臺灣博碩士論文加值系統

中風是最常造成人類失能的一種疾病。在中風患者的復健過程中，重拾步行能力是非常重要的一項議題，與其日後是否能獨立自主生活息息相關。而目前臨床中風訓練多仰賴治療師依據其經驗，為患者訂定適合之復健訓練計畫來進行，但若治療師無治療師在身旁時，患者往往無法利用珍貴時間持續進行一有效率之訓練。視覺及聽覺上之提醒為臨床治療中常使用來訓練中風病人步行的方法，故我們希望利用此概念，發展出一新型之步態訓練輔具，幫助提升中風病人步行復建之效率。
本研究目的為開發新型輔具以提供類似治療師所給予的口令或跨步提醒，藉此輔助治療師進行臨床步態訓練並且能客觀地紀錄患者的能力，同時也可讓患者即便在沒有治療師的情況下亦能充分利用時間正確地自我復健，加速步行能力的恢復。
本研究以感測器和嵌入式系統裝配於標準拐杖上，開發一新型外在提醒輔具，並徵招三位中風患者進行臨床實驗，透過人體動作捕捉系統（Vicon MX motion system, UK）分析受試者使用新型輔具前後之步態表現差異。成效評量包括步輻、步長、行走速度、步態對稱性及行走時施於拐杖之最大力量。
研究結果發現，中風患者使用本輔具後，單點與雙點跨步提示分別使步幅增加了17.12%及20.16%，健側步長進步了34.15%及36.2%，患側步長則分別進步了9.53%及20.6%，患側單腳擺盪時間進步了15.17%及27.58%，健側單腳擺盪時間則進步了21.29%及10.18%，以上各參數雖因個案數少無統計上之明顯差異，但其進步幅度仍具臨床參考價值。另外步態對稱性方面，在單點及雙點跨步提示下，步長對稱性分別進步了10%及26%，但在擺盪時間對稱性方面，本研究之輔具介入則沒有造成明顯改善。
由結果可知，本研究所研發之輔具經過臨床實驗證明，確能有效增進中風患者之步態表現及步態對稱性，與上一代輔具相較也有明顯進步，相信未來開發更加完善後，便能實際使用於臨床，增進中風患者之步態附件效率。

Stroke is one of the most common diseases among older population. During the rehabilitation process, it is important for stroke survivors to retrieve independent mobility. Gait training in clinical practice largely relied on therapists' clinical experiences. Proper cues are usually offered to stroke patients to facilitate better gait patterns. However, in the absence of therapists, stroke patients may develop abnormal walking patterns due to lack of cues, which would affect their future rehabilitation largely. So the purpose of the study was to develop a novel assistive device which can provide external cues during gait training in stroke patients. We hope the device could help therapists to enhance gait training efficiency.
In this study, a novel assisted device with external cues using sensors and embedded system was established. Three stroke patients were recruited and their gait performances and gait symmetry as outcome measures were collected by Vicon motion system and analyzed by SPSS20.0 to determine the intervention effects.
The results showed that when use the assistive device, subjects’ stride length increased 17.12% and 20.16% that used 1 and 2 lacer target respectively, step length of affected side increased 9.53% and 20.6%, step length of sound side increased 34.15% and 36.2%, single foot swing time of affected side increased 15.17% and 27.58%, and single foot swing time of sound side increased 21.29% and 10.18%. The step length symmetry also increase 10% and 26%. All of the above-mentioned parameters revealed clinical importance.
The device we developed has been basically proved to be helpful in stroke gait performance. It may be potentially useful in general clinical rehabilitation for normalizing walking patterns and performances in stroke patients.

