臺灣博碩士論文加值系統

斜坡行走為日常生活行動不可或缺的一部分，然而行走於斜坡上對於下肢造成更多挑戰。完整的斜坡行走生物力學分析有助於設計步態訓練或者預防跌倒之方法。本研究已建立年輕人於行走不同坡度斜坡時之完整下肢動力學資料，並且探討其下肢關節間以及兩腳間之協調策略，並進一步探討老年人於行走不同斜坡時之下肢生物力學。結果顯示年輕人利用增加骨盆前傾與軀幹屈曲之策略進行上坡走路，反之於下坡時利用骨盆後傾之方式行走。這些策略改變了下肢不同關節之分配與負擔。此外本研究並發現行走於平地、上坡與下坡各有明顯不同的下肢分配協調策略，下肢任一環節出問題皆會影響上下坡行走之表現。而本研究更進一步發現老年人利用骨盆更前傾但減少軀幹屈曲之策略進行上下斜坡，此策略可使老年人以保守的方式上下坡，如減少步距以及保持身體質心維持在軀幹中軸附近。此外，老年人面對斜坡之趨勢與年輕人不同，老年人以增加髖關節比重的方式面對增加坡度時所造成的負擔。而於研究老年人於行走斜坡之動態平衡的結果顯示，老年人能維持與年輕人相同前後重心傾角，但其行走速度較慢，因此若老年人於斜坡增加行走速度時，將會使前後重心傾角變大而增加跌倒之風險。

Slope walking is an inevitable part of daily living, placing more challenges on the locomotor system than level walking does. Investigating kinematics, kinetics, intra- and inter-limb load sharing patterns of the locomotor system as well as the whole body dynamic balance control during slope walking may help in devising strategies for gait retraining and fall prevention in the elderly. The work was carried out by a series of studies on the 3D kinetics, intra- and inter-limb load sharing of the lower limbs, and dynamic balance during slope in the young and elder subjects. The results showed that the young subjects increased the anterior tilt of the pelvis and the trunk flexion during uphill walking but increased the posterior tilt of the pelvis during downhill walking. The modulated moments resulted in varied mechanical demands at the lower limb joints. Distinct intra- and inter-limb load-sharing strategies were found in level, uphill and downhill walking. However, greater anterior tilt of the pelvis but lesser trunk flexion were found in the elderly during slope walking. The kinematic configuration showed that the elderly adopted a conservative strategy to decrease the step length and thus maintain the body’s COM control in the sagittal plane. The elderly were found to perform different trend with increasing slope angles compared with the young, and showed a hip strategy to meet the increased demand during slope walking. Furthermore, the elderly were found to walk with greater excursions of boby’s center of mass if they walked at the same speed as the young adults did. It indicated that the elderly suffered greater risk of sagittal instability during slope walking.

