臺灣博碩士論文加值系統

由於衛生與醫療體系的健全發展，人們的平均壽命逐年增加，加上出生率的低落使人口結構逐漸朝「高齡社會」邁進，屆時老年人口將超越14%。且高齡化社會已是全球開發或開發中國家皆須面臨的挑戰，足以左右經濟發展及產業型態。高齡者模擬體驗裝(Ageing suit)為老人服務產業與醫療院所之專業教學輔具，也是年輕人與老年人代間教育之工具，用於推廣高齡教育，使年輕人體驗高齡者因身體不適而造成的行動不便。但市售體驗裝肘關節處大多以束套拘束為主，並未針對老化後肘關節肌力下降數值進行設計。
本研究蒐集老年人與年輕人等長收縮之力矩數據，再利用柏格運動自覺量表縮小力矩，以此作為依據設計纏線凸輪輪廓，接著透過鋼索壓縮線性彈簧產生的張力以及隨凸輪輪廓改變的力臂，使得凸輪中心產生與屈曲方向相反的非線性力矩，藉此使穿戴者屈曲困難。且透過切換不同凸輪的方式，可使穿戴者簡單快速地模擬不同族群之高齡者。
本研究透過臨床平衡及協調性評估試驗，包含指鼻測驗、功能性前伸測試、上肢功能受損自評問卷。進行肘關節限制機構之功能評估，共有18名約為23歲、肘關節健康狀況良好之年輕受測者參與實驗。透過兩種穿著模式，包含正常情況之對照組、穿著肘關節機構實驗組，發現肘關節限制機構能有效降低受測者屈曲時肌肉收縮速度，並能針對不同年齡層作調整。而於臨床平衡評估測驗中，肘關節束套對於男性受測者影響較小、女性受測者則會影響其平衡性。

Since improved development of the health care system, the life expectancy has increased. Besides that, the declining birth rates will make Taiwan become aged society. This will influence the economic development and industry type. The adjustable elbow constrained mechanism for aging suit, which simulated the degeneration of the elbow because of the aging, let young people know how hard when elders flex their arm. This study collect the data of elbow flexion isometric contraction of the young, the elderly aged 60 and 70 then reduce the difference between the three groups by Borg’s cr10 scale. This study use the modified data to design the profiles of the four wrapping cams which can simulate the four kinds of the elderly respectively classified with gender and age. The method of designing a cam with desired torque function applied on the adjustable restrained elbow mechanism is available. And the way to change the different mode to simulate different people is easy and quick. This study tested the subjects wearing the adjustable elbow restrained mechanism by clinical test like functional reach test(FRT) and finger nose test. There are eighteen young and healthy subjects involving in these test. The mechanism is able to restrain the subject and make them feel hard to flex their arm. Besides, when doing finger-nose test, their arms were shaking and uncoordinated. And the precision was decreasing with the increasing of the extent of the difficulty. However, the weight and the method of fixing the holder are the thorny problems needed to be improved.

