臺灣博碩士論文加值系統

靜止站立時身體姿勢的穩定程度被認為與老年人跌倒發生率有關。研究已發現增加足底皮膚感覺輸入可以提升健康正常青年人姿勢的穩定，但此效應尚未在老人族群獲得證實。而足底皮膚感覺輸入如何影響姿勢穩定度亦尚無定論，因此本實驗的目的有二，其一乃在測試老年人與年輕人增進足底皮膚感覺輸入後對姿勢穩定度調控的差異，其二乃在觀察足底皮膚感覺輸入是否透過調控踝關節蹠屈肌動作神經元之興奮性而影響姿勢穩定度。

12位健康青年人與12位健康老年人以方便取樣方式參與實驗。實驗設計採用混合因子實驗設計結合拉丁方格排列順序，在提供不同足底皮膚感覺輸入的情況下，評估受試者身體姿勢穩定度，受試者身體姿勢穩定度的量化是以觀察人體質量中心在四種不同站立情境下（張眼雙腳站立、閉眼雙腳站立、張眼單腳站立、閉眼單腳站立）於矢狀面之最大位移量及速度。此外，並觀測姿勢向前或向後擺盪過程中於觀測比目魚肌之霍夫曼反射表現程度，以評估其動作神經元興奮程度。姿勢穩定度與比目魚肌動作神經元興奮性之實驗數據以三因子重複測量變異數分析進行統計分析姿勢穩定度與比目魚肌動作神經元興奮性之實驗數據。

結果顯示不論青年人與老年人皆可藉由增加足底感覺輸入提高身體在往前加速時下位動作神經元的興奮性來提升姿勢穩定度。並且在平衡威脅較大且失去視覺輸入的情況下，增加足底感覺輸入更能增進身體姿勢穩定度。然而年齡的差異僅影響下位動作神經元興奮性。而青年人在增加足底感覺輸入後藉由調控下位動作神經元興奮性維持身體姿勢穩定度的能力較老年人強。總結本研究的結果，我們發現當老年人與青年人在靜止站立時皆可以藉由增加足底感覺輸入來增進身體姿勢穩定度，身體往前擺盪時蹠屈肌動作神經元的興奮性改變而影響到蹠屈肌的張力與活動應是導致此身體姿勢穩定度的增進之原因。

Postural stability during quiet stance has been used as an index to evaluate balance performance in patients with neurological disease and elderly. Especially, postural stability during quiet stance, the degrees of postural sway, have been found to correlated with falls incidence in elderly. Previous studies found that enhanced cutaneous inputs from the feet improve postural stability in young adults. However, the effect has not been confirmed in elderly population. Furthermore, information regarding how cutaneous inputs from the feet modulate postural stability is limited. Therefore, the purposes of this study has two folds：1) to exam the effect of cutaneous inputs from the feet in regulating lower motoneurons excitability of ankle plantarflexor；2) to exam the impact of postural stability in elderly and young population by enhanced cutaneous inputs from the feet.

Twelve healthy young and 12 elderly participants were recruited by convenient sampling for this study. Mixed factorial design with Latin square procedure was adopt as design scheme for this study. Postural stability and excitability of soleus motoneurons of participants were evaluated in 4 standing conditions (Single or double stance × eye open or closed) in normal and enhanced cutaneous inputs. Postural stability was evaluated by maximal displacement and velocity of center of mass in sagittal plane. Excitability of soleus motoneurons was evaluated by maximal Hoffman reflex to maximal motor response ratio (H/M ratio) . The data was examined by mixed three-way ANOVA with repeated measure to determine differences within the testing conditions between young and elderly groups.

The results showed that both young and elderly subjects improved their postural stability and increase the motoneurons excitability of soleus during anterior sway by enhanced cutaneous input whereas the effect of enhanced cutaneous inputs was more prominent in more balance threatened condition such as a single support and missing visual information. However, aging decreased motoneurons excitability in general but not postural stability. Furthermore, young individuals were more responsive to enhanced cutaneous inputs in regulating motoneurons excitability during anterior sway. According to the findings of this study we conclude that cutaneous inputs from the feet regulate soleus motoneurons excitability and thus control postural stability in sagittal plane. Nevertheless, enhanced cutaneous inputs improve postural stability for both young and elderly individuals.

第一章 前言……………………………………………………………………………………1
第一節 研究背景與動機………………………………………………………………………1
第二節 名詞解釋………………………………………………………………………………4
第三節 研究問題………………………………………………………………………………5
第四節 定義研究問題…………………………………………………………………………6
第五節 研究假說………………………………………………………………………………6
第二章 文獻回顧………………………………………………………………………………8
第一節 平衡控制理論於姿勢穩定度調控……………………………………………………8
第二節 平衡表現測量…………………………………………………………………………14
第三節 年輕人與老年人站立姿勢調控………………………………………………………21
第四節 站立時踝關節對於姿勢擺盪的調整…………………………………………………25
第五節 足底皮膚感覺輸入……………………………………………………………………34
第六節 站立時表皮皮膚感覺輸入對姿勢調控的研究現況…………………………………36
第三章 方法……………………………………………………………………………………44
第一節 實驗設計………………………………………………………………………………44
第二節 受試者…………………………………………………………………………………45
第三節 實驗儀器………………………………………………………………………………47
第四節 研究步驟………………………………………………………………………………55
第五節 資料處理………………………………………………………………………………58
第六節 統計分析………………………………………………………………………………60
第四章 結果……………………………………………………………………………………62
第一節 受試者基本資料………………………………………………………………………62
第二節 增加足底感覺輸入對老年人與青年人身體矢狀面的擺盪狀態之影響……………63
第三節 增加足底感覺輸入對老年人與青年人其下位動作神經元的興奮性之影響………79
第五章 討論……………………………………………………………………………………96
第一節 增加足底感覺輸入後對於身體擺盪幅度與下位動作神經元興奮性的相互影響…96
第二節 年齡的差異對於身體擺盪幅度與下位動作神經元興奮性的相互影響……………101
第三節 不同站立姿勢下視覺輸入的有無於身體擺盪幅度與下位動作神經元興奮性的相互影響………………104
第四節 單腳站立時矢狀面最大位移速度項足底皮膚感覺輸入與視覺輸入交互作用之探討………………108
第五節 單腳站立身體往前加速擺盪時下位動作神經元興奮性項年齡與足底皮膚感覺輸入交互作用之探討…109
第六節 研究限制………………………………………………………………………………111
第六章 結論……………………………………………………………………………………114
參考文獻………………………………………………………………………………………116
附錄一 受試者同意書………………………………………………………………………123
附錄二 受試者基本資料與病史問卷………………………………………………………128
附錄三 動作分析系統於量測質量中心位移量之信效度…………………………………129
附錄四 矢狀面的最大位移量與最大位移速度，與個體質量中心在鉛垂線距離相除之標準化數據…………132
附錄五 受試者基本資料與足底感覺閥值、前庭功能測試之統計數據…………………134
附錄六 質量中心矢狀面最大位移量之統計數據…………………………………………136
附錄七 質量中心矢狀面最大位移速度之統計數據………………………………………142
附錄八 身體往前加速擺盪時下位動作神經元興奮性之統計數據………………………148
附錄九 身體往後加速擺盪時下位動作神經元興奮性之統計數據………………………153

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