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研究生:高禎陽
研究生(外文):Chen-Yang Kao
論文名稱:承重轉移訓練對增加高齡者動態平衡能力的療效分析
論文名稱(外文):Effects of Weight-Shift Training for Improving Elderly Dynamic Balance Ability
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:94
中文關鍵詞:高齡者跌倒承重轉移動態平衡復健評估訓練系統
外文關鍵詞:elderly fallweight-shift trainingdynamic balancelimit of stability
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研究背景與動機:跌倒是威脅老年人健康品質的最大危險因子之一,研究及早篩檢出有潛在跌倒的高危險群老人及研發出預防老人跌倒的平衡復健設備,將有助於減低老人跌倒的發生率。過去已有研究指出經由動態的承重偏移訓練,偏癱病人能增加其站立的穩定限制範圍(limit of stability, LOS),並減低之後跌倒的機率。但國內利用測力板系統進行檢測之研究大多為針對不同類型的病患(如:脊髓損傷患者、中風病患等),較無針對一般老年族群進行穩定限制範圍(LOS)的檢測。且過去關於高齡者平衡的研究,比較著重在兩腳長時間站立時看靜態重心(center of pressure, COP)的改變,較少在執行動態承重偏移(weight-shifting)時看重心動態參數的改變,且少有研究探討承重偏移(weight-shifting)訓練的效果是否能轉移到日常生活的動作功能上。研究目的: (1)比較年輕人與高齡者穩定限制範圍(LOS)的特性與COP參數的差異 (2)探討經過視覺提示下的承重轉移(weight-shifting)平衡訓練後能否增加高齡者的動態穩定限制範圍(LOS)以及動態平衡能力 (3)探討經過承重轉移(weight-shifting)平衡訓練的效果是否能轉移到日常功能性的動作表現上。受試者:收取18~30歲年輕人–共10位,以及符合收案條件的65歲以上高齡者-共取收29位,分為訓練組(15位)與控制組(14位)。實驗方法:實驗組老年族群接受視覺提示承重轉移訓練,一次30分鐘,每周3次,為期六周。控制組則僅給予衛教未做任何訓練,兩組受試者將於訓練前後各接受一次測力板與臨床平衡測試以評估療效。評量參數:於測力板上進行動態平衡能力測試,以及以下臨床測試:柏格氏平衡測試(Berg Balance Test)、起走測試(timed-up and go test)、功能性前伸測試(functional reach test)等。統計分析: (1)使用independent T test來比較年輕人與高齡者COP各項參數的差異 (2)使用paired t test來檢驗訓練組與控制組高齡者訓練前後各項COP參數的改變量,以及臨床量表的進步情形,顯著差異值p<0.05。結果:(1)年輕人無論在動態平衡的各項參數上,年輕族群表現都明顯比老年族群來的好 (p皆<0.002) (2) 經過六週的承重轉移訓練後,訓練組老年族群在左右/前後方向總位移、總位移距離、左右位移範圍、往右/往左/往前最大位移移動速度等方面皆有顯著的進步,且臨床量表方面,柏格式量表的分數平均進步了10分,進步百分比達23.9%,起立起走測試所花的秒數平均下降約4秒(由17.08秒進步到13.13秒),進步百分比達23%,功能性前伸測試的距離平均進步了4cm。結論:(1)老年族群與年輕族群相比,無論是在動態移動速度、移動位移與移動面積範圍等方面,表現皆明顯比年輕人較差 (2)經由視覺提示承重轉移(weight-shifting)運動訓練能顯著增加高齡者的動態穩定限制範圍(LOS)以及動態平衡能力 (3)承重轉移運動訓練的效果
能夠成功轉移到功能性的動作表現上。
Background: To function in daily life, human must be able to maintain and adopt various positions, interact with external disturbances, and use automatic postural responses that precede voluntary movements. Balance capability requires that the body’s center of gravity (COG) lies over base of support. Ability of quickly reweigh and select reliable sensory information when faced with conflicting sensory conditions in changing environments is crucial to the avoidance of falls among elderly. A number of investigators have used postural feedback devices to improve symmetry in standing posture. However, the enhanced effects of balance training on dynamic functional ability for elderly are still unclear. Purposes: purpose of this study included (1) comparing ability of weight-shifting and dynamic limit of stability (LOS) between elderly and adult subjects, (2) investigating whether weight-shift training could increase limit of stability (LOS) on elderly subjects, and (3) investigating whether LOS incensement could transfer into daily functions. Study design: An experimental study, single blind, randomized controlled trial. Subjects: 15 adults aged 18~30 and 29 old adults over 65 years fitting the inclusion criteria would