摘要 I
致謝 VI
目錄 VII
表目錄 X
圖目錄 XI
符號說明 XIV
第一章 緒論 1
1.1 前言 1
1.2 各國高齡者模擬體驗裝回顧 3
1.3 論文架構 7
第二章 研究背景 9
2.1 前臂的組成與動作 9
2.1.1 上肢之骨骼 9
2.1.2 前臂的動作 10
2.2 肌力量測方式 12
2.2.1 臨床常見的肘關節扭矩測量種類 12
2.2.2 測量儀器介紹 13
2.2.3 峰值力矩與測量速度之關係 14
2.2.4 數據選用 15
2.3 感知評量表 18
2.4 骨骼肌構造 21
2.5 老化對關節的影響 23
2.5.1 骨骼肌的老化 23
2.5.2 肌少症(Sarcopenia) 24
2.5.3 關節的老化 25
第三章 肘關節限制機構設計 26
3.1 肘關節等長收縮扭矩數據 26
3.2 纏線凸輪輪廓設計 29
3.2.1 非線性扭轉彈簧凸輪機構設計方法 29
3.2.2 纏線凸輪的限制 35
3.2.3 決定設計參數 39
3.3 機構加工與實體化 44
3.3.1 凸輪製作 44
3.3.2 支架製作 47
3.3.3 肘關節限制機構檢視 54
第四章 肘關節限制機構限制效果評估 56
4.1 扭矩值驗證實驗 56
4.1.1 實驗設備 56
4.1.2 實驗方法 58
4.1.3 實驗結果 60
4.2 上肢功能受損程度問卷(DASH) 62
4.3 指鼻測試 64
4.3.1 實驗介紹 64
4.3.2 實驗設備 64
4.3.3 實驗方法 65
4.3.4 實驗結果 67
4.4 功能性前伸測試 70
4.4.1 實驗介紹 70
4.4.2 實驗設備 71
4.4.3 實驗方法 72
4.4.4 實驗結果 73
第五章 結論與建議 76
5.1 結論 76
5.2 未來發展與建議 77
參考文獻 78
附錄A Disabilities of the Arm, Shoulder and Hand (DASH) 83

AgeLab, M. I. o. T. (2012). Age Gain Now Empathy System(AGNES). http://agelab.mit.edu/agnes-age-gain-now-empathy-system.
Boone, D. C. and Azen, S. P. (1979). Normal range of motion of joint in male subjects. Journal of Bone and Joint Surgery-American Volume 61(5): 756-759.
Borg, G. A. V. (1982). Psychophysical bases of perceived exertion. Plastic and Reconstructive Surgery 14(5): 377-381.
Brusse, K. J., Zimdars, S., Zalewski, K. R. and Steffen, T. M. (2005). Testing functional performance in people with Parkinson disease. Phys Ther 85(2): 134-141.
Carola, R., Harley, J. P. and Noback, C. R. (2000). Human Anatomy. New York, USA, McGraw-Hill.
Chen, L. K., Liu, L. K., Woo, J., Assantachai, P., Auyeung, T. W., Bahyah, K. S., Chou, M. Y., Chen, L. Y., Hsu, P. S., Krairit, O., Lee, J. S. W., Lee, W. J., Lee, Y., Liang, C. K., Limpawattana, P., Lin, C. S., Peng, L. N., Satake, S., Suzuki, T., Won, C. W., Wu, C. H., Wu, S. N., Zhang, T., Zeng, P., Akishita, M. and Arai, H. (2014). Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia. Journal of the American Medical Directors Association. 15: 95-101.
Danneskiold-Samsoe, B., Bartels, E. M., Bulow, P. M., Lund, H., Stockmarr, A., Holm, C. C., Watjen, I., Appleyard, M. and Bliddal, H. (2009). Isokinetic and isometric muscle strength in a healthy population with special reference to age and gender. Acta Physiol (Oxf) 197 Suppl 673: 1-68.
Desrosiers, J., Hebert, R., Bravo, G. and Dutil, E. (1995). Upper-extremity motor co-ordination of healthy elderly people. Age and Ageing 24(2): 108-112.
Duncan, P., Studenski, S., Richards, L., Gollub, S., Lai, S. M., Reker, D., Perera, S., Yates, J., Koch, V., Rigler, S. and Johnson, D. (2003). Randomized clinical trial of therapeutic exercise in subacute stroke. Stroke 34(9): 2173-2180.
Duncan, P. W., Weiner, D. K., Chandler, J. and Studenski, S. (1990). Functional reach: a new clinical measure of balance. J Gerontol 45(6): M192-197.
Escalante, A., Lichtenstein, M. J. and Hazuda, H. P. (1999). Determinants of shoulder and elbow flexion range: results from the San Antonio Longitudinal Study of Aging. Arthritis Care Res 12(4): 277-286.
Fornalski, S., Gupta, R. and Lee, T. Q. (2003). Anatomy and biomechanics of the elbow joint. Sports Medicine and Arthroscopy Review 11(1): 1-9.
