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系統識別號 U0026-1901201423352500
論文名稱(中文) Wii Fit韻律踏步訓練對於社區老年人在跨步能力與步態表現之效益
論文名稱(英文) The effects of Wii Fit rhythmic stepping exercise on stepping ability and gait performance in community-dwelling older adults
校院名稱 成功大學
系所名稱(中) 物理治療學系
系所名稱(英) Department of Physical Therapy
學年度 102
學期 1
出版年 103
研究生(中文) 黃于珊
研究生(英文) Yu-Shan Huang
學號 T66001045
學位類別 碩士
語文別 英文
論文頁數 90頁
口試委員 指導教授-卓瓊鈺
召集委員-黃英修
口試委員-楊政峰
口試委員-成戎珠
中文關鍵字 電視遊戲  跨步  預期性姿勢調節  走路  雙重作業  老年人 
英文關鍵字 Video game  Stepping  APA  Walking  Dual task  Elderly 
學科別分類
中文摘要 背景與目的:平衡與步態的退化是造成老人跌倒最常見的危險因子,而在執行複雜的任務且注意力必須分散情況下跌倒也經常發生。因此,調節注意力的能力對於因應真實生活中雙重作業的情境是很重要的。此外跨步能力是跌倒時維持平衡的策略之一,老化以及平衡能力的退化亦會影響跨步能力,而使平衡反應變差。新一代的運動遊戲-Wii Fit在現代家庭中相當普遍。先前的研究表示Wii Fit運動訓練有許多好處,而對於改善行走時雙重任務能力、跨步和步態表現或許是一種有效的介入方式。然而,到目前為止尚未有研究探討Wii Fit韻律踏步訓練對於跨步能力、步態表現與行走時雙重作業表現的效益。因此,本篇研究的目的乃在探討Wii Fit韻律踏步訓練對於社區健康老年人是否能夠改善其跨步能力、步態表現以及行走時的雙重作業表現。此外研究者也想探討Wii Fit韻律踏步訓練對體能測驗、跌倒關注程度與執行功能的效益。

方法:本實驗將從台南的地方社區徵募健康老年人。受試者接受基本臨床評估、跨步測試以及三度空間的步態分析。在步態分析方面,本實驗使用雙重作業的設計,第二項任務為包含執行辨認字體顏色測驗(Stroop test)與手部動作任務兩項。施行前測後,受試者會依隨機分配原則被分配到Wii Fit訓練組或控制組,同時Wii Fit組會接受四周的介入。本實驗使用三因子變異數重複測量分析(重複因子為任務及時間)比較兩組步態以及次項任務表現的測量結果。二因子(組別與時間)變異數重複測量則用於分析跨步能力。

結果:經過四周的訓練,在向前跨步任務中,Wii Fit組顯著減少預期性姿勢調節(anticipatory postural adjustments)時間。另外在向前和向後跨步任務中,Wii Fit組在四周訓練後顯著降低足底壓力中心於預期性姿勢調節時之最大向後位移的變異性 (p皆<.0125)。在從事手部動作任務的雙重作業下,雖然Wii Fit訓練組的走路速度的改變量比從事單一和認知任務時大,但並沒有達到統計上的意義。Wii Fit訓練組在訓練後的整體平衡表現(p <.025)、執行功能以及右髖曲肌和伸肌皆有顯著改善(p皆<.0125)。

結論:在經過四周訓練後,Wii Fit訓練組的準備時間變快並表現較穩定的預期性姿勢調節幅度,該結果表示Wii Fit訓練對於老年人的跨步能力是有明顯效益的。此外Wii Fit訓練對於受試者的平衡能力、下肢肌力以及執行功能有正向的影響。然而四周的Wii Fit訓練對於行走時的雙重作業表現的效益卻不明顯。因此Wii Fit韻律踏步訓練對於受試者的平衡控制和健康促進是有效益的,而它對於社區健康老年人的跌倒預防也可能是一種合適的訓練方式。日後的研究或許可以增長訓練的時間,如此Wii Fit 韻律踏步訓練對於行走時的雙重作業表現的效益可能會較為顯著。
英文摘要 Background and purposes: Balance and gait deterioration are the most common risk factors of falling in the elderly population. Falls often occur in complex dividing attention task situation. Therefore, the ability to modulate attention may play an important role in overcoming real-life situation. Besides, stepping ability is one of the balance strategies to against fall which is affected by aging and balance impairment. A next-generation exergame “Nintendo Wii Fit” is popular in many families. Previous studies have shown that Wii Fit has several benefits and it may be an effective way to improve stepping ability and dual task capability while walking. Nevertheless, none of the previous studies has investigated the effects of Wii Fit rhythmic stepping exercise on stepping ability and dual task ability during walking. The purposes of this study were to investigate whether the Wii Fit rhythmic stepping exercise program would improve stepping ability, gait performance, and dual task performance of walking in community-dwelling older adults. Additionally, we would like to examine the training effects of Wii Fit on physical test, concern of falling, and executive function.

Methods: Older adults were recruited from local community in Tainan. Participants received clinical evaluation, stepping task on 2 force platforms, and 3-D gait analysis with a dual task paradigm. Stroop test and manual task were chosen as the secondary tasks during walking. After baseline measure, individuals were randomly divided into Wii Fit (WF) group or control group and the WF group received a 4-week period intervention. Three-way ANOVA with repeated measures on time and task factors were used to analyze the gait spatiotemporal parameters and secondary task performance between 2 groups. Two-way ANOVA with repeated measure were used to analyze step ability.

