臺灣博碩士論文加值系統

研究背景與目的：在實驗室以及臨床測驗中，功能性伸取測試時常被用來測量站立時動態平衡的能力，所量測之伸取距離越長，代表有較大的穩定限度，因此表示有較好的動態平衡控制能力。但在過去文獻中，功能性伸取測試之距離是否能確實反應一個人的動態平衡表現仍存在有許多爭議。其中一個可能的原因是不同的動作策略可能會影響到伸取的表現，然而策略如何影響伸取距離仍不甚明確。因此，本篇研究的目的是要探討在不同策略中伸取距離能夠反應動態平衡能力的程度，以及運動學上不同的關節角度和往前伸取動作之關係。
研究方法：共有三十三位健康年輕受試者參與本實驗。此測試要求受試者雙腳與肩同寬站立，右手往前舉到90度，聽到”開始”的指令後就盡量往前伸，越遠越好，但是不可以跨出一步或是跌倒。受試者要完成3種不同的情況，第一種即控制之情況，除了以上所述之口令外，沒有更改或加入其他口令。另外兩種情況是為了誘發受試者出現不同的動作策略，除了先前口令之內容外，還加入其他指令。碼尺之情況（YARDSTICK condition）請受試者在往前伸的動作過程中，手都要沿著擺放在肩膀高度的尺往前伸。目標物之情況（TARGET condition）是請受試者往前方約兩公尺遠、位於肩膀高度之目標物前伸。本研究利用VICON動作分析儀以及38顆反光球來記錄身體運動學在伸取過程中之資料。策略之定義方面，髖策略是指往前伸的過程中踝關節是往蹠曲的方向運動；踝策略指的是開始動作時踝關節是往背曲方向運動，並且動作過程中髖關節之角度位移小於15度。混合策略指的是開始動作時踝關節是往背曲方向運動，但動作過程中髖關節之角度位移大於15度。計算的參數包括前伸距離、質量中心往前位移的距離、髖關節中心往後位移的距離、質量中心移動的速度，以及軀幹、髖關節和踝關節位移的角度。
結果：不同口令下出現三種策略的頻率沒有顯著差異。在相關方面，前伸距離和質量中心往前位移的距離在控制情況、踝策略和混合策略都有顯著正相關，但在髖策略卻沒有相關。伸取距離、軀幹、髖關節和踝關節的角度在控制情形和三種策略中皆有差異，然質量中心之位移距離以及速度沒有顯著差異。運動學參數方面，軀幹以及髖關節運動在控制情況以及三種不同策略中皆有顯著相關。
結論：健康年輕族群在往前伸取動作時，會採用不同的動作策略。此外，當受試者出現以髖策略來進行伸取時，伸取距離會比踝策略遠但質量中心卻沒有相對的移動較遠，所以其動態平衡能力可能會被高估。因此，本研究發現不同的動作策略確實會影響往前伸取時距離所能反應的動態平衡能力，在臨床上應將策略影響測試之關係列入考慮，才能更適當的解釋功能性伸取測試之結果。

Background and purposes. Functional reach test (FRT) is a reliable test and frequently used to measure dynamic standing balance clinically. However, it is not clear if reach strategy would affect the association between reach distance and dynamic balance ability. The purposes of this study were to investigate the extent to which reach distance reflected dynamic balance in different strategies.
Methods. Thirty-three healthy young adults performed FRT that required the subjects to stand with the feet shoulder width apart and one arm raised to 90,°and then reach forward as far as possible without moving the feet or losing balance (control condition). Two additional instructions were given to induce different strategies: keeping the raised arm at 90° throughout the test, and reaching toward a shoulder-height target about 2 m in front. The body kinematics was recorded and 3 different strategies, hip, ankle and mixed, were identified based upon angular motion of the hip and ankle.
Results. The results showed that subjects would adopt different strategies during FRT. Significant correlations were found between reach distance and center of mass (COM) displacement in the control condition, ankle, and mixed strategies, except in hip strategy. Reach distance, hip posterior displacement and angular displacement of the trunk, hip and ankle, except the COM displacement or speed, were significantly different among the control condition and three strategies.
Conclusion. Different strategies during FRT would be adopted, and movement strategies affected the extent to which reach distance reflected dynamic balance ability. Reach distance or strategies adopted alone might not serve as an indicator for dynamic balance. It is thus suggested that in clinical test, both reach distance and movement patterns should be monitored.

Abstract ------------------------------------------------------------I
Chinese abstract ----------------------------------------------------------III
Acknowledgement ------------------------------------------------------------V
List of tables ----------------------------------------------------------VII
List of figures ---------------------------------------------------------VIII
Introduction ------------------------------------------------------------1
Methods ------------------------------------------------------------4
Results ------------------------------------------------------------8
Discussion -----------------------------------------------------------10
Conclusion -----------------------------------------------------------15
References -----------------------------------------------------------16
Appendix -----------------------------------------------------------33
Author’s background---------------------------------------------------------35

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