be recruited and randomized into experimental group (n=15) or control group (n=14). Intervention: Conventional balance rehabilitation program plus visual feedback weight-shift training, 3 times a week for 6 weeks. Training effect will be evaluated by assessing the dynamic balance performance and clinical tests. Statistical analysis: Independent t test was used to compare COP measurements of adults and elderly. Paired t test was used to compare two groups of elderly (training and control group) and the two measurement periods (pre-training and post-training). The statistically significant level was set at 0.05. Results: Adults were found to have better dynamic balance performances than elderly. Elderly subject obtained significant improvement in LOS area, sway velocity, and maximal displacement both on anterior and lateral direction after 6 weeks weight shifting training. Additionally, after 6 weeks of weight-shift training, elderly subjects showed improving their daily function that included increasing 23.9% of Berg balance scores; decreasing 23% seconds of TUG test, and increasing 24% functional reach test when comparing with previous test. Discussions and Conclusions: To avoid fall accident occurring in older persons, weight-shifting training can be implicated on them due to improving their balance function. Weight-shifting training alternated older persons’ dynamic balance function. This alternation also can help them improving certain activities of daily functions.
誌謝 ii
目錄 i
中文摘要 vii
Abstract viii
第 一 章 緒論 1
1-1 研究背景 1
1-2 研究動機 2
1-3 研究目的 5
第 二 章 文獻回顧 6
2-1 平衡與姿勢控制之概念 6
2-2 平衡與姿勢控制之組成因子 8
2-3 重心與支撐底面積之相對關係 9
2-4 檢測平衡之方法 13
2-4-1 平衡相關之臨床測試 13
2-4-2 電子系統評估 14
2-5 目前臨床平衡訓練方式回顧與比較 18
2-5-1 姿勢對稱性訓練 18
2-5-2 穩定度(Steadiness)訓練 20
2-5-3 動態穩定度(Dynamic Stability)訓練 20
2-5-4 視覺回饋方式之訓練效益 22
2-6 高齡者平衡動作策略的改變與調控反應 22
2-7 綜合評述 24
第 三 章 研究方法 26
3-1 系統建立 26
3-1-1 硬體建立 29
3-1-2 軟體撰寫 31
3-1-3 評估參數 40
3-2 系統臨床評估及訓練療效 43
3-2-1 受試者 43
3-2-2 施測流程 43
3-2-3 承重轉移復健運動前評估 45
3-2-4 承重轉移平衡訓練 49
3-3 統計分析 50
第 四 章 結果 51
4-1 受試者基本資料 52
4-2 高齡者與年輕人動態平衡能力的比較 53
4-3 控制組高齡者的動態平衡能力改變情形 56
4-4 訓練組高齡者的動態平衡能力改變情形 58
第 五 章 討論 64
5-1 評估系統硬軟體與其他評估方法的適用性比較 64
5-2 評估系統硬軟體功能成效 65
5-2-1 評估硬體功能成效 65
5-2-2 評估系統軟體功能成效 66
5-3 高齡者動態平衡能力各項參數的比較 68
5-4 臨床量表訓練前後的比較 72
5-5 評估參數的應用 75
5-6 未來工作 75
第 六 章 結論 77
參考文獻 78
附錄 82
附錄1 陽明大學人體試驗暨倫理委員會同意書 82
附錄2 受試者同意書 83
附錄3 乙類人體試驗審查申請表 86
附錄4 柏格氏平衡量表(BBS) 88
1. 胡名霞。動作控制與動作學習。金名圖書有限公司,2001。
2. 徐中盈。中風患者的偏癱治療-軀幹的動作訓練。合記圖書出版社,1990。
3. 台灣高齡者口比例。內政部統計處,民國98 年。
4. 傅麗蘭。平衡運動訓練前後高齡者之平衡表現及步寬的改變。物理治療,23(2),98-105,1998。
5. Allison L. Balance disorders. In Umphred DA (ed). Neurological rehabilitation, 3rd ed. St. Louis: Mosby. 802-37, 1995.
6. Ayres AJ. Sensory integration and the child. Los Angeles: Western Psychological Services, 1979.
7. Badke, M. B., Duncan, P. W., and Di Fabio, R. P. (1987). Influence of prior knowledge on automatic and voluntary postural adjustments in healthy and hemiplegic subjects. Physical Therapy, 67, 1495-1500.
