研究背景：中風屬上運動神經元損傷，接受復健治療後，患者還是有可能會有殘留的症狀，因此臨床上常使用踝足矯具輔助病患。過去研究指出傳統踝足矯具可以提供踝關節穩定度，進一步改善平衡及行走能力。但傳統踝足矯具因提供穩定度，降低踝關節附近肌肉的使用、且因包覆性太高而使病患感到不舒適。研究目的：本研究設計一新式踝足矯具，探討新式踝足矯具對中風患者平衡及步行能力之影響。研究方法：本實驗納入15位受測者，使用Noraxon肌電儀於行走測試時收集踝關節內翻角度以及脛前肌與外側腓腸肌之肌電訊號，另外以Zebris 測力板做靜止站立測試以及穩定限度測試。以魏克生符號檢定分析比較受測者在穿戴新式踝足矯具前後，步行時患側腳踝關節內翻角度變化、脛前肌與外側腓腸肌肌電圖電位強度、靜止站立時患側腳承重量、壓力中心移動距離以及穩定限度之差異。結果與討論：穿戴新式踝足矯具後，步行時踝關節內翻角度顯著下降；步行時站立期之外側腓腸肌肌電圖電位強度顯著降低；往患側邊之穩定限度顯著增加。結論：穿戴新式踝足矯具後，在步行時踝關節內翻角度、站立期之外側腓腸肌肌電圖電位強度、與往患側邊之穩定限度達到統計上之顯著差異。對於新式踝足矯具來說，雖然塑料包覆範圍較小，亦能提供踝關節穩定度，減少步行時踝關節內翻角度，改善往患側腳方向之穩定限度能力。

Background: Stroke belongs to upper motor neuron injury. After rehabilitation, patients may still have residual disability. In clinical, therapists often use ankle-foot orthosis (AFO) to assist patients. Previous studies have suggested that traditional AFO can provide ankle stability and further improve balance and walking ability. However, the traditional AFO provides stability leading to reduce the use of muscle surrounding ankle joint. Besides, patients are uncomfortable because of its high coverage. The aim of the present study was to evaluate the effects of new designed AFO on ankle and postural control in patients with stroke. Methods: Fifteen patients with stroke were administered the walking test, static standing test and limit of stability test. Statistical Analysis: Wilcoxon signed-rank test was used to test for statistical significance (p<0.05). Results: When compared with using no AFO, the new designed AFO significantly decreased the maximal ankle inversion angle at heel strike (p=.001), subjects exhibited significantly less lateral gastrocnemius muscle electromyography during the stance phase of gait (p=.044), and the limit of stability on the affected side was improved significantly (p=.031). Conclusion: Based on our outcomes, new designed AFO can also support ankle providing stability.

誌謝 i
中文摘要 ii
英文摘要 iii
目錄 iv
圖目錄 vi
表目錄 vii

第一章　緒論 1
第一節　研究背景與動機 1
第二節　研究目的 4
第三節　研究假設 5
第二章　文獻探討 6
第一節　中風患者常見損傷 6
第二節　中風患者之平衡能力與步行能力 8
第三節　中風患者常用之踝足矯具 11
第四節　踝足矯具對中風患者之踝關節及姿勢控制之影響 15
第五節　文獻總結 17
第三章　研究方法 18
第一節　研究設計 18
第二節　研究對象 19
第三節　實驗地點及時間 20
第四節　實驗儀器及設備 21
第五節　測量變項 24
第六節　實驗流程與方法 26
第七節　資料分析與處理 31
第四章　結果 33
第一節　受測者基本資料 33
第二節　前後測差異之結果 34
第三節　步行時踝關節內翻角度差異之結果 34
第四節　步行時肌電圖電位強度差異之結果 36
第五節　靜止站立時患側腳承重差異之結果 38
第六節　靜止站立時壓力中心移動距離差異之結果 41
第七節　穩定限度差異之結果 42
第五章　討論 46
第六章　結論與建議 50
第一節　結論 50
第二節　建議 51
參考文獻 52
附錄 55