Results: After 4 weeks of training, durations of anticipatory postural adjustments (APAs) phase decreased for stepping forward (p<.0125). For both stepping forward and backward, variability of peak COPAP displacement during APAs phase reduced after the WF training (all p<.0125). Although change in gait speed of the WF group during performing manual task was larger than single and cognitive tasks, it did not reach the significant level. WF group had significant improvement in overall balance performance (p<.025), executive function, and muscle strength of right hip flexors and extensors after training (p<.0125).

Conclusion: The WF training showed benefits on stepping ability of older adults with shortened their preparation time and more stable APA amplitudes. The WF training also had positive impacts on balance performance, muscle strength of lower limbs and executive function. However, the effect of WF training on dual task capability of walking was not obvious after 4 weeks training. Therefore, Wii Fit rhythmic stepping exercise has shown effects on balance control and health promotion. It might be an appropriate training program for fall prevention in community-dwelling older adults. For further study, the training period could be extended and the training effect on dual task capability of walking might become apparent.
論文目次 Abstract………………………………………………………………………………………………………………………………………I
摘要………………………………………………………………………………………………………………………………………………IV
誌謝………………………………………………………………………………………………………………………………………………VI
Chapter 1 Introduction…………………………………………………………………………………………………1
1.1 Falls in the elderly……………………………………………………………………………………………1
1.2 Deterioration of stepping and gait………………………………………………………2
1.3 Dual task paradigm…………………………………………………………………………………………………5
1.4 Exercise program in the elderly………………………………………………………………7
1.5 Nintendo Wii Fit………………………………………………………………………………………………………8
1.6 Motivation and purposes…………………………………………………………………………………10
Chapter 2 Methods……………………………………………………………………………………………………………13
2.1 Participants………………………………………………………………………………………………………………13
2.2 Experimental procedure……………………………………………………………………………………13
2.3 Instrumentation………………………………………………………………………………………………………14
2.3. 1 Force platform…………………………………………………………………………………………………14
2.3. 2 Motion capture system………………………………………………………………………………14
2.3. 3 Dynamometer…………………………………………………………………………………………………………15
2.4 Clinical evaluation……………………………………………………………………………………………15
2.4. 1 Ten-meter Walking Test (10MWT)………………………………………………………15
2.4. 2 Timed Up and Go test (TUG)…………………………………………………………………15
2.4. 3 Fullerton Advanced Balance Score (FAB)…………………………………16
2.4. 5 Two-minute step test (2MST)………………………………………………………………16
2.4. 6 Muscle strength of lower extremities………………………………………16
2.4. 7 Falls Efficacy Scale-International (FES-I)………………………17
2.4. 8 Stroop test…………………………………………………………………………………………………………17
2.5 Experimental trials……………………………………………………………………………………………18
2.5. 1 Stepping task……………………………………………………………………………………………………18
2.5. 2 Gait performance……………………………………………………………………………………………19
2.6 Intervention………………………………………………………………………………………………………………20
2.7 Data analysis……………………………………………………………………………………………………………21
2.7. 1 Kinetic data from force platform…………………………………………………21
2.7. 2 Kinematic data from motion capture system…………………………22
2.7. 3 Performance of secondary task…………………………………………………………23
2.8 Statistical analysis…………………………………………………………………………………………23
Chapter 3 Results……………………………………………………………………………………………………………25
3.1 Participants’ characteristics…………………………………………………………………25
3.2 Physical tests, concern of falling, and executive
function…………………………………………………………………………………………………………………………25
3.3 Muscle strength………………………………………………………………………………………………………26
3.4 Stepping task……………………………………………………………………………………………………………27
3.4. 1 Phase duration of stepping task……………………………………………………27
3.4. 2 COP variables of anticipatory postural adjustments
……………………………………………………………………………………………………………………………………29
3.4. 3 Successful rate of initial anticipatory postural
adjustments direction………………………………………………………………………………30
3.5 Gait performance……………………………………………………………………………………………………30
3.5. 1 Spatial parameters………………………………………………………………………………………30
3.5. 2 Temporal parameters……………………………………………………………………………………31
3.5. 3 Gait variability……………………………………………………………………………………………31
3.6 Secondary task performance…………………………………………………………………………32
Chapter 4 Discussion……………………………………………………………………………………………………33
4.1 The elderly adopted a more efficient way to complete the
stepping task after Wii Fit training………………………………………………34
4.2 Both groups had greater APA amplitudes on stepping task
after four weeks……………………………………………………………………………………………………37
4.3 Walking performance was not affected by Wii Fit training
……………………………………………………………………………………………………………………………………………38
4.4 Manual task had a more significant effect on dual task
gait performance than cognitive
task……………………………………………………………………………………………………………………………………41
4.5 Dual task capability hardly improved after Wii Fit
training…………………………………………………………………………………………………………………………42
4.6 Wii Fit training showed improvement in muscle strength
of the proximal part, balance performance, and executive
function…………………………………………………………………………………………………………………………45
4.7 Limitation and future study………………………………………………………………………47
Chapter 5 Conclusion……………………………………………………………………………………………………50
References………………………………………………………………………………………………………………………………51
Appendix……………………………………………………………………………………………………………………………………63
Appendix 1 Mini-cog………………………………………………………………………………………………………63
Appendix 2 Fullerton Advanced Balance (FAB)………………………………………64
Appendix 3 Falls Efficacy Scale-International (FES-I)……………66
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