臺灣博碩士論文加值系統

背景：慢性踝關節不穩（CAI）是由踝關節反覆扭傷至少兩次扭傷的病史發展而來，造成踝關節有關節不穩的徵象。 CAI 機制通常發生在站立階段，當它有其外力、不正確的腳放置或在行走過程中快速停止時，會產生關節不穩的問題。患有 CAI 的人會存在生活品質下降，包括：身體活動、關節運動、關節位置感和行走等活動中的平衡控制下降。近來因研究技術的先進更新，我們利用多段足部模型 (MSFM)，例如：帶有 Plug-in-Gait 的牛津足部模型，進行時空變量、足部運動、下肢運動學、下肢動力學和內側縱向足弓位移 (MLA) ，來解釋慢性踝關節不穩 （CAI） 在動態任務中可能的運動策略的變化，例如：平地行走（單次行走和連續性行走）。
目的：本論文研究主要目的為： 1）確認在健康和CAI組中單次和繼續行走時的可靠性；2）比較CAI 與健康參與者在平地行走期間以不同速度進行單次行走和連續性行走任務時的運動策略評估；3）CAI 患者在不同速度下採用的運動策略。
研究設計：觀察性研究設計（橫斷面研究）。
方法：本研究招募三十六位受試者，分別為 18 名參與者（9 男 9 女）經問卷確認有 CAI 作為實驗組和 18 名健康年齡和 BMI 匹配作為健康對照組，通過檢定力分析（G*power，Universität），確認參與者的人數。使用牛津足部模型 (OFM) 的嵌入式步態 (PiG)模組，來捕捉裸足條件下參與者的行走的時空參數、下肢關節運動學、動力學等特徵參數。我們以自定的步速、快速（140 bpm）和慢速（80 bpm）平地行走期間收集每組受試者的行走數據。
統計分析：使用獨立 t 檢驗，在各組的人體計測資料和時空參數之間進行比較，顯著性水平定義為 p 值 < 0.05。使用統計參數映射 （SPM SPM1D v.0.4 2017） 對行走時期中站立階段的下肢各關節運動學的所有參數、下肢動力學數據和足部內側縱弓 (MLA) 的位移進行比較，具有 p 值 < 0.05 處定義為顯著性水平。
結果：在單次步行中，和健康對照組相比之下，CAI 實驗組在三種步行速度下的踝關節內翻和內旋明顯地增加（P < 0.05）。增加後足倒置表現為明顯地在自選和慢速下呈現（P < 0.05）。對於關節力矩和力量的比較，所有三種步行速度下，CAI 組在足跟觸地期間顯示出增加的膝關節附加力矩和在中間站姿期間減少的膝關節內收力矩（P <0 .05）。在自選速度中，CAI 組在最終站立時膝關節離心收縮減少。在慢速下，CAI 患者的膝關節內旋力矩增加，但踝關節內旋力矩降低 (P < 0.05)。在連續步行中，與健康對照組相比，CAI 患者在所有三種步行速度下的踝關節和後足的內翻均有所增加（P < 0.05）。在快速速度中，CAI 在中間站立時增加了膝關節內旋（P < 0.05）。在慢速行走下，CAI 組顯示向上傾斜的減少。在關節力矩和功率方面，行走速度快的CAI組其髖外旋和膝內收力矩顯著增加（P < 0.05）。在自選速度中，CAI 組的踝關節背屈力矩降低，踝關節向心力增加。在慢速時，CAI組膝關節內旋力矩減小。CAI組在單次和連續行走中，自選速度期間，顯示時空變量其降低節奏（P = 0.018）、增加步頻（P = 0.012）、步幅時間（P = 0.019）和雙支撐時間（P = 0.023）。
結論：這項研究結果顯示患有踝關節不穩的個案表現出他們的動態活動適應改變，這可能是導致再次受傷復發率的潛在先兆。不同的步行速度和任務速度代表了CAI的動態活動方式的改變。因此，當我們想將治療應用於患有 CAI 的個案時，我們應考慮為他們設計特定的任務，而步行速度可以是我們進行臨床介入或研究分析時必需考慮的標準之一。
關鍵詞：慢性踝關節不穩；運動學；動力學;時空參數；內側縱向足弓位移；牛津模型

