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系統識別號 U0026-1102201220343200
論文名稱(中文) 雙重作業情境下健康年輕人及健康老年人行走於平地及樓梯時表現之比較
論文名稱(英文) Comparison of dual task performance on level ground and staircase between healthy young and older adults
校院名稱 成功大學
系所名稱(中) 物理治療研究所
系所名稱(英) Department of Physical Therapy
學年度 100
學期 1
出版年 101
研究生(中文) 黃瓊瑩
研究生(英文) Chiung-Ying Huang
學號 T66984023
學位類別 碩士
語文別 英文
論文頁數 101頁
口試委員 指導教授-卓瓊鈺
口試委員-成戎珠
口試委員-黃英修
口試委員-楊政峰
中文關鍵字 上下樓梯  年齡  步態  雙重作業  下肢動作表現 
英文關鍵字 Stair ambulation  Age  Gait  Dual task  Lower extremity kinematics 
學科別分類
中文摘要 背景:
行走是日常生活中常見的功能性活動,例如:在平地或是樓梯上行走。相較於平地行走,上下樓梯需要更多的生物力學需求。除此之外,老年人因為肌力(muscle capacity)變差及認知注意力功能(cognition-attentional resource)衰退等年齡相關因素,導致跌倒風險(fall risk)相對較高。根據前人的研究發現:上下樓梯時,需要較大的關節活動度以及較高的肌肉活化程度;為達到這些需求,老年人在上下樓梯時候常會出現一些代償性動作,以確保動作順利完成。然而,先前有關雙重作業的相關研究主要著重於平地行走,鮮少實驗關注人類在雙重作業情境下,上下樓梯之動作表現。
目的:
本研究主要目的旨在探究雙重作業情境下,平地行走與上下樓梯表現之異同。此外,本研究亦欲探討年齡對於雙重作業情境下,行走於平地及樓梯表現之影響。再者,執行任務之優先順序對於行走及認知表現之影響,亦為本研究探討之範疇。
方法:
本實驗召集十二名健康年輕人及十一名健康老年人受試者。受試者在單一及雙重作業的情境下,執行平地行走與上下樓梯之任務。所謂單一作業指的是受試者以平常速度執行平地行走與上下樓梯任務。在雙重作業的情境下,受試者需要依據指示調整執行任務之優先順序(task priority),包括:無特定優先順序(no priority)、優先執行動作任務(motor priority)、優先執行認知作業(cognitive priority)三種。本研究採取的認知作業為倒數數字的記憶測試(backward digit span test)。研究過程利用六台紅外線攝影機記錄受試者執行任務時下肢之運動學表現。以路徑描繪測驗(trail making test, TMT)來評估受試者之心理彈性(mental flexibility)及大腦的執行功能(executive function)。針對老年受試者,另外會施測老年體適能測試(Senior Fitness Test, SFT)、自評跌倒關注程度量表(Fall Efficacy Scale- International, FES-I)及柏格氏平衡量表(Berg Balance Scale, BBS),以評估老年人體能狀況與對於跌倒之關注程度以及平衡能力。在統計方面,以描述性統計分析受試者之基本資料。受試者之運動學表現及路境描繪測驗結果以三因子變異數重複型分析(three-way ANOVA with repeated measure)比較兩組間差異。所有統計將使用第十五版「統計產品與服務解決方案」(SPSS version 15.0)軟體進行分析。統計顯著水準定於p值小於0.05。
結果:
在矢狀面的動作部分,上下樓梯時,受試者需較大之雙側髖關節屈曲、膝關節屈曲及踝關節背屈角度;及較小之雙側髖關節伸直、膝關節伸直角度。此外,受試者在上樓梯時需要更大之髖關節屈曲角度,在下樓梯時則需要更大之踝關節背屈角度。在冠狀面的動作部分,研究結果發現:受試者左側下肢在上樓梯時需要較大之髖關節內轉及踝關節旋前角度,而下樓梯時則需要較小之膝關節外翻角度。再者,老年人在上樓梯時需要較大之踝關節蹠屈角度,而下樓梯時則需要較大之髖關節屈曲角度。在步態參數的部分,研究結果顯示:在雙重作業的情境下,受試者行走於平地時,其步伐較小且步行速度也較慢。然而優先順序對大部分的步態參數並無影響。
結論:
上下樓梯時,受試者下肢在矢狀面呈現較為屈曲狀態,且在冠狀面及水平面出現代償性動作,以應付上下樓梯時較高之生物力學需求。然而,老化容易導致神經肌肉控制及功能性活動的功能衰退,因而使老年人在下肢動作表現出現改變。因此,物理治療師在臨床評估老年人行走樓梯之表現時除了應觀察其矢狀面之下肢動作表現外,冠狀面及水平面之代償動作也要特別關注。
英文摘要 Background:
Human locomotion is one of the most important functional physical activities in daily life. Ambulation on level ground and stairs are common functional mobility tasks that we may encounter. Compared to level walking, stair ambulation tasks are more biomechanical demanding tasks. For older adults, there are some age-related changes that may increase their fall risk, such as decline in muscle capacities and cognition-attentional resource. Previous studies indicated that greater ranges of motion and muscle activation are both required to complete the stair ambulation task. Besides, older adults adopt some compensatory strategies to reach the higher demand of stair ambulation task. However, previous studies conducted using dual task paradigm mainly focused on level walking. Relative few studies paid attention to the dual task performance on stair ambulation.
