臺灣博碩士論文加值系統

前庭神經系統(Vestibular system)是和人體自身平衡感和空間感相關的感覺系統，負責人的運動和平衡能力。前庭障礙會導致經常性的頭暈、眩暈、噁心、嘔吐等的症狀，這些症狀會造成患者日常生活中的不便，像是平衡困難、害怕跌倒、活動量減少等的困擾，嚴重的影響患者的日常生活，此外許多研究指出，與正常人相比，患有頭暈的患者的生活品質較低。目前臨床上主要是透過頭暈障礙量表讓患者自評頭暈對日常生活中造成的影響，但問卷可能受陳述問卷的語言、施測者闡述及受測者的教育程度和理解及當地文化影響，使評估結果易產生誤差和受試者主觀的影響。
隨著科技的進步，近年來穿戴式慣性感測器已被廣泛應用至動作分析，以協助臨床的客觀量化動作平衡評估。本研究的目的是透過感測器客觀量化前庭障礙患者平衡動作特徵，並探討擷取出的平衡特徵與頭暈障礙問卷量表間的相關性。臨床試驗共招募72位前庭功能障礙的患者，在其雙腳腳踝、腰部、頭部配戴慣性感測器，並進行了睜眼的龍伯格測試、閉眼的龍伯格測試、睜眼的腳跟對腳尖版本的龍伯格測試、閉眼的腳跟對腳尖版本的龍伯格測試、福田踏步測試、腳尖腳跟縱列走測試等6種不同的平衡測試。以斯皮爾曼等級相關係數分析了6種平衡測試不同的身體平衡特徵和頭暈障礙量表身體性(Physical)與功能性(Functional)之間的關係性，並使用單因子變異數分析法(one way ANOVA)和Tukey法進行事後檢定，來比較各組受試者相關的平衡特徵之間的差異。結果顯示閉眼的腳跟對腳尖版本的龍伯格測試的平衡特徵和頭暈障礙量表身體性(Physical)與功能性(Functional)有最多相關的平衡特徵，分別是46個和29個。與身體性評分相關的大多為上下(CC)軸向的平衡特徵，而與功能性評分相關的大多為左右(AP)軸向的平衡特徵，其中相關性最高的特徵為後腳腳踝左右軸向的平均搖擺速率。

The vestibular system is a sensory system related to the body's balance. Vestibular disorders can cause frequent symptoms such as dizziness, vertigo, nausea, and vomiting. These symptoms will cause inconvenience to patients in daily life, such as difficulty in balance, fear of falling, and reduced activity, which will seriously affect patients' daily life. In addition, many studies have show that patient with dizziness have a lower quality of life. Currently, patients are mainly asked to self-evaluate the impact of dizziness on daily life through the Dizziness Handicap Inventory(DHI), but DHI may has Response bias, and sometimes, the subjects may not be able to assess themselves accurately.
Inertial measurement units(IMUs) have been widely used in motion analysis in recent years to assist clinical objective quantitative motion balance assessment. This study aimed to investigate the relationship between objective physical features of balance and subjective dizziness perception in patients with vestibular disorders. 72 patients wearing IMUs on their shanks, pelvis, and head. There are 6 different balance tests including four versions of Romberg test, Fukuda stepping test, and Tandem gait test.
The Spearman rank correlation coefficient was used to analyze the relationship between the physical balance features of the 6 balance tests and the DHI Physical(P-score) and Functional(F-score), and use one way ANOVA and post-hoc(Tukey) to compare the difference between the balance ability of the subjects in each group. Results showed that the balance features of the Romberg tandem test with eyes-closed and the P-score and F-score had the most relevant balance features, 46 and 29, respectively. Most of the balance features related to the physical score are CC axis, most of the F-score are related to the balance feature of the AP axis, and the most correlated feature is the AP axis of the back shank mean sway velocity.
Key words: Dizziness, Vestibular disorders, wearable inertial sensor, Dizziness Handicap Inventory, Romberg test, Fukuda stepping test, tandem gait test

致謝 i
摘要 ii
Abstract iii
目錄 iv
圖目錄 vi
表目錄 vii
1 第一章 緒論 1
1.1 研究背景 1
1.2 研究動機 3
1.3 研究目的 4
1.4 論文架構 5
2 第二章 文獻回顧 6
2.1 前庭功能評估檢查 6
2.1.1 熱量反射測試 6
2.1.2 頭部脈衝測試 7
2.1.3 平衡測試 8
2.1.4 頭暈障礙量表 8
2.2 電腦化動態姿勢檢查 9
2.3 影像式前庭功能評估 9
2.4 穿戴式前庭功能評估 10
第三章 材料與方法 11
3.1實驗對象 11
3.2實驗設備 12
3.3實驗流程 13
3.3.1龍伯格測試 13
3.3.2福田踏步測試 15
3.3.3腳尖腳跟縱列走測試 15
3.4資料前處理 16
3.5 平衡特徵萃取 16
3.6 統計分析 (DHI 分組) 17
3 第四章 結果與討論 18
4.1 REO的平衡特徵與DHI評分之間的相關性 18
4.2 REC的平衡特徵與DHI評分之間的相關性 19
4.3 RTEO的平衡特徵與DHI評分之間的相關性 19
4.4 RTEC的平衡特徵與DHI評分之間的相關性 20
4.5 FST的平衡特徵與DHI評分之間的相關性 21
4.6 Tandem的平衡特徵與DHI評分之間的相關性 21
4.7 討論 38
4 第五章 結論 39
5 參考文獻 40
6 附錄 44

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