目錄
摘要 I
Abstract III
目錄 V
圖目錄 IX
表目錄 XI
1-1 研究背景 1
1-2 研究目的 3
第二章 文獻回顧 5
2-1 中風的致病機轉與影響 5
2-2 中風患者的步態特徵及評量方式 6
2-3 中風患者之步態訓練 8
2-4文獻回顧總結 18
第三章 研究方法 19
3-1 系統設計與建置 19
3-1-1 外在提醒輔具之開發概念 19
3-1-2 視覺提醒介入 19
3-1-3 承重回饋介入 20
3-1-4外在提醒輔具之硬體開發 21
3-1-5 外在提醒輔具之軟體開發 24
3-1-6 外在提醒輔具之操作介面 25
3-2實驗設計 27
3-2-1 受試者條件 27
3-2-2 實驗方法 28
3-2-3 實驗環境 29
3-2-4 實驗流程 32
3-2-5 實驗參數 35
3-3 資料分析及統計方法 37
第四章 結果 39
4-1 受試者基本資料 39
4-2 口令提醒與跨步位置提醒分別對於步態參數之影響 40
4-2-1 步幅 41
4-2-2 步長與步長對稱性 42
4-2-3 步速 47
4-2-4 單腳擺盪時間與單腳擺盪時間對稱性 49
4-3 跨步位置提醒對於拐杖承重大小之影響 52
4-4使用者回饋問卷 53
第五章 討論 55
5-1 口令提醒與跨步位置提醒對於中風患者步態參數之影響 55
5-1-1 步幅表現 55
5-1-2 步長和對稱性表現 55
5-1-3 步速表現 57
5-1-4單腳擺盪時間與對稱性 58
5-2 單點與雙點跨步位置提示間之差異 59
5-2-1 步長對稱性表現 60
5-2-2 單腳擺盪時間與對稱性表現 61
5-3標準拐杖與四腳拐間步態對稱性之差異 62
5-3-1 步長對稱性表現 63
5-3-2 單腳擺盪時間與對稱性表現 64
5-4 外在提醒輔具之承重提示探討 65
5-5 受試者主觀感覺及回饋問卷探討 66
5-6 輔具介入時機探討 67
5-7 臨床價值探討 67
第六章 結論 71
參考文獻 72
附錄一 零件規格表 78
附錄二 台北榮總同意臨床試驗證明書 79
附錄三 簡易智能狀態量表 80
附錄四 Functional ambulatory category 81
附錄五 輔具使用回饋問卷 83

圖目錄
圖2-1 PNF運用於步態訓練 16
圖2-2傳統中風患者步態訓練方式 17
圖2-3虛擬實境步態訓練 18
圖2-4懸吊式步態訓練及Lokomat 20
圖2-5跨步對稱性訓練之視覺回饋腳踏車 23
圖2-6外在提示輔具 24
圖3-1跨步位置提醒示意圖 20
圖3-2 輔具整體外觀 23
圖3-3 輔具細部結構 24
圖3-4 嵌入式系統執行流程圖 25
圖3-5 輔具操作介面 26
圖3-6 實驗環境示意圖 30
圖3-7 反光球黏貼點(Plug-in gait model) 32
圖3-8 實驗流程 35
圖3-9 步態週期及步長定義 36
圖4- 1 步幅 42
圖4- 2患側腳步長 44
圖4- 3健側腳步長 45
圖4- 4 步長對稱性 47
圖4- 5步速 48
圖4- 6患側腳擺盪時間 50
圖4- 7健側腳擺盪時間 51
圖4- 8擺盪時間對稱性 52
圖4- 9拐杖最大承重佔體重百分比 53
圖5- 1 單、雙點跨步提示步長對稱性比較 61
圖5- 2 單、雙點跨步提示擺盪時間對稱性比較 62
圖5- 3 不同輔具步長對稱性比較 63
圖5- 4 不同輔具擺盪時間對稱性比較 65

表目錄
表3-1 操作流程說明 26
表3-2 反光求黏貼部位 31
表4-1受試者基本資料 39
表4-2受試者量表分數與輔具使用情形 40
表4-3 受試者回饋問卷 51

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