本研究目的在探討不同情境樓梯高度下使用不同拐杖長度對於年長者肌力及平衡的影響。隨著年齡增長，在生理上出現退化現象，影響日常生活而造成不便。生理的退化使得行走出現困難、步態改變，容易發生跌倒現象，也因此跌倒事故常成為年長者死亡原因。多數的跌倒現象發生於輕度至中等移位，如走路、上下樓梯、改變位置；除一般常見階梯環境外，市區公車亦為年長者常接觸之階梯環境，而「上下車」常使年長者擔心失去平衡而跌倒。良好輔具可以克服年長者退4化所產生的障礙、補償身體機能上的老化或是行動力受限。過去關於拐杖使用與跌倒之間關係常受許多爭論，並對於何謂正確拐杖長度提出不同看法。適當拐杖長度為能使手肘呈現15°~30°，提供手肘適當的伸縮空間，因此也為一般建議的拐杖長度。而地板至股骨大轉子及地板至手腕亦為使用拐杖時長度指標。因此本研究欲探討在四種環境階梯高度下 1.平地(0cm)、2. 家中樓梯(18cm)、3. 低底盤客運(27cm)以及4. 傳統公車(33cm)下，使用四種拐杖長度a. 地板至股骨大轉子、b. 地板至手腕、c. 手肘呈現15°~30°及d. 無持拐杖，對於年長者生心理之影響。在生理方面，針對每位年長者肌電反應 (Electromyogram, EMG)以及壓力中心點(Center of Pressure, CoP)進行生理量測並分別將其轉換為均方根(Root Mean Square, RMS)、傳統指標以及多尺度熵(MSE)做分析，搭配主觀問卷了解受測者感受。
根據本研究結果發現，當高度越高時拿持任何拐杖下樓梯，手部施力將越大，雙腳亦出現相同情形。然比較0公分及18公分階梯狀態，18公分雙腳施力反而會較在平地時來的小。而拐杖長度對於肌肉施力並不具明顯影響。在平衡傳統指標方面，高度越高，搖晃程度逐漸下降。平衡多尺度熵方面，高度越高，複雜度將會逐漸下降。當使用柺杖長度較短時，會產生較高左右方向的晃動。而在心理方面，高度越高的環境以及較短的拐杖對於年長者心理感受較為不適，相對的使用較長的柺杖則帶給年長者較為穩固、好執行動作的感受。透過研究結果，期望於未來能提供不同需求年長者一個較好的柺杖使用建議，此外並能於未來環境設施規畫時能提供一個良好的參考。

The purpose of the study is to realize muscle strength and body balance when elderly getting down from different height of stairway with different cane length. As people grow older, there will appear degeneration on physiology and as a result cause inconvenience in life. The phenomenon often leads to difficulty in walking, gait changing and fall easily which became the common reason of death in elderly. Fall accident often arises from the shift of position, such as walking, stepping up and down. Besides, city bus is one of transportation elderly used. However, losing balance was one of worried thing when getting up and down the bus in the past investigation. Using cane might be the one assistance that can conquer difficulty in the mobility and reduce obstacle with degeneration. Nevertheless, there were lots of disputation between using cane and fall. Furthermore, researchers held different opinions on correct cane length. Proper cane length can offer elbow ideally flex between 15 to 30 degrees and which usually as a recommended cane length. According to suggestion, the floor to the greater trochanter and the floor to the distal wrist crease are the index of cane length. Thus, the study is to explore the impact of physiology and psychology in four types of environment 1.Level (0cm), 2.Stair in home (18cm), 3.Low floor bus (27cm), & 4.Traditional bus (33cm) with four types of cane length. The study measured EMG, CoP signal and then comparing to psychological data to realize the subjects’ condition.
The results showed the higher stair the more arm strength and both leg strength they used with any types of cane length. However, when both leg stepped down from 18 cm stair, the force were lower than when get down from 0cm. All RMS value had no significant impact in cane length. Oppositely, CoP Stabilometric Parameters showed elderly swayed smaller when stair higher but MSE value was lower. It had medial lateral sway when using shorter cane length. In psychology, the higher stair environment and shorter cane length often caused elderly feel uncomfortable. Longer cane length would make elderly feel stable and safe relatively. Finally, we expect that we can provide a better suggestion to elderly who need using cane through our research, in addition, supply a good reference for environment facility plan in the future.

摘要 i
ABSTRACT iii
誌謝 v
目錄 vii
表目錄 xi
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 3
第三節 研究目的 4
第四節 研究架構 5
第二章 文獻探討 8
第一節 年長者之生理 8
2.1.1 肌力 8
2.1.2 平衡 10
2.1.3 跌倒 10
第二節 環境高度 12
2.2.1 家中樓梯環境 12
2.2.2 低底盤公車及規範 13
第三節 拐杖 17
2.3.1 拐杖的對於年長者影響 17
2.3.2 適當長度及拐杖長度量測方法 18
第四節 肌電訊號(Electromyogram, EMG) 19
2.4.1 肌電訊號(EMG) 19
2.4.2 肌電訊號與樓梯相關研究 20
2.4.3 肌肉部位介紹 22
第五節 壓力中心點(Center of Pressure, COP) 23
2.5.1 壓力中心點(COP) 23
2.5.2 傳統指標 25
2.5.3 多尺度熵 26
第三章 研究方法 28
第一節 實驗介紹 28
3.1.1 研究對象與條件限制 28
3.1.2 研究儀器設備及環境 29
3.1.3 實驗流程 32
3.1.4 實驗變項設計 33
第二節 分析流程 37
第三節 分析方法 37
3.3.1 EMG傳統指標 37
3.3.2 COP傳統指標 38
3.3.3 多尺度熵 42
第四節 統計資料分析 45
第四章 實驗數據分析 47
第一節 EMG訊號分析 47
4.1.1 動作初期 49
4.1.2 動作後期 54
第二節 COP數據分析 59
4.2.1 傳統指標 59
4.2.1.1 動作初期 60
4.2.1.2 動作後期 80
4.2.2 多尺度熵(Multiscale Entropy, MSE) 80
4.2.2.1 動作初期 81
4.2.2.2 動作後期 84
第三節 問卷分析結果 87
第五章 討論 117
第六章 結論及建議 126
附錄一 受試者同意書 135
附錄二 行為與社會科學研究倫理審查合可證明 143
附錄三 分析結果長條圖細目內容 144

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