8. Bouisset, S. and Zattara, M. (1987). Biomechanical study of the programming of anticipatory postural adjustments associated with voluntary movement. Journal of Biomechanics, 20, 735-742.
9. Brown, L. A. and Frank, J. S. (1997). Postural compensations to the potential consequences of instability: kinematics. Gait and Posture, 6, 89-97.
10. Diener, H. C., Horak, F. B., and Nashner, L. M. (1988). Influence of stimulus parameters on human postural responses. Journal of Neurophysiology, 59, 1888-1905.
11.Diener, H. C., Horak, F., Stelmach, G., Guschlbauer, B., and Dichgans, J. (1991). Direction and amplitude precuing has no effect on automatic posture responses. Experimental Brain Research, 84, 219-223.
12. Dietz, V. and Berger, W. (1984). Interlimb coordination of posture in patients with spastic paresis. Impaired function of spinal reflexes. Brain, 107 ( Pt 3), 965-978.
13. Dietz, V., Quintern, J., Berger, W., and Schenck, E. (1985). Cerebral potentials and leg muscle e.m.g. responses associated with stance perturbation. Experimental Brain Research, 57, 348-354.
14. Gilles, M., Wing, A. M., and Kirker, S. G. (1999). Lateral balance organisation in human stance in response to a random or predictable perturbation. Experimental Brain Research, 124, 137-144.
15. Harburn, K. L., Hill, K. M., Kramer, J. F., Noh, S., Vandervoort, A. A., and Teasell, R. (1995). Clinical applicability and test-retest reliability of an external perturbation test of balance in stroke subjects. Archives of Physical Medicine and Rehabilitation, 76, 317-323.
16. Hocherman, S., Dickstein, R., and Pillar, T. (1984). Platform training and postural stability in hemiplegia. Archives of Physical Medicine and Rehabilitation, 65, 588-592.
17. Holt, R. R., Simpson, D., Jenner, J. R., Kirker, S. G., and Wing, A. M. (2000). Ground reaction force after a sideways push as a measure of balance in recovery from stroke. Clinical Rehabilitation, 14, 88-95.
18. Horak, F. B., Diener, H. C., and Nashner, L. M. (1989). Influence of central set on human postural responses. Journal of Neurophysiology, 62, 841-853.
19. Horak, F. B., Henry, S. M., and Shumway-Cook, A. (1997). Postural perturbations: new insights for treatment of balance disorders. Physical Therapy, 77, 517-533.
20. Horak, F. B. and Nashner, L. M. (1986). Central programming of postural movements: adaptation to altered support-surface configurations. Journal of Neurophysiology, 55, 1369-1381.
21. Ikai, T., Kamikubo, T., Takehara, I., Nishi, M., and Miyano, S. (2003). Dynamic postural control in patients with hemiparesis. American Journal of Physical Medicine & Rehabilitation, 82, 463-469.
22. Kirker, S. G., Simpson, D. S., Jenner, J. R., and Wing, A. M. (2000). Stepping before standing: hip muscle function in stepping and standing balance after stroke. Journal of Neurology, Neurosurgery, and Psychiatry, 68, 458-464.
23. McIlroy, W. E. and Maki, B. E. (1994). The 'deceleration response' to transient perturbation of upright stance. Neuroscience Letters, 175, 13-16.
24. Nashner, L. M. (1976). Adapting reflexes controlling the human posture. Experimental Brain Research, 26, 59-72.
25. Nashner, L. M. and Cordo, P. J. (1981). Relation of automatic postural responses and reaction-time voluntary movements of human leg muscles. Experimental Brain Research, 43, 395-405.
26. Nyberg, L. and Gustafson, Y. (1995). Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. Stroke, 26, 838-842.
27. Pavol, M. J. and Pai, Y. C. (2002). Feedforward adaptations are used to compensate for a potential loss of balance. Experimental Brain Research, 145, 528-538.
28. Shumway-Cook, A. and Woollacott, M. (2001). Clinical management of the patient with a postural control disorder. In Motor Control: Theory and Practive Applications (2 ed., pp. 271-304). Baltimore: Lippincott Williams & Wilkins.
29. Tang, P. F., Woollacott, M. H., and Chong, R. K. (1998). Control of reactive balance adjustments in perturbed human walking: roles of proximal and distal postural muscle activity. Experimental Brain Research, 119, 141-152.
