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研究生:陳博因
研究生(外文):Po-Yin Chen
論文名稱:下肢瞬發力復健系統建立-應用於高齡者下肢動態功能回復
論文名稱(外文):Develop a Lower Limb Power Rehabilitation (LLPR) System: Application in Recovery Lower Limb Dynamic Function of Elderly
指導教授:蔚順華蔚順華引用關係
指導教授(外文):Shun-Hwa Wei
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療暨輔助科技學系
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:154
中文關鍵詞:高齡者功能性動作下肢肌肉瞬發力測力板坐到站瞬發力訓練
外文關鍵詞:elderlyfunctional movementlower limb powerforce platesit to standpower rehabilitation
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研究背景:高齡者隨著老化的過程會導致下肢動態功能的退化,下肢功能退化的情形進而影響高齡者執行日常生活的功能表現、降低其生活品質,甚至造成高齡者跌倒機率的上升。其中高齡者下肢表現的肌肉瞬發力與日常生活功能表現以及跌倒危險息息相關。良好的下肢肌肉瞬發力可以確保高齡者日常生活的獨立與安全。而高齡者的日常生活功能又以坐到站能力為其代表。因此客觀的量化評量高齡者在執行坐到站所產生的下肢瞬發力等動力參數,並以功能性姿勢針對下肢肌肉瞬發能力進行訓練,有助於了解高齡者在日常生活的活動中有無跌倒發生之危險並能有效的預防跌倒的發生。目的:(一)發展以電腦互動為基礎的下肢瞬發力評估復健平台,(二)比較評估高齡者接受訓練前後的下肢肌肉瞬發能力等動力、時間參數的改善成效,(三)探討運動訓練後臨床功能性評估的成效,驗證其可轉移至日常生活的能力。方法:本研究硬體的建立包括一由四個荷重元所製成的自製單軸測力平台與訊號處理及類比數位轉換系統,軟體則利用National Instruments LabVIEW 程式開發軟體進行撰寫。主要用於評估坐到站所產生的動力參數和時間參數與進行電腦互動的下肢瞬發能力訓練。受試者徵求高齡者(35位)與健康年輕人(10位)相互對照進行評量,另外再與臨床日常生活功能表現的量表做驗證。瞬發力訓練的部分主要挑選量測結果較差的高齡者(15位)進行為期六週的電腦互動基礎之下肢瞬發力復健訓練;另外有11位高齡者則做為對照的控制組。受試者主要在系統上執行快速低負重的蹲踞活動來進行訓練,以快速蹲站動作控制滑鼠點擊進行特別選擇的遊戲,並在每週做評量,六週後將其執行坐到站的動力、時間參數與日常功能參數做比較,α值定為0.05。結果:經過建立完成的下肢瞬發力復健系統六週的訓練,高齡者運動組的下肢瞬發力增加86%、動力參數平均改善54%、時間參數縮短39% (p<0.05),而日常生活功能表現平均也改善了38%(p<0.05);反之,控制組的六週前後變化都只有平均5%左右,沒達到顯著差異(p>0.05)。討論與結果:大部分高齡者都有下肢瞬發力較小、動作執行較慢的情況,但日常生活中的活動如坐到站、爬樓梯、甚至預防跌倒大都需要一個強而快速的下肢肌肉收縮。以功能性動作進行下肢瞬發力復健能有效的改善高齡者下肢肌肉的動力與時間表現,並在其日常生活功能與跌倒危險量表中也看見顯著的進步。此不但改善了高齡者生理上的機能,也提升其日常生活能力,因此下肢瞬發力的訓練將可以提高高齡者的日常生活功能能力並降低其跌倒發生的危險性。
Background: Aging process may contribute deficiency of dynamic function in lower extremity of elders, and it often causes elderly decreasing their ADL(Activities of Daily Life ) function and quality of life, even suffering fall accident.The muscle power of lower extremity is crucial to quality of ADL and falling. And Sit-to-stand(STS) ability is most important ADL ability. Therefore, to quantify the lower limb power from STS and to train lower limb power will be helpful to understand falling risk of elderly and to prevent falling. Purpose: (1) to develop a lower limb power rehabilitation (LLPR) system and (2) to compare the effects of kinetic and time parameters of elderly after six weeks LLPR training.(3)to compare the result of functional ability after LLPR training and to demonstrate the effects of functional ability of LLPR training. Methods: Forty-five subjects were recruited to participate in this study. They were categorized into elderly(35) and young adults(10) and were evaluated their kinetic and time parameter of STS and their functional ability. 