Purposes:
The main purpose of this study was to investigate the effect of dual task paradigm on stair ambulation and level walking. Furthermore, we also attempt to explore the effects of age on the stair ambulation and level walking under dual task condition. In addition, we would also like to examine the effect of task prioritization on both walking and cognitive task performance.
Methods:
We recruited twelve healthy young adults and eleven healthy older adults to our study. Participants were asked to complete the level walking and stair ambulation tasks under both single and dual conditions. For the dual task condition, participants encountered three different task prioritizations, including: no priority, motor priority and cognitive priority. The backward digit span test was used as the cognitive task. Six infra-red-camera motion capture system was used to measure the kinematics of the lower extremities. In addition, the trail making test (TMT) was used to assess the mental flexibility and executive function. For the older adults, senior fitness test (SFT), fall efficacy scale-international (FES-I) and Berg balance scale (BBS) were used to assess the physical performance, concern about fall and balance ability in elderly. The demographic data were analyzed by descriptive statistics. Three-way ANOVA (2 age groups × 3 motor tasks × 4 task priorities) with repeated measures was used to analyze the joint angles of lower extremities and the result of trail making test between two groups. SPSS version 15.0 was used for statistical analysis. The significant level was set at p-value lesser than 0.05.
Results:
Significant greater bilateral peak hip flexion, knee flexion and ankle dorsiflexion angles were found in stair ambulation; at the same time, less bilateral hip extension
and knee extension angles were found in stair ambulation. Also, significant greater bilateral hip flexion angles during stair ascent and greater bilateral ankle dorsiflexion angles were found during stair descent. Significant greater peak hip internal rotation and ankle pronation angles were only found on the left side while performing stair ascent task. On the contrast, a lesser peak left knee valgus angle was found during stair descent task. Furthermore, while ascending stairs, older adults demonstrated greater peak ankle plantar flexion angles than young adults; meanwhile, they required greater dynamic range of motion in left ankle dorsi-plantar flexion. During stair descent task, older adults performed greater peak left hip flexion angle. (all p<0.05) As for the spatiotemporal parameters, participants walked with a longer stride length and faster gait velocity under single task condition as compared to dual task which is only valid during level walking (all p<0.05). However, prioritization did not alter most of the gait parameters.
Conclusion:
Stair ambulation is a physically demanding task while greater peak flexed attitude of lower extremities in the sagittal plane were required and some compensatory motions in the frontal and horizontal planes were adopted as compared to level walking. As for the elderly, some kinematic data changed due to the insufficient neuromuscular control and age-related decline in functional capacity. Therefore, physical therapist should not only pay attention to motions in the sagittal plane but also motions out of progression directions while evaluating the stair ambulation performance of elderly.
論文目次 Abstract ..... I
Chinese abstract ..... III
Acknowledgement ..... V
Table of contents ..... VI
List of tables ..... VIII
List of figures ..... IX
Chapter 1 Introduction ..... 1
1.1 Background ..... 1
1.2 Aging effect and fall risks ..... 1
1.3 Stair ambulation ..... 2
1.4 Dual task paradigm ..... 5
1.5 Motivation and purposes ..... 8
Chapter 2 Methods ..... 9
2.1 Participants ..... 9
2.2 Instrumentations ..... 10
2.3 Motor task ..... 15
2.4 Cognitive task ..... 16
2.5 Experimental procedure ..... 17
2.6 Data analysis ..... 18
2.7 Statistical analysis ..... 20
Chapter 3 Results ..... 22
3.1 Demographic data ..... 22
3.2 Mini-Cog test ..... 22
3.3 Berg balance scale (BBS) ..... 23
3.4 Fall Efficacy Scale- International (FES-I) ..... 23
3.5 Ten-Meter Walking Test (10MWT) ..... 23
3.6 Senior Fitness Test (SFT) ..... 24
3.7 Trail Making Test (TMT) ..... 25
3.8 Kinematics ..... 25
3.9 Spatiotemporal parameters of gait ..... 42
3.10 Cognitive performance ..... 43
3.11 Relationship between spatiotemporal gait parameters and physical performance ..... 44
Chapter 4 Discussion ..... 45
4.1 Comparisons between stair ambulation and level walking ..... 46
4.2 The effect of age ..... 49
4.3 The effect of dual task paradigm ..... 57
4.4 Limitations and future study ..... 58
Chapter 5 Conclusion ..... 60
References ..... 61
Appendix ..... 97
Appendix A. Senior Fitness Test ..... 97
Appendix B. Fall Efficacy Scale- International (FES-I) ..... 100
Author’s background ..... 101
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