30. Wing, A. M., Allison, S., and Jenner, J. R. (1993a). Retaining and retraining balance after stroke. Baillieres Clinical Neurology, 2, 87-120.
31. Wing, A. M., Goodrich, S., Virji-Babul, N., Jenner, J. R., and Clapp, S. (1993b). Balance evaluation in hemiparetic stroke patients using lateral forces applied to the hip. Archives of Physical Medicine and Rehabilitation, 74, 292-299.
32. Wing, A. M., Flanagan, J. R., and Richardson, J. (1997). Anticipatory postural adjustments in stance and grip. Experimental Brain Research, 116, 122-130.
33. Richter,E.(1980).Quantitative study od human Scarpa’s ganglion and vestibular sensory epithelia.Acta Oto-Laryngologica, 90(3-4),199-208.
34. Sheldon,J.H.(1963).The effect of age on the control of sway. Gerontologia Clinica,5,129-138.
35. Woollacott, M.H,Shumway-Cook,A.,&Nashner,L.M.(1986).Aging and posture control: Changes in sensory organization and muscular coordination. International Journal of aging & Human Developmen,23(2),97-114.
36. Peterka,R.J.,&Black,F.O.(1990-91). Age-related changes in human posture control: sensory organization tests, Journal of Vestibular Research,l(1),73-85.
37. Matheson,A.J.,Darlington,C.L.,& Smith,P. F.,(1999).Further evidence for age-related deficits in human postural function. Journal of Vestibular research,9(4),261-4.
38. Wolfson, L., Whipple, M., & Derby, C. A.(1992).A dynamic posturography study of balance in healthy elderly, Neurology ,42,2069-2075.
39. Hu,M.H.,& Woollacott,M.H.(1994).Multisensory training of standing balance in older adults: Postural stability and one-leg stance balance. Journal of Gerontology,49(2),M52-61.
40. Hong,Y.,Li,J.X.,& Robinson,P.D.(2002).Balance control, flexibility, and cardiorespiratory fitness among older Tai Chi practitioners. British Journal of sports Medicine,34(1),29-34.
41. Wong,A.M.,Lin,Y.C.,Chou,S.W.,Tang, F.T.,&Wong,P.Y.(2001).Coordination exercise and postural stability in elderly people: Effect of Tai Chi Chuan. Archives of Physical Medicine & Rehabilitation,82(5),608-12.
42. Campbell AJ, Borrie MJ & Spears GF. Risk Factors for Falls in a community-based prospective study of people 70 years and older. J Gerontol 1989; 44(4): M112-117.
43. Chang HA & Krebs DE. Dynamic balance control in elders: Gait initiation assessment as a screening tool. Arch Phys Med Rehabil 1999; 80: 490-494.
44. Cipriani DJ, Armstrong CW & Gaul S. Backward walking at three levels of treadmill inclination: An electromyographic and kinematic analysis. JOSPT 1998; 27(5): 356-360.
45. Cordo PJ & Nashner LM. Properties of postural adjustments association with rapid arm movements. J. Neurophysiol 1982; 47(2): 287-302.
46. Elble RJ, Moody C, Leffler K & Sinha R. The initiation of normal walking. Mov Disord 1994; 9(2): 139-146.
47. Eng JJ, Winter DA. Estimations of the horizontal displacement of the total body centre of mass: Considerations during standing activities. Gait Posture 1993; (1)141-144.
48. Folstein MF, Folstein SE & McHugh PR. “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 1975; 12: 189-198.
49. Frank JS & Earl M. Coordination of posture and movement. Phys Ther 1990; 70(12): 855-863.
50. Friedli WG, Hallett M & Simon SR. Posture adjustments associated with rapid volutary arm movement 1. Electromyographic data. J. Neurol Neurosurg Psychiatry 1984; 47: 611-622.
51. Hageman PA, Leibowitz JM & Blanke D. Age and gender effects on postural control measures. Arch Phys Med Rehabil 1995; 76: 961-9655.
52. Harada N, Chiu V, Damron-Rodriguez J, Fowler E, Siu A & Reuben DB. Screening for balance and mobility impairment in elderly individuals living in residential care facilities. Phys Ther 1995; 75: 462-469.
53. Hasan SS, Robin DW, Szurkus DC, Ashmead DH, Peterson SW & Shiavi RG. Simultaneous measurement of body center of pressure and center of gravity during upright stance. Part I: Methods. Gait Posture 1996; 4: 1-10.
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