進階搜尋


 
系統識別號 U0026-0812200912095232
論文名稱(中文) 老年人於站立穿褲之動作表現
論文名稱(英文) Motion Performance of Putting-on Pants in the Elderly
校院名稱 成功大學
系所名稱(中) 醫學工程研究所碩博士班
系所名稱(英) Institute of Biomedical Engineering
學年度 94
學期 2
出版年 95
研究生(中文) 鄭伊芳
研究生(英文) I-Fang Cheng
學號 p8693128
學位類別 碩士
語文別 中文
論文頁數 72頁
口試委員 指導教授-張志涵
口試委員-周有禮
口試委員-張冠諒
指導教授-蘇芳慶
指導教授-林啟禎
中文關鍵字 動作分析  平衡  老年人 
英文關鍵字 elderly  motion analysis  balance 
學科別分類
中文摘要 人口高齡化是人類在現代化過程中必然會面臨到的問題。隨著人體的老化,人體會有明顯的功能退化現象,其中也包括與平衡控制相關的系統功能退化。老年人一旦有平衡控制障礙,發生跌倒的機率以及跌倒後發生嚴重傷害的危險性大為增加,而老年人的跌倒問題不僅對其本身生命安全極具威脅,照護因此失能的老年人所需花費的人力與金錢以及醫療照護或社會福利方面,對於社會成本也是一大沉重負擔;其中,老年族群中常見的退化性膝關節炎已被證實會影響老年人的平衡功能而使跌倒的機率增加。
本研究以日常生活中的站立穿褲動作來探討老年人的動作平衡表現,徵求了十四位健康的老年人(十女四男;平均年齡: 69.3±4.0歲;平均身高: 158.9±10.3公分;平均體重: 60.8±9.6公斤)以及三位被專業骨科醫師診斷為退化性膝關節之老年患者(皆為女性;平均年齡: 71.0±1.0歲;平均身高: 153.2±6.8公分;平均體重: 58.0±12.3公斤)。利用3D動作分析系統以八部紅色可見光LED數位攝影機以及兩塊Kistler力板去擷取受試者在站立穿褲動作的運動學與運動力學資料,其中並以動作之習慣性(習慣性/非慣性)及改變褲子長度(長/短)作為影響因子。結果顯示: 動作的習慣性,與動作完成的流暢度有密切關聯,尤其當老年人在執行非慣性動作時,受動作困難度(褲子長度)的影響較為明顯;而年齡是ㄧ重要但並非唯一影響動作表現的因素,本研究中發現,膝關節的功能、BMI值與單腳站立的能力…等,都會對動作平衡表現有顯著的影響。膝功能越好或單腳站立能力越佳者,在穿褲動作中的單腳站立期之平衡控制越好,且動作效率越高。而體重過重者(BMI值超過25以上),其平衡控制顯得格外吃力。從三位退化性膝關節炎受試者的實驗結果中,也再度觀察到,膝關節功能的衰退確實會使老年人的平衡控制造成影響,尤其是在較複雜的動態平衡動作中,發生跌倒的危險性應該會較一般老年人更高。
站立穿褲動作是一較複雜的動態平衡動作,但也是日常生活中避免不了的更衣動作,藉由本研究的結果,可提醒老年人動作熟練度的重要性,反覆練習以熟悉動作,必要時以手扶助以增加動作穩定度,再加上環境設計的改良,則可提高在複雜的動態平衡動作中之安全性。此外,站立穿褲動作也可融合在針對膝關節功能的評估動作中,以日常生活中常要執行的動作以作為膝關節功能的評分指標,可以讓膝關節疾病之患者更加了解自身在日常生活動作的限制,也可以作為醫療人員在擬定治療目標與治療計畫時的參考依據,甚或是作為評估患者接受治療前後之功能表現的一項指標。



英文摘要 Aging is a natural process for human being. As aged, the general physical degeneration would occur, such as central nervous system (CNS), vestibular system, proprioception, vision, muscular strength and endurance, which are responsible for the balance control. Falls resulted from imbalance and the fall-related injuries are harmful to the elderly. It not only threatens the safety of the elderly, but also induces a serious burden on the costs of the healthcare system and social welfare. Furthermore, osteoarthritis of knee, a common chronic disease in the elderly, is evidenced to be a risk factor of falls by affecting the ability of balance control.
