine the changes of neck muscle activities and neck postures when using different pillows through a period of time and at conditions of using pillow with or without neck support. Method : Thirty young volunteers without history of neck pathology for at lease three months before testing were recruited and randomized to three conditions with a neck support pillow, a standard pillow, or without using pillow. Electromyographic data of sternocleidomastoid (SCM) and upper trapezius were collected and the angles of craniocervical postures were collected by universal goniometer in supine and sitting position. And the EMG data of neck muscles in sitting position were being the relative values for normalization. The values of this study were examined by statistical analysis by SPSS for Windows (version 10.0). Results : There is a significant correlation between the time-points and neck muscle activities of sternocleidomastoid (SCM) when using different kind of pillows (p<0.05). The neck muscle activities of SCM when using neck support pillow were most less than others. The neck muscle activities of upper trapezius when using pillow or not were obviously smaller through 30 minutes (p>0.05). The craniocervical flexion angles in sagittal plane were significant differences between different kind of pillows (p<0.05). Both in frontal and transverse plane the craniocervical flexion angle were no significant differences (p>0.05). Conclusion: The significant differences were focus on neck muscle activities. The neck muscle activities of SCM was decreased mostly when using neck support pillow and been a relaxation condition. The neck muscle activities were decreased lesser than other condition when lying down without pillow. The craniocervical flexion angle and neck muscle activities of trapezius both had not changed within 30 minutes in supine position no matter what conditions with pillows were used. Clinical Relevance: This study could be as a tool to assess the usability of a pillow by the cervical angle and muscular activities of neck muscles in a short-term period of using pillows.

致謝 vi
中文摘要 vii
Abstract ix
目錄 xi
圖目錄 xiv
表目錄 xvi
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 2
1.3 虛無假設 2
第二章 文獻回顧 4
2.1 枕頭種類與相關的研究分析 4
2.2 枕頭種類與頸部疼痛失能者的關係 4
第三章 研究方法 18
3.1設計架構 18
3.2 研究對象 19
3.3 研究設備 20
3.3.1 枕頭 20
3.3.2 頭頸姿勢角度量測器材 20
3.3.3 頭頸姿勢角度 (CCF)之再測試信度量測 21
3.3.4 坐姿狀態時額狀面和水平面的頭頸姿勢角度之再測試信度量測 23
3.3.5 肌肉電訊號量測儀器 24
3.3.6 頸部肌肉電位訊號之再測試信度量測 25
3.3.7 實驗地點與環境 26
3.4 研究步驟 26
3.5 資料處理與統計分析 31
第四章 結果 40
4.1 受測者基本資料分析 40
4.2 使用不同型式枕頭時頸部肌肉的活動：胸鎖乳突肌 40
4.3 使用不同型式枕頭時頸部肌肉的活動：上斜方肌 45
4.4 頭頸姿勢角度分析 48
4.4.1 坐姿狀態頭頸姿勢角度分析 49
4.4.2 仰躺姿勢頭頸姿勢角度分析 49
4.4.3 頸部肌肉活動表現與頭頸姿勢角度的相關性分析 50
第五章 討論 68
5.1 研究基本資料 68
5.2 頭頸姿勢角度 69
5.2.1 不同支撐型態枕頭的使用與頭頸姿勢角度之分析 69
5.2.2 頭頸姿勢角度與頸部肌肉之相關性探討 70
5.2.3 姿勢改變對頭頸姿勢角度與頸部肌肉活動之影響探討 71
5.3 頸部肌肉活動 73
5.3.1 使用不同支撐型態枕頭與頸部肌肉活動間之探討 74
5.3.2 頸部肌肉活動表現與枕頭使用時間之探討 78
5.4 研究限制 81
5.5 臨床意義 81
5.6 未來研究方向 82
第六章 結論 83
參考文獻 84
附錄 88
附錄一、受測者同意書 88
附錄二、受測者基本資料問卷 91

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