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研究生:林敬予
研究生(外文):Chin-Yu, Lin
論文名稱:功能性踝關節穩定障礙之神經肌肉控制研究
論文名稱(外文):The neuromuscular control of the ankle joint in subjects with functional ankle instability
指導教授:施怡芬施怡芬引用關係
指導教授(外文):Yi-Fen, Shin
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:英文
論文頁數:86
中文關鍵詞:足踝扭傷功能性踝關節穩定障礙反應時間單腳著地神經肌肉控制
外文關鍵詞:ankle sprainfunctional ankle instabilityreaction timesingle leg landingneuromuscular control
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研究背景:功能性踝關節控制障礙常認為是造成運動員重複性扭傷與不良動作控制的主因。功能性踝關節控制障礙可能是受傷後下肢肌群的反應時間延遲與收縮強度減低所致;回顧文獻發現目前分辨功能性踝關節控制障礙患者以自述症狀為主,缺乏一致的區別標準。突然足踝內翻用測試中的下肢肌群反應時間、單腳著地的肌力反應強度,是目前常用來分析功能性踝關節控制障礙的方式。現有的研究利用不同的測試參數,紀錄下肢肌群反應時間與收縮強度,但彼此間結論並不一致。此外,不同測試參數是否會影響功能性足踝控制障礙或健康受試者的下肢肌群反應時間與收縮強度,目前並無研究探討。研究目的:針對健康與踝關節控制障礙受試者,利用不同測試參數進行突然足踝內翻與單腳著地測試,探討測試參數對下肢肌群反應時間與收縮強度的影響,檢測相關測試的信度,並分析組間測試結果間之差異。研究方法:本實驗利用體表肌電圖系統,收取健康受試者與踝關節控制障礙患者各14名,進行突然足踝內翻與單腳著地測試,依序由低、中、高三種不同測試參數進行實驗,紀錄突然內翻實驗下的肌群反應時間與單腳著地前後的肌群收縮強度,比較踝關節穩定障礙組之健側、患側與對照組的差異。結果:各項測試信度為中等到良好。在不同測試參數條件下,肌肉反應時間與收縮強度會有參數間的差別。在肌肉反應時間方面,在30°突然傾斜測試中,功能性踝關節穩定障礙組之患側腓腸肌反應時間較短;在單腳著地測試中,功能性踝關節穩定障礙組患側腓腸肌與比目魚肌肌肉收縮量,相較於對照組有顯著減少的情形。結論:不同測試參數的確會造成反應時間與反應強度的不同,且本實驗發現踝關節控制障礙的患者有較快速的腓腸肌反應時間,但有較弱的著地前肌肉活化量。本實驗對於現有研究提供測試參數方面的證據,受試者反應的確會因會因不同參數而有所差異。至於受傷後是否有神經肌肉生理或功能代償,導致反應時間與反應強度改變,則需進一步實驗探討。
Background: Functional ankle instability (FAI) was considered as the main reason of recurrent ankle sprains in athletes. The major hypotheses of causing functional ankle instability are delayed reaction time and decreased muscle activity in lower extremities during threats of ankle sprain. Despite self-reported symptoms, there is no universal standard to identify the case with FAI. Researchers often use the peroneal muscle reaction time during the sudden inversion test, and the peroneal muscle activity in the single leg landing to assess individuals with FAI. However, the findings regarding the peroneal reaction time in the literature were inconsistent, mainly due to the variations in the testing parameters. Furthermore, there was few data available for the peroneal muscle activities and muscle coordination during the single leg landing in previous studies. Purpose: This study was therefore designed to investigate the effects of various testing parameters in the sudden inversion and single leg landing tests; and to compare the differences in the muscle reaction time and muscle activities of the peroneus longus, tibialis anterior, and soleus between subjects with and without FAI. Method: We recruited 14 healthy and 14 FAI subjects for this investigation. Three levels of testing parameters were used: 15, 30, and 45 degrees for the sudden inversion test, and 25, 35, and 45 cm for the landing test. Muscle activities and reaction time of tibialis anterior, soleus and peroneus longus of involved side and sound side in FAI group, and both sides in control group, were recorded by surface electromyography system. Results: There were significant differences in the muscle reaction time and muscle activation under different testing conditions in both control and FAI groups. Compared to the control group, the involved side of FAI group showed faster peroneal reaction time and smaller peroneal muscle activation during testing. Conclusion: The inclination angle of the sudden inversion test and the landing height would significantly influence the result of peroneal muscle performance. The reaction time and muscle activation of the peroneus longus altered in subjects with FAI. Further studies should take into considerations of the effect of testing parameters, and to investigate the mechanisms behind the changes of the muscle performance in subjects with functional ankle instability.
