臺灣博碩士論文加值系統

根據美國勞工統計局於2014年的調查，醫護人員罹患肌肉骨骼疾病的案例佔全美國案例的46.9%且盛行率有逐漸上升的趨勢，僅次於運輸業及倉儲業，而最常發生肌肉骨骼疾病的部位為下背部及肩頸部，然而過去研究多針對下背部分進行探討，鮮少有針對肩膀等上肢肌肉進行研究，同時有學者指出搬運病患重量為造成肌肉骨骼疾病的ㄧ大風險因子，因此本研究將加入重量因子以探討救護人員在搬運不同重量的病患及執行不同搬運任務情形下，對上肢肌肉的負荷程度。
本研究採用較常見之表面肌電圖做為研究工具，而在肌電圖的分析方法中可分為時域分析及頻域分析方法，本研究在時域分析方法將使用EA值進行分析；在頻域方面將使用經過小波轉換及希伯爾特-黃轉換計算出的頻率相關指標觀察肌電訊號的活化程度；本研究共招募18名在職救護隊隊員擔任受試者，設計了6種任務及2種病患重量，並以搬運15公斤及23公斤的箱子做為徒手搬運標準比較基準，在搬運的過程中以肌電圖記錄上斜方肌、中斜方肌、前三角肌、中三角肌、鎖骨胸大肌、肱二頭肌、外腹斜肌、豎脊肌等八條肌肉的肌電訊號並依此進行後續分析。
研究結果顯示，當救護人員執行側舉軟式擔架及擔任使用軟式擔架將病人推移到病床上的協助者時，肩頸部分的肌肉產生了較高的肌肉活化程度；而在執行蹲舉長背板上擔架時則是在腰部的肌肉產生了較高的肌電訊號及平均頻率；同時於雙人任務中，使用軟式擔架將病人推移到病床上的協助者其肩膀附近的肌肉：前三角肌、中三角肌及鎖骨胸大肌的肌肉活化程度皆顯著的大於指揮者，而當執行將病人及長背板直立於地面時的指揮者其肌肉的肌肉活化程度除了豎脊肌外皆顯著的大於協助者，而當搬運病患重量不同時，肌肉活化程度較平均頻率容易看出兩者間是否有顯著的差異，而從Borg量表可發現救護人員並無法完全察覺各任務可能帶來之危害，可能因此造成救護人員的誤判而增加了受傷的風險。

According to the survey by BLS in 2014, the proportion of case of health care workers suffering from musculoskeletal disorders is 46.9% in America and there is an increasing trend in prevalence, second only to the transportation and warehousing industry. And the neck, lower back and shoulder are among the body that tend to be troublesome by musculoskeletal disorders. The past research, however usually focus on low back with a limited focus on the upper limb such as shoulder. Meanwhile, some scholars also indicate that the weight of the patient is an important risk factor that causes musculoskeletal disorders. Therefore this research would investigate the loading of upper limb muscles when performing the different types of patient-handling tasks.
We recruited 18 Emergency Medical Technicians (EMT) to participant in this research, there are six kinds of tasks and two kinds of patient weights handled, along with two benchmark boxes(15/23kg). We use Electromyography (EMG) to record muscle activity from Upper trapezius, Middle trapezius, Middle deltoid, Anterior deltoid, Pectoralis major, Biceps brachii, External oblique abdominis and Erector spinae. After post-signal processing, this research would calculate Electrical Activity value was used as an index in time domain; Frequency analyses are based on the resulting mean frequency after Wavelet and Hilbert-Huang transform.
The result indicated that side lifting patients and pushing the patients from a stretcher to a bed lead to higher muscle activity on neck and shoulder; lifting patients from the ground to the stretcher by longboard lead to greater muscle activity and increased mean frequency around the waist. Moreover, during the team task, the muscle activity around shoulder of the follower was higher than that of the leader while shifting the patient from the stretcher to the bed by a soft stretcher; and when uprighting the longboard with the patient, leader’s muscle activity tended to be higher than those from the follower in all muscles, except Erector spinae.
In conclusion, EA is more sensitive to the difference caused by muscle activity compared to mean frequency, we have found that the EMT can’t aware the risk of handling tasks fully based on subjective rating, and this in turn could increase the risk of injury because of the misjudgment.

