臺灣博碩士論文加值系統

跌倒是老人或中風病患常見的傷害之一，也是老年人事故的死因之一，其可能導致老人或中風病患的獨立活動功能喪失，進一步加速身體功能的退化，帶來家庭與社會的龐大支出。故本研究旨在觀察不同族群(健康年輕人、健康老人、中風患者)站立前伸觸壓按鈕的變異，利用距離的增加，觀察人體接近失去平衡的過程中，相關之生物力學變數，並找出可能造成跌倒的相關因子。本實驗招收健康年輕人、健康老人和中風病患，利用三維動作捕捉系統、無線肌電儀和六軸測力板，讓受測者進行站立前伸的動作。由簡單的穩定極限之動作控制為基準，發現年輕人比老年人可以摸得更遠，除了身體本身肌肉的延展外，還加上了踝關節的策略，從肌肉的活化程度，年輕人會用較多的腓腸肌（Gastrocnemius），而老年人和中風病患皆在股二頭肌（Biceps femoris）上有較顯著的表現，在COP的移動軌跡方面，老年人與中風患者都有明顯向斜前方移動的表現，導致臀中肌(Gluteal medium)須要使用較多的力量，而年輕人的足底壓力軌跡都是向前的部分比較多，老人則是兩側移動，推估可能也是老人容易跌倒的重點之一。此研究結果日後回饋於臨床訓練人員，希望能夠藉由訓練病患應付正常生活常見之站立前伸動作，降低老人或中風患者的跌倒機率。

Fall is one of the most common leading causes to accelerate the degradation of physical function especially in the elderly and in the patients with stroke. Current study aimed to investigate the postural control and biomechanical strategies during standing reaching in healthy young controls, the elderly and patients with stroke. Subjects in each of the healthy controls, the elderly, and stroke group were recruited. Three-dimensional motion capture system, wireless electromyography system and force plates were used to collect motion data during standing reaching with difference distance until limit of stability. Objective biomechanical indices, namely joint angles and moments at hip, knee, and ankle as well as ground reaction force and electromyography variables during reaching tasks were calculated and compared between conditions and between groups. It was found that the young controls were able to reach further than the elderly, not only using the extensor of the trunk, but also using the ankle strategy. From the measurement of muscle activation, we found that the young subject used more gastrocnemius, while the elderly and the patients with stroke used more biceps femoris. In terms of center of pressure movement trajectory, the movement trajectory of the young people shift more anteriorly. Study design of forward reaching was established with preliminary results. Continuing study with more profound analysis is warranted to identify related factors which may cause loss of stability and falls and to provide more insight for the prevention of falls.

謝誌 III
Abstract IV
中文摘要 V
目錄 VI
圖目錄 X
表目錄 XI
附錄目錄 XII
第一章、緒論 1
1.1研究背景與動機 1
1.2文獻回顧 2
1.2.1姿勢與跌倒風險之動作控制相關研究 2
1.2.2老化對姿勢控制之影響 2
1.2.3中風對姿勢控制之影響 3
1.2.4站立穩定限度Limit of Stability 4
1.3研究目的 15
1.4研究假設 16
第二章、材料與方法 17
2.1實驗對象 18
2.1.1健康人納入條件 18
2.1.2中風患者納入排除條件 18
2.2實驗設備 19
2.2.1動作捕捉系統 19
2.2.2表面肌電圖儀 19
2.2.3三軸測力板 20
2.2.4自製按鈕 20
2.3實驗流程 21
2.3.1實驗室硬體系統校正 21
2.3.2受試者準備與校正 22
2.3.3站立向前觸摸動作測試 23
2.4實驗週期定義 27
2.4受試者基本資料與理學評估檢查表 28
2.5資料分析 29
2.5.1人體座標系統 29
2.5.2肌電圖分析 31
2.5.3測力板所得參數分析 31
2.5.4手臂移動速度分析 31
2.5.5Center of Mass (COM)以及Center of Pressure (COP)關係之參數 32
2.6統計分析 32
第三章、研究結果 33
3.1髖關節、膝關節、踝關節角度與腳跟離地狀態 34
3.2 髖關節、膝關節、踝關節角度與腳跟離地狀態 35
3.3髖關節、膝關節、踝關節角度與腳跟離地狀態 36
3.4髖關節、膝關節、踝關節角度與腳跟離地狀態 37
3.5髖關節、膝關節、踝關節角度與腳跟離地狀態 38
3.6 髖關節、膝關節、踝關節角度與腳跟離地狀態 39
3.7肩峰旋轉角度 40
3.3 Sway Area 42
3.4 EMG活化程度 44
3.5 COP-COM角度 50
3.6手部移動軌跡 52
3.7 為什麼又重複 53
第四章 討論 64
第五章 結論與臨床運用 65
第六章 參考文獻 66
附錄 76
人體試驗計畫同意函 88
89

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