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系統識別號 U0026-1401201722253900
論文名稱(中文) 目標物大小與距離對中風患者手臂-軀幹協調之影響
論文名稱(英文) Effects of Target Size and Distance on Arm-Trunk Coordination in Patients with Stroke
校院名稱 成功大學
系所名稱(中) 職能治療學系
系所名稱(英) Department of Occupational Therapy
學年度 105
學期 1
出版年 106
研究生(中文) 陳星妤
研究生(英文) Hsing-Yu Chen
學號 t76031042
學位類別 碩士
語文別 中文
論文頁數 65頁
口試委員 指導教授-馬慧英
口試委員-范詩辰
口試委員-徐秀雲
口試委員-黃百川
中文關鍵字 手臂-軀幹協調  目標物大小  目標物距離  運動學分析  伸手取物 
英文關鍵字 Arm-trunk coordination  target size  target distance  kinematics analysis  reaching 
學科別分類
中文摘要 伸手取物動作是日常生活活動中最常見且必要的動作,而中風病人因上肢動作缺損以及手臂-軀幹協調能力較差,使用過多的身體代償,限制患側手的進步。因此臨床工作者除了注意上肢功能恢復之外,也應思考如何減少中風患者產生不適當的身體代償。本研究目的為探討目標物大小與距離對中風患者伸手取物動作中手臂-軀幹協調之影響。
本研究在台南地區招募22位中風患者以及23位年齡、性別配對之健康成人。本研究為重複測量研究設計,情境因子有目標物大小(大目標物直徑7公分以及小目標物直徑3.5公分)與目標物距離(125%及100%手臂長位置)。目標物為3D列印之杯狀物品,高度、重量相同。中風患者以及健康成人需要分別以患側手及對照手執行伸手取物之四情境任務:大且近、大且遠、小且近、小且遠,以比較參與者之間以及情境任務間之手臂-軀幹協調表現。上肢與軀幹之動作表現將以運動學分析,運動學參數包含:上肢動作參數、軀幹動作參數、以及手臂-軀幹關聯性參數,並利用三維變異數分析檢驗研究假設,比較兩種大小、兩種距離對於兩組受試者伸手動作表現的影響,另外也會計算效應值(r)了解速度、距離對各個參數的影響程度。
目標物大小會影響手肘最大伸展角度、上肢尖峰速度、加速度佔總動作時間百分比、軀幹位移、軀幹尖峰速度、動作起始時間差與動作中期軀幹參與之斜率比值等參數,目標物越大手肘最大伸展角度、上肢尖峰速度、軀幹位移、軀幹尖峰速度越大,加速度佔總動作時間百分比越小。動作起始時間差與動作中期軀幹參與之斜率比值受到目標物大小與組別的二因子交互作用影響,代表目標物大小對兩組的動作效應有所不同,動作起始時間差的目標物大小影響之效果量在中風患者組的較大,動作中期軀幹參與之斜率比值則是健康成人組的目標物大小影響效果量較大。
目標物距離會影響動作單元以外的所有參數,目標物距離越遠,會有較大的手肘最大伸展角度、上肢尖峰速度、軀幹位移、軀幹尖峰速度,較小的標準化手臂動作時間、加速度佔總動作時間百分比、較為同時的動作起始與結束,以及較小的動作初期與中期軀幹參與之斜率比值。其中手肘最大伸展角度、上肢尖峰速度、標準化手臂動作時間、軀幹尖峰速度與動作中期軀幹參與之斜率比值受到目標物距離與組別的二因子交互作用影響,表示目標物距離對兩組的效應相似但程度不同。
目標物大小對兩組的上肢路徑位移之比值、標準化軀幹動作時間以及動作末期軀幹參與之斜率比值等變項的效應會隨著距離的不同而有所不同。
目標物大小與距離皆會影響伸手動作中上肢與軀幹的動作表現與協調,且目標物距離效應較目標物大小來得大。對中風患者而言,考量到目標物大小與距離對各個參數有不同程度的影響,因此在設計治療活動時,應以主要治療目標來選擇適當的大小與距離目標物作為活動難易度的分級與調整。
英文摘要 The purpose of this study was to investigate the effects of target size and distance on arm-trunk coordination in patients with stroke. This study used a repeated-measures design and kinematic analysis. 22 patients with stroke and 23 age-gender-matched healthy adults were required to use their affected/ corresponding hands to reach for cups that were varied with size (7cm versus 3.5cm in diameter) and distance (100% versus 125% of arm length). The height and weight of the large and small cups were kept the same. The movement kinematics was collected by a three-dimensional ultrasonic motion tracking system, Zebris. Our results revealed that target size significantly affected arm (elbow extension, peak velocity, percentage of total movement time represented by the acceleration phase), trunk (displacement, peak velocity) movements and arm-trunk coordination (onset interval, and mid phase of trunk contribution slope) in people with stroke and healthy adults. Target distance significantly affected almost all the parameters. The results of this study may provide direction for therapists to setup therapeutic task in motor rehabilitation for stroke.
論文目次 中文摘要 I
Abstract III
致謝 VI
目錄 VII
表目錄 X
圖目錄 XI
第一章、 文獻回顧 1
第一節、 腦中風盛行率及其影響 1
第二節、 伸手取物動作與協調表現 2
壹、 一般伸手取物動作與軀幹角色 2
貳、 中風患者的上肢動作表現與手臂-軀幹協調 2
第三節、 影響手臂-軀幹協調表現之因子 5
壹、 目標物距離 5
貳、 動作速度 5
參、 軀幹侷限 6
第四節、 目標物大小與距離影響伸手動作與手臂-軀幹協調之理論基礎 7
壹、 費茲定律 (Fitts’ law) 7
貳、 任務侷限 (Task constraint) 7
參、 任務之目標物大小與距離對伸手取物動作表現之影響 8
第二章、 研究重要性、目的與假設 10
第三章、 研究方法 12
第一節、 研究設計 12
第二節、 研究對象 13
第三節、 研究工具 14
壹、 臨床篩檢工具 14
貳、 動作分析儀器 16
第四節、 研究流程 17
第五節、 參數定義與資料處理 18
壹、 上肢動作參數 18
貳、 軀幹動作參數 19
參、 手臂-軀幹關聯性參數 19
第六節、 資料分析與統計方法 21
第四章、 研究結果 22
第一節、 基本人口學資料 22
第二節、 兩組受試者在四種不同情境下的運動學表現 23
第三節、 目標物大小對伸手取物動作表現的影響 24
第四節、 目標物距離對伸手取物動作表現的影響 26
第五節、 目標物大小與距離之交互作用對伸手取物動作表現的影響 28
第五章、 討論 30
第一節、 目標物大小對伸手取物動作表現之影響探討 32
第二節、 目標物距離對伸手取物動作表現之影響探討 36
第三節、 目標物大小與距離對伸手取物動作表現之影響探討 38
第四節、 研究限制及未來方向 40
第六章、 結論 42
第七章、 參考文獻 43
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