TABLE OF CONTENTS………………………………………………………………i
LIST OF TABLES……………………...……………………………………………...v
LIST OF FIGURES……………………...…………………………………………...vii
ABSTRACT…………………………….………………………………………….…ix
Chapter 1: INTRODUCTION…………………………………………………………1
Chapter 2: LITERATURE REVIEW………………………………………………….5
2.1 Functional ankle instability (FAI)……………………………………………5
2.1.1 Definition………………………………………………………………5
2.1.2 Prevalence, symptoms and injury mechanism…………………………5
2.1.3 Interventions………………...……………………………….………...7
2.2 Sudden inversion test…………………………………………….…………7
2.2.1 Experimental design of sudden inversion test……..………….………8
2.2.1.1 Definition of muscle reaction time in sudden inversion test……8
2.2.1.2 Testing angle...………………………………………………......9
2.2.1.3 Tilting duration and tilting speed………………………….…...10
2.2.1.4 Side dominance……………………………………………….12
2.3 Single leg landing………..………………………………………………….13
2.3.1 Kinematic study………………..…………………………………….13
2.3.2 Kinetic study……………...………………………………………….14
2.3.3 Muscle activations during single leg landing……………….……..…15
2.4 Summary and study purpose………………...………………………………16
Chapter 3: METHOD………………………………………………………………...19
3.1 Study design…………………………………………………………….19
3.2 Subjects…………………….……………………………..……………19
3.2.1 Inclusion criteria…………………………………..……………..19
3.2.2 Exclusion criteria…………………………………..………….....20
3.3 Instrumentation…………………………………………..…………….20
3.3.1 Electromypgraphy…….………………...…………..……………20
3.3.2 Design of sudden inversion trapdoor…………..…………..…21
3.4 Testing procedure……………………………………...……………....22
3.4.1 Basic data collection…………………………..………………..22
3.4.2 Maximal voluntary isometric contravtion…..…………………22
3.4.3 Muscle reaction time………………………..……………….....23
3.4.4 Muscle activity before and after landing…..…………………24
3.5 Data reduction and analysis…………………………………………..24
Chapter 4: RESULTS……………………………………..………………………….27
4.1 Pilot analysis…………………………………………………………...27
4.1.1 Reliability of measurement………………………….…………27
4.1.2 Effect of leg dominance and testing parameter…….…….….27
4.2 Results of the main study……………………………………………28
4.2.1 Basic data comparisons…………………………………….…..28
4.2.2 Muscle reaction time in the sudden inversion test……….....28
4.2.3 Muscle activity during single leg landing…………………....29
4.2.4 Muscle coordination………………………………………….…29
4.2.4.1 Reaction time difference……………………………..….29
4.2.4.2 Firing index………………………………………………30
Chapter 5: DISCUSSION…………………………………………………………….31
5.1 Effect of testing parameter……………………………………………….32
5.2 Altered neuromuscular control of subjects with FAI…………..……34
5.2.1 Faster peroneal muscle reaction time……………………………34
5.2.2 Decreased muscle activity………………………………………...35
5.2.3 Muscle coordination……………………………………………….37
5.3 Limitations……………………………………………………………….38
5.4 Future works………………………………………………………….…39
5.5 Conclusion and clinical relevance……………………………………...40
Reference……………………………………………………………………………..41Appendices…………………………………………………………………………...86
Reference

1. Freeman MA, Dean MR, Hanham IW. The etiology and prevention of functional instability of the foot. J Bone Joint Surg Br 1965;47(4):678-85.
2. Verhagen RA, de Keizer G, van Dijk CN. Long-term follow-up of inversion trauma of the ankle. Arch Orthop Trauma Surg 1995;114(2):92-6.
3. Santos MJ, Liu W. Possible factors related to functional ankle instability. J Orthop Sports Phys Ther 2008;38(3):150-7.
4. Hertel J. Functional instability following lateral ankle sprain. Sports Med 2000;29(5):361-71.
5. Hertel J. Functional Anatomy, Pathomechanics, and Pathophysiology of Lateral Ankle Instability. J Athl Train 2002;37(4):364-75.
6. Benesch S, Putz W, Rosenbaum D, Becker H. Reliability of peroneal reaction time measurements. Clin Biomech (Bristol, Avon) 2000;15(1):21-8.
7. Ebig M, Lephart SM, Burdett RG, Miller MC, Pincivero DM. The effect of sudden inversion stress on EMG activity of the peroneal and tibialis anterior muscles in the chronically unstable ankle. J Orthop Sports Phys Ther 1997;26(2):73-7.
8. Ross SE, Guskiewicz KM, Gross MT, Yu B. Assessment tools for identifying functional limitations associated with functional ankle instability. J Athl Train 2008;43(1):44-50.