35 older subjects categorized into control group(18) and exercise group(17) for LLPR. A single-axis force plate, data acquisition (DAQ) system and LabVIEW software were used to evaluate biomechanical parameters in each group and execute LLPR training. Paired-t test were used to exam pre-post differences (p<0.05). Results: In the exercise group, we compared pre-test with post-test, and found 86% increment in muscle power of lower extremity, 54% increment in kinetic parameter, 39%decrement in time parameter, and 38% increment in functional ability(p<0.05).Discussions & Conclusions : Many elderly have problem of deficiency of daily function in lower extremity and movement velocity. But a lot of functional tasks are associated with speed of strength generation in lower extremity such as standing from seated position, climbing stairs, and preventing a fall. It is necessary that lower extremity execute movement immediately to prevent falling. And LLPR in functional position improved the kinetic, time, and functional parameter of elderly effectively and decrease the falling risk in clinic assessment. LLPR not only improve physical ability of elderly but also increase the quality of ADL performance. Therefore, we conclude LLPR training can improve lower limb power, functional ability and decrease falling rate effectively.
致謝 I
中文摘要 II
英文摘要 III
目錄 IV
圖目錄 VI
表目錄 VIII
第一章 緒論 1
1-1 研究背景 1
1-2 研究動機 8
1-3 研究目的 11
第二章 文獻回顧 12
2-1 跌倒的發生 12
2-1-1 跌倒的相關因素 13
2-2 肌肉瞬發力的重要性 18
2-3 瞬發力的訓練與評估 22
2-3-1 瞬發力的訓練 22
2-3-2 瞬發力的評估 26
2-4 目前臨床上對於跌倒危險與日常功能表現之相關評估 29
2-4-1 複合型評估 (Composite Ratings of Performance ) 29
2-4-2 表現型評估(Performance Measure) 31
2-4-3 動作分析系統(Motion Analysis System) 40
2-4-4 結論 41
2-5 電腦互動-電玩應用 42
2-6 總結 46
第三章 研究方法 47
3-1 系統建立 47
3-1-1 實驗儀器和設備 49
3-1-2 系統開發 53
3-1-3 資料處理與參數定義 65
3-1-4 臨床驗證 78
3-2 高齡者下肢瞬發力復健(Lower Limb Power Rehabilitation)與評估 81
3-2-1 參加對象 81
3-2-2 實驗步驟及流程 82
3-3 臨床日常活動功能性量表的評估 87
3-3-1 改良式跌倒恐懼預測量表(Modified falls efficacy scale) 87
3-3-2 緹氏平衡量表(Tinetti Balance Assessment) 88
3-3-3 功能性前伸測試 88
3-3-4 連續五次坐到站 89
3-3-5 計時起走測試 90
3-4統計分析 91
第四章 結果 93
4-1 系統鑑別度驗證結果 94
4-1-1 評估坐到站下之瞬發力參數 94
4-1-2 系統評估信度 96
4-2 電腦輔助復健訓練動力與時間結果 97
4-3 日常生活功能能力評量結果 108
4-4 下肢瞬發力區分參數分析結果 113
第五章 討論 125
5-1 系統功能成效與鑑別能力 125
5-1-1 評估量測系統 125
5-1-2 電腦輔助復健系統 128
5-1-3 系統鑑別能力 128
5-2 電腦輔助的下肢瞬發力復健訓練 129
5-3 下肢瞬發力復健訓練對於日常生活功能成效 132
5-4 下肢評量參數與跌倒危險性區分 134
第六章 結論 137
附錄 139
文獻參考 145
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