Background: Chronic ankle instability (CAI) was developed from recurrent ankle sprains at least two sprains on the same side, and the ankle had the sign of giving way. CAI mechanism usually occurs during the stance phase when it had other force, incorrect foot placement, or rapid stop during walking. Individuals with CAI have a reduced quality of life, which may consist of decreased physical activity, joint movement, joint position sense, and balance control in activities such as walking. Recently advanced update in technology, we used multi-segment foot models (MSFM) such as Oxford Foot Model with Plug-in-Gait to provide the foot movement, lower limb kinetic, kinematic, spatio-temporal variables, and displacement in the medial longitudinal arch (MLA) to explain the movement strategy of CAI during dynamic tasks.
Purpose: This thesis study was aimed to 1) identify movement strategy of CAI when compared to healthy participants during level-walking with single and continue walking task at different speeds 2) investigate the movement strategy employed by patients with CAI at varying speeds 3) examine the reliability during single and continue walking in healthy and CAI group
Design: Observational study design (cross-sectional study).
Methods: 18 individuals (9 males and 9 females) with CAI as the experimental group (CAI) and 18 healthy age and BMI matched as the healthy control group were recruited for this study, as determined by a power analysis (G*power, Universität Düsseldorf). The Plug-in-Gait (PiG) with the Oxford Foot Model (OFM) was used to capture lower limb extremity kinematics in participants in barefoot conditions. We have collected the data in each group during level-walking at a self-paced speed, fast speed (140 bpm), and slow speed (80 bpm).
Statistical analysis: Comparisons were made between groups in the baseline of each group and spatio-temporal parameters using independent t-tests (SPSS v17, IBM Corp., Armonk, USA), with a significance level defined at a p-value ≤ 0.05. All parameters during the stance phase of joint kinematics, kinetics data on the lower limb, and displacement of the medial longitudinal arch (MLA) will be compared by using Statistical Parametric Mapping (SPM), SPM1D v.0.4 package for Matlab 2017, with a significance level defined at p-value ≤ 0.05
Results: In single walking, when compared with healthy control groups, individuals with CAI has demonstrated an increase in ankle inversion and internal rotation during three walking speeds (P<0.05). Increase hindfoot inversion was shown in self-selected and slow speed (P<0.05). For the joint moment and power, the CAI group showed an increased knee addition moment during heel strike and decreased knee adduction moment during mid-stance for all three walking speeds (P<0.05). In self-selected speed, the CAI group showed decreased knee eccentric contraction during terminal stance. In slow speed, increased internal rotation knee moment but decreased internal rotation ankle moment (P<0.05) was shown in individuals with CAI. In continuous walking when compared with healthy control groups, individuals with CAI was demonstrated an increase in the ankle and hind-foot inversion at all three walking speeds (P<0.05). In fast speed, CAI was increased knee internal rotation during mid-stance (P<0.05). In slow speed, a decrease in upward tilt is shown in the CAI group. In joint moment and power, the CAI group with fast walking speed showed increased hip external rotation and knee adduction moment (P<0.05). In self-selected speed, decreased ankle dorsiflexion moment and increased ankle concentric power was shown in the CAI group. In slow speed, the CAI group was decreased knee internal rotation moment. Spatio-temporal variables decrease cadence (P=0.018), increase step time (P=0.012), stride time (P=0.019), and double support time (P=0.023) were shown in the CAI group in both single and continue walking during self-selected speed. Another parameter on joint kinematic, joint kinetic, and spatio-temporal variables didn’t have differences between groups.
Conclusion: This study shows that individuals with CAI demonstrated their movement adaptation which is a potential precursor to contribute to the recurrence rate of re-injury. The different speeds of walking and task represent the movement of CAI didn’t the same. So when we want to apply the treatment to individuals with CAI, we must design the specific task for them. And walking speed can be one of the criteria that we must consider when we conduct research
Keywords: chronic ankle instability; kinematics; kinetics; spatio-temporal parameters; oxford foot model

Table of Contents
Acknowledgment…………………………………………………………………….I

中文摘要...................................................................................................................II

Abstract .....................................................................................................................IV

Table of Contents ......................................................................................................VI

Lists of figures ..........................................................................................................VII

Lists of tables …...........................................................................................................X

Lists of Abbreviation……………………………………………………………..XIII

Chapter 1 Introduction................................................................................................1

Chapter 2 Literature review .......................................................................................3

2.1 Ankle & foot structure and biomechanics................................................................3

2.2 Ankle Injury.............................................................................................................9

2.3 The foot core system..............................................................................................13

2.4 Overview of Multi-segmental Foot Model (MSFM).............................................14

2.5 Gait.........................................................................................................................16

2.6 Ankle and foot during gait......................................................................................20

2.7 Gait measurement parameter...................................................................................22
2.8 The effect of the CAI on joint kinematic, joint kinetic and spatio-temporal data…………………………………………………………………………………...24
2.9 Study hypothesis………………………………………………………………….48
2.10 Pilot study……………………………………………………………………….49
Chapter 3 Methodology ............................................................................................71

3.1 Ethical Consideration ............................................................................................71

3.2 Participants ............................................................................................................71

3.3 Instrumentation ......................................................................................................72

