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系統識別號 U0026-0812200915343723
論文名稱(中文) 腕隧道症候群患者寫字動作之生物力學分析
論文名稱(英文) Biomechanical Analysis of Handwriting Movements for Patients with Carpal Tunnel Syndrome
校院名稱 成功大學
系所名稱(中) 職能治療學系碩博士班
系所名稱(英) Department of Occupational Therapy
學年度 97
學期 2
出版年 98
研究生(中文) 許筱曼
研究生(英文) Hsiao-Man Hsu
學號 T7696104
學位類別 碩士
語文別 中文
論文頁數 103頁
口試委員 指導教授-郭立杰
口試委員-蘇芳慶
口試委員-周一鳴
口試委員-馬慧英
中文關鍵字 腕隧道症候群  生物力學  寫字  握筆力量 
英文關鍵字 Biomechanics  Carpal tunnel syndrome  Handwriting  Pen grip force 
學科別分類
中文摘要 腕隧道症候群 (Carpal Tunnel Syndrome, CTS)患者因正中神經受壓迫而出現多種神經症狀,其中手指麻、痛的情形,容易造成患者在執行某些日常生活活動上的困難,寫字便是其中之一。由於寫字過程中必須不斷調控力道與動作,需要大量的感覺回饋方能順利進行,對於觸覺異常的CTS 患者相當不利。但是與分析寫字生物力學相關的工具甚少,因此本研究建立一套可測量握筆力量、具有信效度之研究工具,以紀錄寫字過程中之動力學資訊,並藉由分析CTS 患者與正常族群寫字動作之生物力學參數,以探討該疾病對於寫字表現的影響。
首先本研究以嚴謹的校正技術與統計分析方法,檢測工具之再測信度與效標效度。研究設計採用混合型實驗設計,以方便取樣招募15 名CTS 患者與14 名性別年齡(或工作型態)配對之對照組,CTS 組於術前術後各進行一次資料收集,對照組僅進行一次。藉由所收集之生物力學資訊轉換成具有代表意義之參數,並使用統計方法檢定各組間參數是否具有顯著性差異。
結果顯示工具具有良好之再測信度與效標效度,並在安全邊界值、力量比值與調節指數等生物力學參數部分顯示顯著性之差異。由該結果發現腕隧道正群患者在筆尖施力之調節能力較差,且手指在力量調控的能力上亦較差。此發現可作為職能治療臨床介入上的重要方向參考,而具有信效度之工具可提供日後更多寫字生物力學相關研究使用。
英文摘要 Patients with carpal tunnel syndrome suffer from neurological symptoms which
are caused by the compression on median nerve. Some of the symptoms, like pain and
numbness, may increase the difficulty to execute activities of daily living.
Handwriting task is one of the activities which are easily influenced by the sensory
disturbance, because people need lots of sensory feedback to regulate strength and
movement constantly when doing handwriting task. However, there are few apparatus
for analyzing the biomechanical aspect of handwriting. Thus, this study develops an
apparatus to measure the strength of pen grip and to investigate the
handwriting-related kinetics. By analyzing the data from CTS and normal group, we
could probe into how this disease influencing handwriting movements.
We used a concrete calibration technology and statistical analysis to examine the
test-retest reliability and criterion-related validity of the apparatus. This research
recruited 15 CTS patients and 14 control subjects which are age and sex matched as
the experimental and control group, respectively. The CTS group embraced test twice,
before and after operation, and the normal group proceeded only once to record their handwriting performance via the pen apparatus and motion capture system. Each
complete test contained filling investigation form, clinical evaluation, and writing task.
After data collecting, the recorded information was translated into several meaningful
parameters, and then suitable statistical analyses were used to examine whether
significance difference between groups existence or not.
The results show good test-retest reliability and criterion-related validity of the
apparatus. For those defined parameters, safety margin, modulation index, and force
ratio, some of the experimental results show significant difference between groups.
According to the results, the CTS patients with worse ability of pen-tip force and
finger force regulation were shown. This discovery might provide valuable
information to take part in the clinical intervention of occupational therapy in the
development of new evaluation and treatment strategies. More handwriting
biomechanics- related topic will also be suggested studying using this apparatus with
good reliability and validity in the further works.
論文目次 中文摘要…………………………………………………………..…….II
Abstract……………………………….…………….………….………..III
致謝…………………………………….………………………………..V
目錄……………………………………………………………………..VI
表目錄……………………………..…………………………...………..X
圖目錄…………………………………………...……….……………XII
附錄目錄……………………………………………….……….…….XIV
第一章、 緒論 ............................................ 1
第一節、 研究動機與重要性.............................................................................. 1
第二節、 研究目的.............................................................................................. 4
第三節、 研究假設.............................................................................................. 4
第二章、 文獻回顧 ........................................ 5
第一節、 腕隧道症候群...................................................................................... 5
壹、 成因、病徵與治療.............................................................................. 5
貳、 盛行率與好發族群.............................................................................. 7
第二節、 觸覺回饋與動作................................................................................ 10
壹、 動作控制相關理論............................................................................ 10
貳、 觸覺回饋與手部控制相關探討........................................................ 14
第三節、 寫字動作的生物力學分析................................................................ 18
壹、 運動學分析........................................................................................ 18
貳、 動力學分析........................................................................................ 22
第三章、 研究方法 ....................................... 27
第一節、 研究對象............................................................................................ 27
第二節、 研究工具............................................................................................ 27
壹、 腕隧道症候群寫字困難調查表........................................................ 27
貳、 臨床評估工具.................................................................................... 28
參、 動力學測量工具................................................................................ 29
肆、 運動學測量工具................................................................................ 37
伍、 動力學工具校正方法........................................................................ 39
陸、 指定之寫字活動紙張........................................................................ 42
第三節、 研究流程............................................................................................ 43
第四節、 數據分析............................................................................................ 45
壹、 運動學與動力學參數........................................................................ 45
貳、 統計分析............................................................................................ 48
第四章、 研究結果 ....................................... 49
第一節、 研究工具之信效度分析.................................................................... 49
壹、 指尖壓力計與筆尖荷重元校正與校標效度檢驗............................ 49
貳、 筆尖荷重元與指尖壓力計再測信度檢驗........................................ 50
第二節、 受測者基本資料................................................................................ 51
第三節、 各組手指關節運動學之表現與差異性............................................ 55
第四節、 各組手指與筆尖動力學之表現與差異性........................................ 56
第五節、 各組生物力學參數之表現與差異性................................................ 62
壹、 安全邊界值(Safety Margin) .............................................................. 62
貳、 力量比值(Force Ratio) ................................................................. 64
參、 調節指數(Modulation Index) ............................................................ 65
第五章、 討論 ........................................... 67
第一節、 研究工具之信效度分析與其應用性................................................ 67
第二節、 受測者人口學資料............................................................................ 69
第三節、 各組手指關節運動學之表現與差異性............................................ 70
第四節、 各組手指與筆尖動力學之表現與差異性........................................ 71
第五節、 各組生物力學參數之表現與差異性................................................ 73
壹、 安全邊界值(Safety Margin) .............................................................. 73
貳、 力量比值(Force Ratio) ................................................................. 74
參、 調節指數(Modulation Index) ............................................................ 75
第六章、 結論 ........................................... 77
第一節、 總結.................................................................................................... 77
第二節、 臨床應用與學術發展........................................................................ 79
第三節、 本研究限制及未來研究建議............................................................ 80
參考文獻……………………………….……………………………….81
附錄…………………………………….……………………………….89
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