Frey-Law, L. A., Laake, A., Avin, K. G., Heitsman, J., Marler, T. and Abdel-Malek, K. (2012). Knee and Elbow 3D Strength Surfaces: Peak Torque-Angle-Velocity Relationships. Journal of Applied Biomechanics 28(6): 726-737.
Frontera, W. R., Hughes, V. A., Fielding, R. A., Fiatarone, M. A., Evans, W. J. and Roubenoff, R. (2000). Aging of skeletal muscle: A 12-yr longitudinal study. Journal of Applied Physiology 88(4): 1321-1326.
Frontera, W. R., Hughes, V. A., Lutz, K. J. and Evans, W. J. (1991). A cross-sectional study of muscle strength and mass in 45- to 78-yr-old men and women. Journal of Applied Physiology 71(2): 644-650.
Genworth. (2015). Genworth R70i News. https://www.genworth.com/lets-talk/r70i-aging-experience/long-term-care-news.html.
GUJI, G. (2013). 肌肉（二）. http://www.gujiguji.org/archives/137.
Hageman, P. A., Leibowitz, J. M. and Blanke, D. (1995). Age and gender effects on postural control measures. Archives of Physical Medicine and Rehabilitation 76(10): 961-965.
Harbo, T., Brincks, J. and Andersen, H. (2012). Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. European Journal of Applied Physiology 112(1): 267-275.
Harrison, A. L. (2004). The influence of pathology, pain, balance, and self-efficacy on function in women with osteoarthritis of the knee. Phys Ther 84(9): 822-831.
Hospital, Q. M. Chinese (Queen Mary Hostpital, Hong Kong version) DASH. http://www.dash.iwh.on.ca/available-translations.
Hunter, S. K. and Enoka, R. M. (2001). Sex differences in the fatigability of arm muscles depends on absolute force during isometric contractions. Journal of Applied Physiology 91(6): 2686-2694.
John, E. B., Liu, W. and Gregory, R. W. (2009). Biomechanics of muscular effort: Age-related changes. Medicine and Science in Sports and Exercise 41(2): 418-425.
Kim, B. and Deshpande, A. D. (2014). Design of nonlinear rotational stiffness using a noncircular pulley-spring mechanism. Journal of Mechanisms and Robotics 6(4).
Knapik, J. J., Wright, J. E., Mawdsley, R. H. and Braun, J. (1983). Isometric, isotonic, and isokinetic torque variations in four muscle groups through a range of joint motion. Physical Therapy 63(6): 938-947.
Larsson, L., Grimby, G. and Karlsson, J. (1979). Muscle strength and speed of movement in relation to age and muscle morphology. Journal of Applied Physiology Respiratory Environmental and Exercise Physiology 46(3): 451-456.
London, J. T. (1981). Kinematics of the elbow. Journal of Bone and Joint Surgery - Series A 63(4): 529-535.
Mann, G. C., Whitney, S. L., Redfern, M. S., Borello-France, D. F. and Furman, J. M. (1996). Functional reach and single leg stance in patients with peripheral vestibular disorders. J Vestib Res 6(5): 343-353.
Mehmet, K., Yigit, Y. and Dilek Funda, K. (2012). Synthesis of a torsional spring mechanism with mechanically adjustable stiffness using wrapping cams. Mechanism and Machine Theory 57: 27-39.
Miller, T. A., Allen, G. M. and Gandevia, S. C. (1996). Muscle force, perceived effort, and voluntary activation of the elbow flexors assessed with sensitive twitch interpolation in fibromyalgia. J Rheumatol 23(9): 1621-1627.
Morley, J. E., Abbatecola, A. M., Argiles, J. M., Baracos, V., Bauer, J., Bhasin, S., Cederholm, T., Stewart Coats, A. J., Cummings, S. R., Evans, W. J., Fearon, K., Ferrucci, L., Fielding, R. A., Guralnik, J. M., Harris, T. B., Inui, A., Kalantar-Zadeh, K., Kirwan, B. A., Mantovani, G., Muscaritoli, M., Newman, A. B., Rossi-Fanelli, F., Rosano, G. M. C., Roubenoff, R., Schambelan, M., Sokol, G. H., Storer, T. W., Vellas, B., von Haehling, S., Yeh, S. S. and Anker, S. D. (2011). Sarcopenia With Limited Mobility: An International Consensus. Journal of the American Medical Directors Association 12(6): 403-409.