9. Caulfield B, Garrett M. Changes in ground reaction force during jump landing in subjects with functional instability of the ankle joint. Clin Biomech (Bristol, Avon) 2004;19(6):617-21.
10. Delahunt E, Monaghan K, Caulfield B. Changes in lower limb kinematics, kinetics, and muscle activity in subjects with functional instability of the ankle joint during a single leg drop jump. J Orthop Res 2006;24(10):1991-2000.
11. Beckman SM, Buchanan TS. Ankle inversion injury and hypermobility: effect on hip and ankle muscle electromyography onset latency. Arch Phys Med Rehabil 1995;76(12):1138-43.
12. Nawoczenski DA, Owen MG, Ecker ML, Altman B, Epler M. Objective evaluation of peroneal response to sudden inversion stress. J Orthop Sports Phys Ther 1985;7(3):107-9.
13. Isakov E MJ, Solzi P, Susak Z, et al. Response of the peroneal muscles to sudden inversion of the ankle during standing. International Journal of Sport Biomechnics 1986;2:100--9.
14. Konradsen L, Ravn JB. Ankle instability caused by prolonged peroneal reaction time. Acta Orthop Scand 1990;61(5):388-90.
15. Konradsen L, Ravn JB. Prolonged peroneal reaction time in ankle instability. Int J Sports Med 1991;12(3):290-2.
16. Karlsson J, Andreasson GO. The effect of external ankle support in chronic lateral ankle joint instability. An electromyographic study. Am J Sports Med 1992;20(3):257-61.
17. Johnson MB, Johnson CL. Electromyographic response of peroneal muscles in surgical and nonsurgical injured ankles during sudden inversion. J Orthop Sports Phys Ther 1993;18(3):497-501.
18. Lofvenberg R, Karrholm J, Sundelin G, Ahlgren O. Prolonged reaction time in patients with chronic lateral instability of the ankle. Am J Sports Med 1995;23(4):414-7.
19. Lynch SA, Eklund U, Gottlieb D, Renstrom PA, Beynnon B. Electromyographic latency changes in the ankle musculature during inversion moments. Am J Sports Med 1996;24(3):362-9.
20. Fernandes N, Allison GT, Hopper D. Peroneal latency in normal and injured ankles at varying angles of perturbation. Clin Orthop Relat Res 2000(375):193-201.
21. Vaes P, Duquet W, Van Gheluwe B. Peroneal Reaction Times and Eversion Motor Response in Healthy and Unstable Ankles. J Athl Train 2002;37(4):475-80.
22. Suda EY, Amorim CF, Sacco Ide C. Influence of ankle functional instability on the ankle electromyography during landing after volleyball blocking. J Electromyogr Kinesiol 2009;19(2):e84-93.
23. Tropp H, Odenrick P, Gillquist J. Stabilometry recordings in functional and mechanical instability of the ankle joint. Int J Sports Med 1985;6(3):180-2.
24. Delahunt E, Monaghan K, Caulfield B. Altered neuromuscular control and ankle joint kinematics during walking in subjects with functional instability of the ankle joint. Am J Sports Med 2006;34(12):1970-6.
25. Delahunt E, Monaghan K, Caulfield B. Ankle function during hopping in subjects with functional instability of the ankle joint. Scand J Med Sci Sports 2007;17(6):641-8.
26. Lee AJ, Lin WH. Twelve-week biomechanical ankle platform system training on postural stability and ankle proprioception in subjects with unilateral functional ankle instability. Clin Biomech (Bristol, Avon) 2008;23(8):1065-72.
27. Lephart SM, Pincivero DM, Giraldo JL, Fu FH. The role of proprioception in the management and rehabilitation of athletic injuries. Am J Sports Med 1997;25(1):130-7.
28. Lentell G, Baas B, Lopez D, McGuire L, Sarrels M, Snyder P. The contributions of proprioceptive deficits, muscle function, and anatomic laxity to functional instability of the ankle. J Orthop Sports Phys Ther 1995;21(4):206-15.
29. Garn SN, Newton RA. Kinesthetic awareness in subjects with multiple ankle sprains. Phys Ther 1988;68(11):1667-71.
30. Gerber JP, Williams GN, Scoville CR, Arciero RA, Taylor DC. Persistent disability associated with ankle sprains: a prospective examination of an athletic population. Foot Ankle Int 1998;19(10):653-60.
31. Smith RW, Reischl SF. Treatment of ankle sprains in young athletes. Am J Sports Med 1986;14(6):465-71.
32. McKay GD, Goldie PA, Payne WR, Oakes BW. Ankle injuries in basketball: injury rate and risk factors. Br J Sports Med 2001;35(2):103-8.