1. Jang SH, Lee MH, &Kim KD. (2015) The influence of an ankle foot orthosis on the percentage of weight loading during standing tasks in stroke patients. J Phys Ther Sci. 27(9):2887-90. doi: 10.1589/jpts.29.2887.
2. Geiger RA, Allen JB, O''Keefe J, &Hicks RR. (2001) Balance and mobility following stroke: effects of physical therapy interventions with and without biofeedback/forceplate training. Phys Ther. 81(4):995-1005.
3. Hendrickson J, Patterson KK, Inness EL, McIlroy WE, &Mansfield A. (2014) Relationship between asymmetry of quiet standing balance control and walking post-stroke. Gait Posture. 39(1):177-81. doi: 10.1016/j.gaitpost.2013.06.022.
4. Sheffler LR, &Chae J. (2015) Hemiparetic Gait. Phys Med Rehabil Clin N Am. 26(4):611-23. doi: 10.1016/j.pmr.2015.06.006.
5. Wang RY, Yen Lu, Lee CC, Lin PY, Wang MF, &Yang YR. (2005) Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations. Clin Rehabil. 19(1):37-44.
6. Pohl M, &Mehrholz J. (2006) Immediate effects of an individually designed functional ankle-foot orthosis on stance and gait in hemiparetic patients. Clin Rehabil. 20(4):324-30.
7. Chen CL, Teng YL, Lou SZ, Chang HY, Chen FF, &Yeung KT. (2014) Effects of an anterior ankle-foot orthosis on walking mobility in stroke patients: get up and go and stair walking. Arch Phys Med Rehabil. 95(11):2167-71. doi: 10.1016/j.apmr.2014.07.408.
8. Lairamore C, Garrison MK, Bandy W, &Zabel R. (2011) Comparison of tibialis anterior muscle electromyography, ankle angle, and velocity when individuals post stroke walk with different orthoses. Prosthet Orthot Int. 35(4):402-10. doi: 10.1177/0309364611417040.
9. Bregman DJ, Harlaar J, Meskers CG, &de Groot V. (2012) Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work. Gait Posture. 35(1):148-53. doi: 10.1016/j.gaitpost.2011.08.026.
10. O''Sullivan SB, &Schmitz TJ. (2007) Physical Rehabilitation. Philadelphia, PA: F.A. Davis.
11. Horak FB (2006) Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 35 Suppl 2:ii7-ii11.
12. Genthon N, Rougier P, Gissot AS, Froger J, Pélissier J, &Pérennou D. (2008) Contribution of each lower limb to upright standing in stroke patients. Stroke. 39(6):1793-9. doi: 10.1161/STROKEAHA.107.497701.
13. Newton RA. (2001) Validity of the multi-directional reach test: a practical measure for limits of stability in older adults. J Gerontol A Biol Sci Med Sci. 56(4):M248-52.
14. Hwang WJ, Kim JH, Jeon SH, &Chung Y. (2015) Maximal lateral reaching distance on the affected side using the multi-directional reach test in persons with stroke. J Phys Ther Sci. 27(9):2713-5. doi: 10.1589/jpts.27.2713.
15. Faraldo-García A, Santos-Pérez S, Crujeiras R, &Soto-Varela A. (2016) Postural changes associated with ageing on the sensory organization test and the limits of stability in healthy subjects. Auris Nasus Larynx. 43(2):149-54. doi: 10.1016/j.anl.2015.07.001.
16. Balaban B, &Tok F. (2014) Gait disturbances in patients with stroke. PM R. 6(7):635-42. doi: 10.1016/j.pmrj.2013.12.017.
17. Chen CC, Hong WH, &Wang CM et al. (2010) Kinematic features of rear-foot motion using anterior and posterior ankle-foot orthoses in stroke patients with hemiplegic gait. Arch Phys Med Rehabil. 91(12):1862-8. doi: 10.1016/j.apmr.2010.09.013.
18. National Health Service Quality Improvement Scotland (2009) Best practice statement ~ use of ankle-foot orthoses following stroke. from the website: http://www.nhshealthquality.org/nhsqis/files/ANKLEFOOT_BPS_AUG09.pdf
19. Wu SH. (1992) An Anterior Direct Molding Ankle-Foot Orthosis. J Occup Ther Assoc ROC. 10:75-82.
20. Chisholm AE, &Perry SD. (2012) Ankle-foot orthotic management in neuromuscular disorders: recommendations for future research. Disabil Rehabil Assist Technol. 7(6):437-49. doi: 10.3109/17483107.2012.680940.
21. Kim JH, Sim WS, &Won BH. (2015) Effectiveness of elastic band-type ankle-foot orthoses on postural control in poststroke elderly patients as determined using combined measurement of the stability index and body weight-bearing ratio. Clin Interv Aging. 10:1839-47. doi: 10.2147/CIA.S92888.
22. Chen CL, Chen FF, Lin CH, Lou SZ, Chang HY, &Yeung KT. (2015) Effect of Anterior Ankle-Foot Orthoses on Weight Shift in Persons With Stroke. Arch Phys Med Rehabil. 96(10):1795-801. doi: 10.1016/j.apmr.2015.05.003.
23. Norkin CC, &White DJ (2009) Measurement of Joint Motion : A Guide to Goniometry. Philadelphia, PA: F.A. Davis.
24. Kitatani R, Ohata K, &Sato S et al. (2016) Ankle muscle coactivation and its relationship with ankle joint kinematics and kinetics during gait in hemiplegic patients after stroke. Somatosens Mot Res. 33(2):79-85. doi: 10.1080/08990220.2016.1178636.
25. Romkes J, &Brunner R. (2002) Comparison of a dynamic and a hinged ankle-foot orthosis by gait analysis in patients with hemiplegic cerebral palsy. Gait Posture. 15(1):18-24.
26. Chen CL, Yeung KT, Wang CH, Chu HT, &Yeh CY. (1999) Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients. Arch Phys Med Rehabil. 80(12):1587-92.