3.4 Marker setting.........................................................................................................73

3.5 Sample size estimation…………………………………………………………...74

3.6 Data collection........................................................................................................74

3.7 Preparation of data collection..................................................................................74
3.8 Data processing and analysis……………………………………………………..75

3.9 Outcome measure………………………………………………………………...76

3.10 Statistics analysis…………..……………………………………………………76

3.11 Reliability test…………………………………………………………………...76

Chapter 4 Risk Assessment…………………………………………….…………..77

Chapter 5 Result…………..…………………………………………….…………..78

5.1 Reliability test…….................................................................................................78

5.2 Demographic data……………………………………………………………….103

5.3 Spatio-temporal data…………………………………………………………….104

5.4 Joint kinetamic………………………………………………………………….107

5.5 Joint Kinetic…………………………………………………………………….108

Chapter 6 Discussion………………………………………………...….…………193

Chapter 7 Conclusion………..………………………………………….…………198

Reference...................................................................................................................199
Appendix…………………………………………………………………………...206
List of figures
Figure 2.1 Ankle & foot bone structure…………………………………………….....3

Figure 2.2 Ankle and foot joint ……..…………………………………………….......4

Figure 2.3 Gait event during walking…………………………………………….......16

Figure 2.4 Subdividing of gait event during walking ………………………………..17

Figure 2.5 Modifiled figure eight walking …………………………………………..20

Figure 2.6 Joint kinematics on fast speed during stance phase ……………………...53

Figure 2.7 Joint kinematics on self-paced speed during stance phase ………………54

Figure 2.8 Joint kinematics on slow speed during stance phase …………………….54

Figure 2.9 Ground reaction force (GRF) on 3 gait speeds during stance phase………………………………………………………………………………….55

Figure 2.10 Joint power on 3 gait speeds during stance phase …..…………..............57

Figure 2.11 Joint moment on fast speed during stance phase ..……………………...59

Figure 2.12 Joint moment on self-paced speed during stance phase ………………..61

Figure 2.13 Joint moment on slow speed during stance phase ……………………...62

Figure 2.14 Joint force on fast speed during stance phase…………………………...64

Figure 2.15 Joint force on self-paced speed during stance phase ……………………65

Figure 2.16 Joint force on slow speed during stance phase …………………............66

Figure 3.1 Instrumentation ……………………………………………......................72

Figure 3.2 Marker setting …………………………………………………………....73

Figure 5.1: Joint kinematics on 3 speeds during continuous walking at stance phase………………………………………………………………………………...112

Figure 5.2: Joint kinematics on 3 speeds during single walking at stance phase………………………………………………………………………………...114

Figure 5.3: Other joint kinematics on fast speed during continuous walking at stance phase………………………………………………………………………………...118

Figure 5.4: Other joint kinematics on self-selected speed during continuous walking at stance phase…………………………………………………………………………123

Figure 5.5: Other joint kinematics on slow speed during continuous walking at stance phase………………………………………………………………………...............127

Figure 5.6: Other joint kinematics on fast speed during single walking at stance phase………………………………………………………………………………...131

Figure 5.7: Other joint kinematics onself-selected speed during single walking at stance phase…………………………………………………………………………136


Figure 5.8: Other joint kinematics on slow speed during single walking at stance phase………………………………………………………………………………..140

Figure 5.9: Joint kinetics on 3 speeds during continuous walking at stance phase………………………………………………………………………………...143

Figure 5.10: Joint kinetics on 3 speeds during single walking at stance phase………………………………………………………………………………...145

Figure 5.11: Other ground reaction force and joint reaction force on fast speed during continuous walking at stance phase………………………………………...............149

Figure 5.12: Other ground reaction force and joint reaction force on self-selected speed during continuous walking at stance phase…………………………………..152

Figure 5.13: Other ground reaction force and joint reaction force on slow speed during continuous walking at stance phase………………………………………...156

Figure 5.14: Other joint moment and joint power on fast speed during continuous walking at stance phase……………………………………………….....................159

Figure 5.15: Other joint moment and joint power on self-selected speed during continuous walking at stance phase……………………….......................................162

Figure 5.16: Other joint moment and joint power on slow speed during continuous walking at stance phase……………………………………………………………..165

Figure 5.17: Other ground reaction force and joint reaction force on fast speed during single walking at stance phase………………………………………….…..............168

Figure 5.18: Other ground reaction force and joint reaction force on self-selected speed during single walking at stance phase……………………………..................172

Figure 5.19: Other ground reaction force and joint reaction force on slow speed during single walking at stance phase………………………………………............175

Figure 5.20: Other joint moment and joint power on fast speed during single walking at stance phase………………………………………...............................................179