33. Mattacola CG, Dwyer MK. Rehabilitation of the Ankle After Acute Sprain or Chronic Instability. J Athl Train 2002;37(4):413-29.
34. Bernier JN, Perrin DH. Effect of coordination training on proprioception of the functionally unstable ankle. J Orthop Sports Phys Ther 1998;27(4):264-75.
35. Docherty CL, Moore JH, Arnold BL. Effects of Strength Training on Strength Development and Joint Position Sense in Functionally Unstable Ankles. J Athl Train 1998;33(4):310-4.
36. Rozzi SL, Lephart SM, Sterner R, Kuligowski L. Balance training for persons with functionally unstable ankles. J Orthop Sports Phys Ther 1999;29(8):478-86.
37. Michell TB, Ross SE, Blackburn JT, Hirth CJ, Guskiewicz KM. Functional balance training, with or without exercise sandals, for subjects with stable or unstable ankles. J Athl Train 2006;41(4):393-8.
38. Ross SE, Guskiewicz KM. Effect of coordination training with and without stochastic resonance stimulation on dynamic postural stability of subjects with functional ankle instability and subjects with stable ankles. Clin J Sport Med 2006;16(4):323-8.
39. Eils E, Rosenbaum D. A multi-station proprioceptive exercise program in patients with ankle instability. Med Sci Sports Exerc 2001;33(12):1991-8.
40. Vaes P, Van Gheluwe B, Duquet W. Control of acceleration during sudden ankle supination in people with unstable ankles. J Orthop Sports Phys Ther 2001;31(12):741-52.
41. Konradsen L, Voigt M, Hojsgaard C. Ankle inversion injuries. The role of the dynamic defense mechanism. Am J Sports Med 1997;25(1):54-8.
42. Rosenbaum D BH-P, Gerngross H, Claes L. Peroneal reaction times for diagnosis of functional ankle instability. Foot Ankle Surg 2000;6:31-8.
43. Solomonow M, Krogsgaard M. Sensorimotor control of knee stability. A review. Scand J Med Sci Sports 2001;11(2):64-80.
44. Di Fabio RP, Graf B, Badke MB, Breunig A, Jensen K. Effect of knee joint laxity on long-loop postural reflexes: evidence for a human capsular-hamstring reflex. Exp Brain Res 1992;90(1):189-200.
45. Hewett TE, Myer GD, Ford KR, Slauterbeck JR. Dynamic neuromuscular analysis training for preventing anterior cruciate ligament injury in female athletes. Instr Course Lect 2007;56:397-406.
46. Sadeghi H, Allard P, Prince F, Labelle H. Symmetry and limb dominance in able-bodied gait: a review. Gait Posture 2000;12(1):34-45.
47. Hill SW, Patla AE, Ishac MG, Adkin AL, Supan TJ, Barth DG. Altered kinetic strategy for the control of swing limb elevation over obstacles in unilateral below-knee amputee gait. J Biomech 1999;32(5):545-9.
48. Konradsen L. Sensori-motor control of the uninjured and injured human ankle. J Electromyogr Kinesiol 2002;12(3):199-203.
49. Caulfield BM, Garrett M. Functional instability of the ankle: differences in patterns of ankle and knee movement prior to and post landing in a single leg jump. Int J Sports Med 2002;23(1):64-8.
50. Brown C, Padua D, Marshall SW, Guskiewicz K. Individuals with mechanical ankle instability exhibit different motion patterns than those with functional ankle instability and ankle sprain copers. Clin Biomech (Bristol, Avon) 2008;23(6):822-31.
51. Ross SE, Guskiewicz KM, Yu B. Single-leg jump-landing stabilization times in subjects with functionally unstable ankles. J Athl Train 2005;40(4):298-304.
52. Santello M. Review of motor control mechanisms underlying impact absorption from falls. Gait Posture 2005;21(1):85-94.
53. Santello M, McDonagh MJ. The control of timing and amplitude of EMG activity in landing movements in humans. Exp Physiol 1998;83(6):857-74.
54. Bandy WD, Lovelace-Chandler V, McKitrick-Bandy B. Adaptation of skeletal muscle to resistance training. J Orthop Sports Phys Ther 1990;12(6):248-55.
55. Dayakidis MK, Boudolos K. Ground reaction force data in functional ankle instability during two cutting movements. Clin Biomech (Bristol, Avon) 2006;21(4):405-11.
56. Thonnard JL, Plaghki L, Willems P, Benoit JC, De Nyer J. [Pathogenesis of ankle sprain: testing of a hypothesis]. Acta Belg Med Phys 1986;9(2):141-5.
57. Konradsen L, Ravn JB, Sorensen AI. Proprioception at the ankle: the effect of anaesthetic blockade of ligament receptors. J Bone Joint Surg Br 1993;75(3):433-6.
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