臺灣博碩士論文加值系統

背景與目的：不同頻率之震動刺激由振動平台產生不同震動加速度傳導到身體，產生不同神經肌肉表現，本研究目的在探討六種震動頻率的全身震動刺激對腦性麻痺孩童肌力、肌張力和柔軟度的影響。研究方法：15位痙孿型腦性麻痺（平均9.14±3.30歲）隨機接受六種頻率（頻率12、16、20、25、30和35Hz × 振幅1.8mm）的震動刺激（震動機型號：Body Green AV001A），受試者於膝關節屈曲30度下站立接受振動刺激，分兩天進行，每次振動一分鐘，中間休息一小時，震動前後量測肌力、肌張力與柔軟度表現。以自製手握測力計（使用Load cell型號：MLP 200, Transducer Techniques )量測膝伸直肌肌力之最大自主收縮（Maximum voluntary contraction, MVC），用鐘擺運動之放鬆指數（Relaxation index, RI）量測肌張力，以坐姿體前彎（Sit to reach）量測柔軟度。用pair t test比較肌力、肌張力、柔軟度接受震動前後之差異，用Repeated measure ANOVA分析六種頻率震動前的MVC、RI與Sit to reach之差異，以及震動頻率對於MVC、RI和Sit to reach百分比變化的影響，用Person`s correlation分析MVC、RI和Sit to reach之百分比變化相關性。結果：在六種不同頻率震動前的變化中，MVC值、RI值與Sit to reach值皆無顯著差異(p＞0.05)；在震動前後比較中，MVC值在六種頻率皆有顯著增加（p＜0.05），30Hz 值最大，RI值在大部份頻率有顯著增加（p＜0.05）(除35Hz外，p＝0.11) ，20Hz值最大，Sit to reach於20Hz值最大且有顯著增加（p＝0.00）。在不同頻率變化中，不同頻率對於MVC、RI與Sit to reach皆有顯著影響（p＜0.05），MVC表現中，30Hz顯著大於12Hz（p＝0.002）與16Hz（p＝0.017），Sit to reach表現中，35Hz 顯著小於12Hz、16Hz、20Hz（p＜0.05）。相關性表現中RI與Sit to reach顯著負相關（r＝－0.45，p＜0.05）。結論：六種頻率震動前的MVC、RI與Sit to reach之表現無顯著差異，顯示不同頻率震動刺激的效果不會相互影響，每次震動效果於六十分鐘內消失。震動刺激均會增加肌力表現且不會引起肌張力負面效果；頻率變化對於肌力、肌張力與柔軟度均有影響。12Hz與16Hz表現中因此震動頻率範圍容易引發身體器官共震較大，而導致身體肢段之震盪減小，使得肌力表現比30Hz低，且柔軟度沒變化；身體軟組織變化對肌張力與柔軟度表現皆有影響，20Hz震動刺激可能改變肌肉與關節之黏滯性較多而顯著改善肌張力與柔軟度；30Hz震動刺激可能造成肌肉活動較多而顯著增加膝伸直肌肌力；30Hz以上的震動刺激較易產生肌肉疲勞之現象而造成35Hz震動刺激的肌張力無改善和柔軟度表現較差。臨床意義：本研究建議以30Hz為肌力訓練模式，以20Hz為改善張力與柔軟度之訓練模式。