This study investigated the balance performance during putting on pants in the elderly. Fourteen healthy elderly (10 females, 4males; mean age: 69.3±4.0; body height: 158.9±10.3cm; body weight: 60.8±9.6Kg) and 3 aged females diagnosed with OA knee (mean age: 71.0±1.0; body height: 153.2±6.8cm; body weight: 58.0±12.3Kg) were recruited. An 8-camera Motion Analysis System and two Kistler force plates were used to capture the motion of putting-on pants and ground reaction force, respectively. Familiarity to movement (habit) and different lengths of pants were chosen as two control factors. The results show that habits of the movement had a great effect on the motion performance, especially under the condition of longer pants. Age indeed has significant influence on the balance performance, but it is not the only vital factors. The individuals with better knee function or one limb standing ability had more efficient balance control, and the overweight individuals had poorer performance in putting-on pants. In the data of three knee OA subjects, it was found that degenerated knee function makes the complicated dynamic movement more unstable and would be a high risk of falls to the knee OA elderly compared to the healthy ones.
Putting-on pants is a complicated composite activity in daily life. According to the results of this study, the elderly is suggested to perform the movement more stable and
safely by practicing repeatedly and getting familiar to the movement. It is also suggested that, hand-holding or other appropriate assistant equipments are secure ways to make the movement more stable. Furthermore, putting-on pants can be considered as a reference index to evaluate the knee function. It not only tells the patients the levels of limitation in their daily lives, but also provides physicians and therapists a quantitative and objective method to make the treatment goals and programs, as well as to record the progress before and after the treatment.



論文目次 中文摘要 I
Abstract III
致謝 V
目錄 VI
表目錄 IX
圖目錄 X

第一章 序論 1
1.1 背景 1
1.2 老化所會遭遇到的問題 1
1.3 老年人的平衡功能 2
1.4 老年人與跌倒(falls) 3
1.5 跌倒的危險因子 4
1.6 跌倒導致的傷害與影響 4
1.7 退化性膝關節炎 (Osteoarthritis of Knee Joint) 5
1.8 站立穿褲動作對老年人的挑戰性 6
1.9 研究動機與目的 7
1.10 實驗假說 8
第二章 研究方法 9
2.1 受試者 (Participants) 9
2.2 實驗設備 (Experimental Equipments) 11
2.2.1 硬體設備 (Hardware) 11
2.2.2 Lysholm Knee Scoring Scale 16
2.2.3 應用軟體 (Software) 16
2.3 實驗流程 (Experimental Procedures) 17
2.3.1 準備工作 18
2.3.2 實驗步驟 19
2.4 資料收集與參數計算 (Data Collection and Parameters Calculation) 22
2.4.1 空間座標定義 (Definition of the Coordinate System) 22
2.4.2 質量中心(COM)計算 24
2.4.3 足底壓力中心(COP)計算 24
2.4.4 運動學(Kinematics)計算 25
2.4.5 運動力學(Kinetics)計算 27
2.4.6 動作分期(Phase of movement) 28
2.4.7 實驗參數 29
2.5 統計分析(Statistical Analysis) 30