Morrey, B. F., Askew, L. J., An, K. N. and Chao, E. Y. (1981). A biomechanical study of normal functional elbow motion. Journal of Bone and Joint Surgery - Series A 63(6): 872-877.
Morrey B. F., and Chao, E. Y. (1976). Passive motion of the elbow Joint. Journal of Bone and Joint Surgery-American Volume 58(4): 501-508.
Morrey B. F., and S-S., J. (2008). The Elbow and Its Disorder. China, ELSEVIER: 80.
NASA. (2004). LIDO Active Isokinetic Multi-Joint Dynamometer. https://lsda.jsc.nasa.gov/scripts/hardware/hardw.aspx?hardware_id=309.
Norman, G. (2003). Hi! How are you? Response shift, implicit theories and differing epistemologies. Qual Life Res 12.
Power, G. A., Allen, M. D., Gilmore, K. J., Stashuk, D. W., Doherty, T. J., Hepple, R. T., Taivassalo, T. and Rice, C. L. (2016). Motor unit number and transmission stability in octogenarian world class athletes: can age-related deficits be outrun? Journal of Applied Physiology.
Press, A. (2008). 'Aging suit' helps develop cars for older drivers. http://www.nbcnews.com/id/27200093/ns/business-autos/t/aging-suit-helps-develop-cars-older-drivers/#.WWWAzYR96Ul.
Prospector. Acetal Typical Properties Generic Acetal (POM) Copolymer. https://plastics.ulprospector.com/generics/2/c/t/acetal-properties-processing.
Roubenoff, R. (2003). Sarcopenia: Effects on Body Composition and Function. Journals of Gerontology - Series A Biological Sciences and Medical Sciences 58(11): 1012-1017.
Runnels, E. D., Bemben, D. A., Anderson, M. A. and Bemben, M. G. (2005). Influence of age on isometric, isotonic, and isokinetic force production characteristics in men. Journal of geriatric physical therapy (2001) 28(3): 74-84.
Sebesi, S. B., Groza, H. L., Ianoşi, A., Dimitrova, A. and Mândru, D. (2016). Specific issues of the design for the elderly. IOP Conference Series: Materials Science and Engineering 147: 012049.
Thapa, P. B., Gideon, P., Fought, R. L., Kormicki, M. and Ray, W. A. (1994). Comparison of clinical and biomechanical measures of balance and mobility in elderly nursing home residents. J Am Geriatr Soc 42(5): 493-500.
Tzankoff, S. P. and Norris, A. H. (1977). Effect of muscle mass decrease on age-related BMR changes. Journal of Applied Physiology Respiratory Environmental and Exercise Physiology 43(6): 1001-1006.
Vitiello, N., Lenzi, T., Roccella, S., De Rossi, S. M. M., Cattin, E., Giovacchini, F., Vecchi, F. and Carrozza, M. C. (2013). NEUROExos: A powered elbow exoskeleton for physical rehabilitation. IEEE Transactions on Robotics 29(1): 220-235.
William C. Beam , G. M. A. (2003). Exercise Physiology Laboratory Manual. Europe, McGraw-Hill Education.
行政院經濟建設委員會 (2017). 中華民國人口推估(105至150年)報告. 臺灣.
辛, 和. (2011). 老人生理學. 臺灣, 華格那企業有限公司.
富誠醫療儀器健康中心設備. (2009). 模擬高齡者體驗裝置. http://tw.fubio.com/www/prodshow.asp?ProdId=FLO6852.
黃, 凱. (2013). 高齡者模擬體驗裝之設計與穩定性評估. 臺灣, 國立成功大學機械工程研究所, 碩士論文.