Background：Different neuromuscular responses on human body are produced by different frequencies of vibrations which cause different oscillatory accelerations by vibration platforms. The purpose of this study is to discuss that under the whole body vertical vibration with six different frequencies, the effect of muscular strength, muscular tone and flexibility for children with cerebral palsy. Method：15 children with cerebral palsy (average age: 9.14±3.30 years old) are stimulated by vibration machine (machine type: Body Green AV001A, amplitude: 1.8mm) with six kinds of frequencies (frequency: 12, 16, 20, 25, 30 and 35Hz) randomly in two days. Participants take a standing position and flex knees in 30 degrees and then are vibrated. Vibration takes one minute each time, and participants take a break for an hour between courses. This study uses self-design hand-held dynamometer (load cell type: MLP 200, transducer techniques) to measure the knee extensor maximum voluntary contraction (MVC). Pendulum test’s relaxation index (RI) measures muscle tone, and sit-to-reach measures flexibility. Also, the performances of muscular strength, muscular tone and flexibility are recorded before and after the vibrations. This study applies Pair t test to compare the results of muscle strength, muscle tone, and flexibility before and after accepting vibrations. In addition, Repeated measure ANOVA analyzes the difference between MVC, RI and Sit-to-reach before the vibrations, and analyzes the effects of vibration frequencies versus MVC, RI and Sit-to-reach. Moreover, to know the correlation between MVC, RI and Sit-to-reach after the vibrations, this study uses Person correlation coefficient analysis to analyze it. Result： The values of MVC, RI and Sit-to-reach before the vibrations do not have significant difference (p>0.05). After the vibrations, there are following results. The values of MVC are increased significantly (p<0.05). The value of MVC at 30Hz is the maximum. The values of RI at almost frequencies are increased significantly (p<0.05), except the frequency at 35Hz (P =0.11), and the value of RI at 20Hz is the maximum. The value of Sit-to-reach at 20Hz which is only increased significantly (p =0.00) is the maximum. In the different frequency has significant effects on MVC, RI and Sit-to-reach (p<0.05). The value of MVC at 30Hz is significant higher than 12Hz (P =0.002) and 16Hz（p =0.017）. The value of Sit-to-reach at 35Hz is significant lower than 12Hz, 16Hz and 20Hz (p<0.05). In the correlation part, there is negative correlation significantly between RI and Sit-to-reach (r =-0.45, p<0.05). Conclusion: The performances of MVC, RI and Sit-to-reach do not have significant differences before the six kinds of vibrations. It shows that the effects at different vibrations’ frequencies do not have interference, and each effect disappears in 60mins. However, the vibrations not only can encourage the response of muscular strength, but also can not cause the negative effect of muscular tone, and changing frequency has effects on muscular strength, muscular tone and flexibility. Furthermore, the responses of muscular strength at 12Hz and 16Hz are worse than it at 30Hz and the performances of flexibility do not have any change because these frequencies can easily cause resonances of the body''s organs so that the accelerations of low extremity are decreased. Also, the change of soft tissue has effects on the responses of muscular tone and flexibility. The vibration at 20 Hz may enhance movements of muscles and joints and can improve muscle tone and flexibility. The vibration at 30Hz may increase more muscular activities so it can raise the muscle strength of knee extensor. The vibration at 35Hz results bad responses of flexibility and unimproved muscular tone from its vibration brings about the phenomenon of muscular tiredness. Clinical meaning: This study recommends the training model of muscle strength is the vibration at 30Hz, and the vibration at 20Hz is the training model to improve muscle
tone and flexibility.

目 錄
中文摘要..............................................................................................................I
英文摘要...........................................................................................................III
誌謝.................................................................................................................. IV
目錄. ..................................................................................................................V
表目錄............................................................................................................VIII
圖目錄................................................................................................................X
第一章、前言.....................................................................................................01
第一節、 研究背景................................................................................01
第二節、 研究目的................................................................................05
第三節、 研究假設...................................................................................06
第貳章、 文獻回顧...........................................................................................07
第一節、 腦性麻痺...................................................................................08
一、 腦性麻痺神經肌肉與動作表現與訓練...................................08
第二節、 腦性麻痺兒童之動作與神經肌肉表現測量...........................13
一、 腦性痲痺下肢肌力之量測... ... ...............................................13
二、 腦性痲痺下肢肌張力之量測方式...........................................14
第三節、 全身震動訓練應用於神經肌肉表現.......................................19
一、 震動訓練的理論基礎與原理....................................................19
二、 震動訓練的種類與應用............................................................23
三、 震動訓練過程後之立即效應....................................................26
第参章、研究方法.............................................................................................37
第一節、 試驗研究...................................................................................37
一、 試驗研究設計...........................................................................37
二、 試驗研究之受測者基本資料...................................................38
三、 試驗研究之結果表現...............................................................39
四、 試驗結果結論...........................................................................45
第二節、 實驗設計...................................................................................45
一、 實驗流程...................................................................................46
第三節、 研究對象...................................................................................48
一、 受試者選取之標準...................................................................48
二、 受試者基本資料…...................................................................49
第四節、 實驗方法...................................................................................50
一、 肌力之測量..............................................................................50
二、 下肢肌張力之測量...................................................................50
三、 柔軟度測量---坐姿體前彎…..................................................51
第五節、 實驗設備..........................................52
一、 垂直型全身震盪機...................................................................52
二、 電子量角器...............................................................................53
三、 手握測力計...............................................................................54
四、 InstruNet資料擷取系統...........................................................55
第六節、 實驗資料分析..........................................................................56
一、 接受震盪過程前之前測變化..................................................56
二、 接受震盪訓練過程後之效果影響..........................................56
三、 接受震盪訓練過程後之相關性表現......................................56
第七節、 統計分析...................................................................................56
一、 repeated measure ANOVA 檢定分析......................................57
二、 Multiple Comparisons （Scheffe methode）...............................57
三、 pair t檢定分析….......................................................................57
四、 Pearson''s correlation coefficient................................................57
第肆章、結果....................................................................................................58
第一節、 不同的震動頻率對下肢肌力的立即表現...............................58
一、 股直肌肌力六次測試前之前測基準值分析結果...................58
二、 股四頭肌六種振動頻率之刺激前後結果與pair t 檢定分結
果...................................................................59
三、 股四頭肌接受六種振動頻率之刺激前後增加百分比結果表
現趨勢.....................................................................................60
四、 針對不同頻率震動刺激後之股直肌力，統計方面藉由repeated
measure ANOVA分析.......................................61
五、 針對不同頻率震動刺激後之股直肌力，統計方面藉由Multiple
Comparisons分析.................................61
第二節、 不同的震動頻率對下肢肌張力的立即效果...........................62
一、 肌張力六次測試前之前測基準值分析結果...........................62
二、 肌張力接受六種振動頻率之刺激前後結果與pair t 檢定分析
結果........................................................63
三、 肌張力接受六種振動頻率之刺激前後結果表現趨勢.........64
四、 針對不同頻率震動刺激後之肌張力，統計方面藉由repeated
measure ANOVA分析................................65
五、 針對不同頻率震動刺激後之肌張力，統計方面藉由Multiple
Comparisons分析.......................................65
第三節、 不同的震動頻率對肢體柔軟度的立即效果...........................66
一、 柔軟度六次測試前之repeated measure ANOVA分析結果66
二、 柔軟度六種振動頻率之刺激前後表現與pair t 檢定分析結
果....................................................................67
三、 柔軟度接受六種振動頻率之刺激前後結果表現趨勢….....68
四、 針對不同頻率震動刺激後之柔軟度表現，藉由repeated measure ANOVA分析主效應................................................69
五、 針對不同頻率震動刺激後之柔軟度表現，藉由Multiple
Comparisons分析........................................69
第四節、 震盪過程中與震盪過程後之相關性比較...............................70
第伍章、 討論.....................................................71
第一節、 接受震動刺激測試前之各種測量數值前測基準線表現.......71
第二節、 接受震動刺激前後之各種測量數值之效果影響...................72
一、 肌力表現方面...................................................72
二、 肌張力表現方面..................................................72
三、 柔軟度表現方面.............................................74
第三節、 接受震動刺激後肌力、肌張力與軟度表現.............................74
一、 下肢肌力結果表現..............................................74
二、 下肢肌張力結果表現.............................................75
三、 身體柔軟度結果表現...........................................76
第四節、 震動過程中與震動過程後相關性表現...................................76
一、 震動過程後股直肌肌力與肌張力與肢體柔軟度之相關性...76
第五節、 討論總述 ..............................................77
第陸章、 結論與未來研究方向................................79
第一節、 結 論..........................................79
第二節、 未來研究的方向................................................80
參考資料..........................................80
附錄一、..........................................92