2.5.1變異數分析(ANOVA) 30
2.5.2多元迴歸(Multiple Regression) 30
第三章 實驗結果 31
3.1 時間-空間參數 31
3.2 質量中心(COM)的位移(displacement)與最大速度(peak velocity) 33
3.3 質量中心與足底壓力中心之位移差值 (COM-COP) 35
3.4 運動學參數 37
3.5 運動力學參數 40
3.5.1 髖關節與膝關節力矩 40
3.5.2 髖關節與膝關節功率 41
3.6 退化性膝關節炎受試者群之實驗數據 43
第四章 討論 53
4.1 動作完成總時間與單腳站立期比例 53
4-2 質量中心與足底壓力中心 55
4.3 運動學 58
4.4 運動力學 61
4.5 影響站立穿褲平衡控制的因素 63
4.5.1 膝關節功能 63
4.5.2 BMI值 63
4.5.3 單腳站立穩定側 63
4.5.4 動作的習慣性 63
4.5.5 年齡 64
4.5.6 其他因素 64
4.6 臨床應用 64
4.7 實驗限制 65
第五章 結論 67
參考文獻 68

表目錄
表2-1. 受試者資本資料 10
表3-1 動作完成總時間與單腳站立期比例 (mean±SD) 31
表3-2 質量中心位移範圍 (cm, mean±SD) 34
表3-3 質量中心的最大位移速度 (m/s,mean±SD) 34
表3-4 質量中心與足底壓力中心之位移差值(cm, mean±SD) 35
表3-5 運動學參數(deg, mean±SD) 37
表3-6 足部抬離地面之最大高度(/身高,mean±SD) 39
表3-7 多元迴歸摘要模式 39
表3-8 髖關節與膝關節力矩 (N‧m, mean±SD) 40
表3-9 髖關節與膝關節平均功率(W/sec, mean±SD) 41
表3-10(A) 退化性膝關節炎受試者一之實驗參數 44
表3-10(B) 退化性膝關節炎受試者二之實驗參數 45
表3-10(C) 退化性膝關節炎受試者三之實驗參數 46
附錄1 Lysholm Knee Scoring Scale 71
附錄2 人體計測資料 72


參考文獻 [1] M. T. Liang and W. M. Cameron Chumlea, "Balance and strength of elderly Chinese men and women," J Nutr Health Aging, vol. 2, pp. 21-7, 1998.
[2] P. Era, E. Heikkinen, I. Gause-Nilsson, and M. Schroll, "Postural balance in elderly people: changes over a five-year follow-up and its predictive value for survival," Aging Clin Exp Res, vol. 14, pp. 37-46, 2002.
[3] R. Camicioli, V. P. Panzer, and J. Kaye, "Balance in the healthy elderly: posturography and clinical assessment," Arch Neurol, vol. 54, pp. 976-81, 1997.
[4] C. P. Hobeika, "Equilibrium and balance in the elderly," Ear Nose Throat J, vol. 78, pp. 558-62, 565-6, 1999.
[5] I. G. Amiridis, V. Hatzitaki, and F. Arabatzi, "Age-induced modifications of static postural control in humans," Neurosci Lett, vol. 350, pp. 137-40, 2003.
[6] A. J. Matheson, C. L. Darlington, and P. F. Smith, "Further evidence for age-related deficits in human postural function," J Vestib Res, vol. 9, pp. 261-4, 1999.
[7] N. R. Colledge, P. Cantley, I. Peaston, H. Brash, S. Lewis, and J. A. Wilson, "Ageing and balance: the measurement of spontaneous sway by posturography," Gerontology, vol. 40, pp. 273-8, 1994.
[8] B. J. Vellas, L. Z. Rubenstein, P. J. Ousset, C. Faisant, V. Kostek, F. Nourhashemi, M. Allard, and J. L. Albarede, "One-leg standing balance and functional status in a population of 512 community-living elderly persons," Aging (Milano), vol. 9, pp. 95-8, 1997.
[9] A. G. Drusini, G. P. Eleazer, M. Caiazzo, E. Veronese, N. Carrara, C. Ranzato, F. Businaro, R. Boland, and D. Wieland, "One-leg standing balance and functional status in an elderly community-dwelling population in northeast Italy," Aging Clin Exp Res, vol. 14, pp. 42-6, 2002.
[10] M. W. Rogers and M. L. Mille, "Lateral stability and falls in older people," Exerc Sport Sci Rev, vol. 31, pp. 182-7, 2003.