摘要 I
Abstract II
誌謝 VII
簡寫對照表 VIII
目錄 IX
圖目錄 XIII
表目錄 XV
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 研究限制 3
1.4 研究架構 4
第二章 文獻探討 6
2.1 肌肉骨骼疾病 6
2.1.1 醫護人員與肌肉骨骼疾病 6
2.1.2 上肢肌肉選擇 7
2.1.3 實驗任務選擇 10
2.2 肌電圖(Electromyography) 10
2.2.1 肌電訊號分析 12
2.3 小波轉換 14
2.3.1 小波定義 16
2.3.2 小波轉換種類 16
2.3.3 小波轉換的應用 17
2.4 希爾伯特-黃轉換(Hilbert–Huang transform) 23
2.4.1 經驗模式分解(EMD) 23
2.4.2 希爾伯特轉換(Hilbert transform) 26
2.4.3 HHT的應用 27
第三章 研究方法 28
3.1 實驗設計 28
3.2 研究對象 29
3.3 研究設備 29
3.4 研究流程 33
3.5 實驗變項 38
3.5.1自變項 38
3.5.2 依變項 41
3.5.3 控制變項 42
3.6 實驗資料後處理分析 43
3.6.1 時域分析 43
3.6.2 頻域分析 44
3.7 統計分析 45
第四章 實驗結果 46
4.1 受試者基本資料 46
4.2 執行各任務時肌肉施力的結果 47
4.2.1 上斜方肌(UT)的肌肉活化程度 48
4.2.2 中斜方肌(MT)的肌肉活化程度 50
4.2.3 中三角肌(MD)的肌肉活化程度 52
4.2.4 前三角肌(AD)的肌肉活化程度 54
4.2.5 鎖骨胸大肌(PM)的肌肉活化程度 56
4.2.6 肱二頭肌(BB)的肌肉活化程度 58
4.2.7 外腹斜肌(EO)的肌肉活化程度 60
4.2.8 豎脊肌(ES)的肌肉活化程度 62
4.2.9 肌肉活化程度小結 64
4.3 執行各任務時肌肉之平均頻率(MNF)的結果 65
4.3.1 上斜方肌(UT)的平均頻率 66
4.3.2 中斜方肌(MT)的平均頻率 68
4.3.3 中三角肌(MD)的平均頻率 70
4.3.4 前三角肌(AD)的平均頻率 72
4.3.5 鎖骨胸大肌(PM)的平均頻率 74
4.3.6 肱二頭肌(BB)的平均頻率 76
4.3.7 外腹斜肌(EO)的平均頻率 78
4.3.8 豎脊肌(ES)的平均頻率 80
4.3.9 平均頻率小結 82
4.4 執行各任務的borg量表 83
4.4.1 手腕的RPE值 84
4.4.2 手臂的RPE值 86
4.4.3 肩膀的RPE值 88
4.4.4 頸部的RPE值 90
4.4.5 下背部的RPE值 92
4.4.6 上背部的RPE值 94
4.4.7 RPE值小結 96
4.5 執行部分任務的平均頻率(希爾伯特黃轉換) 97
4.5.1 上斜方肌之平均頻率(經希爾伯特黃轉換) 98
4.5.2 中斜方肌之平均頻率(經希爾伯特黃轉換) 100
4.5.3 外腹斜肌之平均頻率(經希爾伯特黃轉換) 102
4.5.4 豎脊肌之平均頻率(經希爾伯特黃轉換) 104
4.5.5 平均頻率小結(經希爾伯特黃轉換) 106
第五章 討論 107
5.1 肌肉活化程度(%MVE值) 107
5.2 平均頻率(MNF)-小波轉換 109
5.3 平均頻率(MNF)-希爾伯特黃轉換 110
5.4 Borg(CR-10)量表 111
第六章 結論與建議 113
參考文獻 114
附錄一、北歐肌肉骨骼問卷 120
附錄二、The Chinese Oswestry Disability Index (CODI) 129
附錄三、borg(CR-10)問卷 132
附錄四、肌肉活化程度(%MVE值)例圖 133
附錄五、訊號處理示意圖 137

中文文獻
邱珮鈴(2008)。人工搬運作業之動態評估與運動學分析。國立清華大學，新竹市。

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