表目錄
表 2-2-1： Modified Ashworth Scale for Grading Spasticity Score
Degree of muscle tone...............................................15
表 3-1-1： 試驗研究受測者基本資料表表....................................................38
表 3-1-2： 試驗研究之震動前後肌力表現....................................................40
表 3-1-3： 試驗研究之震動前後肌張力表現................................................42
表 3-1-4： 試驗研究之震動前後柔軟度表現................................................44
表 3-3-1： 受試者的基本資料表................................................49
表 3-5-1： 實驗設計的六種頻率改變........................................................53
表 4-1-1： 股四頭肌六種振動頻率之刺激前後差異與pair t檢定分析結果摘要表........................................................59
表 4-1-2： 股直肌接受不同頻率震盪訓練增加百分比之之事後分析....... 61
表 4-2-1： 肌張力接受六種振動頻率之刺激前後差異與pair t檢定分析結果摘要表......................................................63
表 4-2-2： 肌張力接受不同頻率震盪訓練增加百分比之之事後分析結果65
表 4-3-1 : 柔軟度六種振動頻率之刺激前後差異與pair t檢定分析結果摘要表 ..........................................................................67
表 4-3-2： 柔軟度接受不同頻率震盪訓練增加百分比之事後分析表.........69
表 4-4-1：下肢肌力、肌張力與身體柔軟度之相關性................................70
圖目錄
圖 2-2-1：鐘擺測試 Pendulum test. .................................................17
圖 2-2-2：放鬆指數(Relaxation index)................................................18
圖 2-3-1：肌梭結構圖....................................................22
圖 2-3-2：牽張反射路徑....................................................22
圖 2-3-3：tonic vibratin reflex................................................22
圖 2-3-4：tonic vibratin reflex................................................22
圖 3-1-1：試驗研究設計流程圖....................................................38
圖 3-1-2：試驗研究之震動前後肌力趨勢圖...................................................39
圖 3-1-3：試驗研究之震動前後肌張力趨勢圖...............................................41
圖 3-1-4：試驗研究之震動前後柔軟度趨勢圖...............................................43
圖 3-2-1：實驗流程圖......................................................46
圖 3-5-1：垂直型全身震盪機.........................................................53
圖 3-5-2：電子量角器(PASCO)...........................................................54
圖 3-5-3：自製手握測力計.....................................................55
圖 3-5-4：InstruNet資料擷取系統.......................................................55
圖 4-1-1：不同的震動頻率對股四頭肌肌力增加百分比...............................60
圖 4-2-1：不同的震動頻率對肌張力增加百分比...........................................64
圖 4-3-1：不同的震動頻率對柔軟度增加百分比...........................................68

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