中文摘要 ii
Abstract iii
Acknowledgements v
Table of Content vii
List of Figure xi
List of Table xvi
Chapter 1. Introduction 1
1.1 Biomechanics of Slope Walking 1
1.1.1 Overview 1
1.1.2 Gait Mechanics of Slope Walking in Young Adults 2
1.1.3 Limitations of Previous Studies 3
1.2 Approaches of Gait Analysis to Study Slope Walking 5
1.2.1 The Total Support Moment 6
1.2.2 Dynamic Stability 7
1.3 Influence of Aging on Biomechanics of the Locomotor System 10
1.3.1 Aging and Falls on Inclined Surfaces 10
1.3.2 Physiological Changes with Aging 11
1.3.3 Biomechanical Changes of Aging during Functional Activities 13
1.4 Biomechanics of Slope Walking in the Elderly 14
1.5 Aims of this Dissertation 15
Chapter 2. Materials and Methods 18
2.1 Subjects 18
2.1.1 Healthy young subjects 18
2.1.2 Elderly subjects 19
2.2 Instruments 19
2.3 Experiments 22
2.4 Biomechanical Analysis Models 24
2.4.1 Coordinate Systems 25
2.4.2 Anthropometric Parameters 30
2.4.3 Inverse Dynamics Analysis 31
2.4.4 Body’s COM Model 39
2.5 Data Analysis 40
2.5.1 Spatial-Temporal Variables 40
2.5.2 Kinematic Variables 40
2.5.3 Kinetic Variables 41
2.5.4 Variables of the Total Support Moment 42
2.5.5 COM-COP Variables 43
2.5.6 Statistical Analysis 46
Chapter 3. Biomechanics of the Locomotor Systems in Young Adults during Slope Walking7 48
3.1 Subjects 49
3.2 Data Analysis 49
3.3 Results 50
3.3.1 Spatial-temporal variables 50
3.3.2 Trunk, pelvic and joint kinematics 52
3.3.3 Joint Forces 57
3.3.4 Joint Moments 63
3.3.5 Joint Impulses 69
3.4 Discussion 72
3.5 Conclusions 76
Chapter 4. Influence of Inclination Angles on Intra- and Inter-limb Load Sharing during Slope Walking1, 4 77
4.1 Subjects 78
4.2 Data Analysis 78
4.3 Results 79
4.3.1 Joint angles and moments, and lever-arm lengths of GRF 79
4.3.2 Total support moment (Ms) and individual joint contributions (CMs) 84
4.3.3 Inter-limb contributions to whole body support moment (WMs) 85
4.4 Discussion 92
4.5 Conclusions 95
Chapter 5. Comparisons of the Biomechanics in the Locomotor System between Young Adults and the Elderly during Slope Walking 97
5.1 Subjects 97
5.1.1 Healthy young subjects 97
5.1.2 Elderly subjects 98
5.2 Data Analysis 98
5.3 Results 99
5.3.1 Spatial-temporal variables 99
5.3.2 Trunk, pelvic and joint kinematics 101
5.3.3 Joint Forces 102
5.3.4 Joint Moments 109
5.3.5 Joint Impulses 109
5.4 Discussion 116
5.5 Conclusions 118
Chapter 6. Redistributions of Intra- and Inter-limb Load Sharing of the Locomotor System in the Elderly during Slope Walking 120
6.1 Subjects 120
6.1.1 Healthy young subjects 120
6.1.2 Elderly subjects 121
6.2 Data Analysis 121
6.3 Results 122
6.3.1 Joint angles and moments 122
6.3.2 Total support moment (Ms) and individual joint contributions (CMs) 128
6.3.3 Inter-limb contributions to whole body support moment (WMs) 129
6.4 Discussion 134
6.5 Conclusions 136
Chapter 7. Control of Body’s Center of Mass Motion Relative to Center of Pressure During Slope Walking in the Young and Elderly Adults 138
7.1 Subjects 139
7.1.1 Healthy young subjects 139
7.1.2 Elderly subjects 139
7.2 Data Analysis 140
7.3 Results 141
7.4 Discussion 152
7.5 Conclusions 155
Chapter 8. Conclusions and Suggestions 156
8.1 Conclusions 156
8.1.1 Biomechanics of the Locomotor Systems in Young Adults during Slope Walking 156
8.1.2 Changes of Intra- and Inter-limb Load-sharing in the Young Adults When Walking on Different Slopes 157
8.1.3 Comparisons of the Biomechanics in the Locomotor System between Young Adults and the Elderly during Slope Walking 158
8.1.4 Redistributions of Intra- and Inter-limb Load Sharing of the Locomotor System in the Elderly during Slope Walking 159
8.1.5 Control of Body’s Center of Mass Motion Relative to Center of Pressure During Slope Walking in the Young and Elderly Adults 160
8.2 Suggestions and Further Studies 160
8.2.1 Clinical Applications 161
8.2.2 Future Studies 161
Bibliography 163
Appendix: Publication 168
(A) Refereed Journal Article 168
(B) Proceeding Article and Conference Presentations 169

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