Figure 5.21: Other joint moment and joint power on self-selected speed during single walking at stance phase………………………..........................................................182

Figure 5.22: Other joint moment and joint power on slow speed during single walking at stance phase………………………………………..................................184

Figure 5.23: Displacement of the medial longitudinal arch (MLA) on 3 walking speeds during continuous and single walking at stance phase……………………...186
List of tables
Table 2.1: Previous studies of chornic ankle instability on spatiotemporal data…………………………………………………………………………………...29

Table 2.2 Previous studies of chronic ankle instability on kinematic data …………………………………………………………………………………..31

Table 2.3 Previous studies of chronic ankle instability on kinetic data ……………..33

Table 2.4 Previous studies of chronic ankle instability on spatiotemporal data in detial ………………………………………………………………………................35

Table 2.5 Previous studies of chronic ankle instability on kinematic data in detial ….….…………………………………………………………………………..41

Table 2.6 Previous studies of chronic ankle instability on kinetic data in detial….….…………………………………………………………………………..47

Table 2.7 Characteristics of anthropometric data in each group………………...…...49

Table 2.8 Spatio-temporal data (self–selected walking speed)……………………..50

Table 2.9 Spatio-temporal data (fast walking speed)………………...........................50

Table 2.10 Spatio-temporal data (slow walking speed)…………….………………..50

Table 2.11 Joint kinetics and kinematics on hip, knee, ankle, hindfoot, pelvic joint, and GRF at fast walking speed……..………………………………....................…..68

Table 2.12 Joint kinetics and kinematics on hip, knee, ankle, and pelvic joint and GRF at self-selected walking speed…..……………………………………………….…...69

Table 2.13 Joint kinetics and kinematics on hip, knee, ankle, and pelvic joint and GRF at slow walking speed………...………………………………………………………70

Table 3.1 Oxford foot model placement……………………………………………..75

Table 5.1: Intra trial reliability on joint kinematics during continuous walking……………………………………………………………………………….79


Table 5.2: Intra trial reliability on joint reaction force and ground reaction force during continuous walking…………………..............................................................81

Table 5.3: Intra trial reliability on the joint moment and power kinetic during continuous walking…………………………………………………………………..83

Table 5.4: Intra trial reliability on joint kinematics during single walking…………..85

Table 5.5: Intra trial reliability on joint reaction force and ground reaction force during single walking……….......................................................................................88

Table 5.6: Intra trial reliability on the joint moment and power kinetic during single walking……………………………………………………………………………….90

Table 5.7: Intra-day reliability on joint kinematics during continuous walking………………….............................................................................................92

Table 5.8: Intra-day reliability on joint reaction force and ground reaction force during continuous walking…………………...........................................................................94

Table 5.9: Intra-day reliability on the joint moment and power during continuous walking……………………………………………………………………………….96

Table 5.10: Intra-day reliability on joint kinematic during single walking…………..98

Table 5.11: Intra-day reliability on joint reaction force and ground reaction force during single walking……………………………………………………………….100

Table 5.12: Intra-day reliability on the joint moment and power during single walking…………………...........................................................................................102

Table 5.13: Characteristics of anthropometric data in each group………………………………………………………………………………...104

Table 5.14: Spatio-temporal data in each group during continuous walking (CW) (self-selected speed) ………………………………………………………………..104

Table 5.15: Spatio-temporal data in each group during continuous walking (CW) (fast speed) ……………………………………………………………………………….105

Table 5.16: Spatio-temporal data in each group during continuous walking (CW) (slow speed) ………………………………………………………………………...105

Table 5.17: Spatio-temporal data in each group during single walking (CW) (self-selected speed) ……………………………………………………………………...106

Table 5.18: Spatio-temporal data in each group during single walking (SW) (fast speed) ……………………………………………………………………………….106

Table 5.19: Spatio-temporal data in each group during single walking (SW) (slow speed)………………………………………………………………………………..106

Table 5.20: Joint kinetics and kinematics on hip, knee, ankle, and hindfoot joint at fast continuous walking speeds…………………………………...……………………..187

Table 5.21: Joint kinetics and kinematics on the ankle hindfoot joint at self-selected continuous walking speeds………………………………………………...188

Table 5.22: Joint kinetics and kinematics on hip, pelvic, ankle, and hindfoot joint at slow continuous walking speeds……………………………………………………189

Table 5.23: Joint kinetics and kinematics on the knee, and ankle joint at fast single walking speeds……………………………………………………………………...190

Table 5.24: Joint kinetics and kinematics on the knee, ankle, and hindfoot joint at self-selected single walking speeds……………………………………………………..191

Table 5.25: Joint kinetics and kinematics on hip, knee, ankle, and hind-foot joint at slow single walking speeds…………………………………………………………192

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