[11] D. Fife and J. I. Barancik, "Northeastern Ohio Trauma Study III: incidence of fractures," Ann Emerg Med, vol. 14, pp. 244-8, 1985.
[12] M. E. Tinetti, M. Speechley, and S. F. Ginter, "Risk factors for falls among elderly persons living in the community," N Engl J Med, vol. 319, pp. 1701-7, 1988.
[13] L. W. Chu, I. Chi, and A. Y. Chiu, "Incidence and predictors of falls in the chinese elderly," Ann Acad Med Singapore, vol. 34, pp. 60-72, 2005.
[14] T. Masud and R. O. Morris, "Epidemiology of falls," Age Ageing, vol. 30 Suppl 4, pp. 3-7, 2001.
[15] I. Nurmi and P. Luthje, "Incidence and costs of falls and fall injuries among elderly in institutional care," Scand J Prim Health Care, vol. 20, pp. 118-22, 2002.
[16] F. Englander, T. J. Hodson, and R. A. Terregrossa, "Economic dimensions of slip and fall injuries," J Forensic Sci, vol. 41, pp. 733-46, 1996.
[17] L. Wegener, C. Kisner, and D. Nichols, "Static and dynamic balance responses in persons with bilateral knee osteoarthritis," J Orthop Sports Phys Ther, vol. 25, pp. 13-8, 1997.
[18] H. Gur and N. Cakin, "Muscle mass, isokinetic torque, and functional capacity in women with osteoarthritis of the knee," Arch Phys Med Rehabil, vol. 84, pp. 1534-41, 2003.
[19] B. S. Hassan, S. Mockett, and M. Doherty, "Static postural sway, proprioception, and maximal voluntary quadriceps contraction in patients with knee osteoarthritis and normal control subjects," Ann Rheum Dis, vol. 60, pp. 612-8, 2001.
[20] Y. C. Pai, W. Z. Rymer, R. W. Chang, and L. Sharma, "Effect of age and osteoarthritis on knee proprioception," Arthritis Rheum, vol. 40, pp. 2260-5, 1997.
[21] L. Sharma and Y. C. Pai, "Impaired proprioception and osteoarthritis," Curr Opin Rheumatol, vol. 9, pp. 253-8, 1997.
[22] M. D. Lewek, K. S. Rudolph, and L. Snyder-Mackler, "Quadriceps femoris muscle weakness and activation failure in patients with symptomatic knee osteoarthritis," J Orthop Res, vol. 22, pp. 110-5, 2004.
[23] G. Pap, A. Machner, and F. Awiszus, "Strength and voluntary activation of the quadriceps femoris muscle at different severities of osteoarthritic knee joint damage," J Orthop Res, vol. 22, pp. 96-103, 2004.
[24] S. G. Leveille, J. Bean, K. Bandeen-Roche, R. Jones, M. Hochberg, and J. M. Guralnik, "Musculoskeletal pain and risk for falls in older disabled women living in the community," J Am Geriatr Soc, vol. 50, pp. 671-8, 2002.
[25] D. L. Sturnieks, A. Tiedemann, K. Chapman, B. Munro, S. M. Murray, and S. R. Lord, "Physiological risk factors for falls in older people with lower limb arthritis," J Rheumatol, vol. 31, pp. 2272-9, 2004.
[26] K. R. Kaufman, C. Hughes, B. F. Morrey, M. Morrey, and K. N. An, "Gait characteristics of patients with knee osteoarthritis," J Biomech, vol. 34, pp. 907-15, 2001.
[27] K. S. Al-Zahrani and A. M. Bakheit, "A study of the gait characteristics of patients with chronic osteoarthritis of the knee," Disabil Rehabil, vol. 24, pp. 275-80, 2002.
[28] 張嘉玲, "站立穿褲動作姿勢控制," 國立成功大學醫學工程研究所碩士論文,
2005
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2007-08-25起公開。
  • 同意授權校外瀏覽/列印電子全文服務,於2007-08-25起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw