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系統識別號 U0026-2003201716394400
論文名稱(中文) 改善STS期間姿勢性低血壓之神經肌肉電刺激裝置設計與評估
論文名稱(英文) Design of NMES Device for Improving Orthostatic Hypotension during Supine-to-Stand (STS)
校院名稱 成功大學
系所名稱(中) 工業設計學系
系所名稱(英) Department of Industrial Design
學年度 104
學期 2
出版年 105
研究生(中文) 陳信安
研究生(英文) Xin-An Chen
學號 P36041053
學位類別 碩士
語文別 英文
論文頁數 95頁
口試委員 指導教授-吳豐光
指導教授-賴欣喜
口試委員-李傳房
中文關鍵字 從臥至站  姿勢性低血壓  骨骼肌泵  神經肌肉電刺激 
英文關鍵字 supine-to-stand  orthostatic hypotension  skeletal muscle pump  NMES 
學科別分類
中文摘要 健康的人從臥姿轉換至站姿時,他們的下肢骨骼肌會適當地壓縮血管,促進下肢靜脈血回流,得以增加血壓,以補償心引力的作用。然而,某些人因為下肢骨骼肌功能不足或退化,造成姿勢轉換時血壓調節功能遲緩或失能,這種病症稱之為姿勢性低血壓。姿勢低血壓與暈厥、跌倒與骨折等有相當的關係,而其更是造成年長者跌倒的主因之一。因此如何改善姿勢性低血壓帶來的暈厥,將可以提升姿勢患者的安全性與自主性。
下肢骨骼肌被稱之為人類的第二顆心臟。當下肢骨骼肌收縮時,將可促進血管內與周遭的血液從靜脈往心臟回流。一連串由下至上的靜脈瓣膜開合運動,將能確保血液順利流向心臟。因此現有許多非物理治療姿勢性低血壓的方法,許多皆採取刺激骨骼肌的方式改善姿勢性低血壓。然而,根據文獻指出,大多非藥物治療的方法效果不彰並且短暫,更不是皆適用於每位患者。
目前已經有少許研究已經證實神經肌肉電刺激可以刺激骨骼肌收縮並且提升血壓。然而,現有的神經肌肉電刺激的放電方式,皆設定為每片電極貼片同時放電。事實上,骨骼肌刺激血管收縮的方式,是連續由下至上的靜脈瓣膜開合循環促成。因此本研究模擬骨骼肌壓縮血管原理,將放電方式改為的由下至上的輪流電擊,並且與穿戴式裝置結合,設計出新型穿戴式神經肌肉電刺激裝置,將更即時且有效的刺激骨骼肌收縮,改善姿勢性低血壓。
本研究結果指出,新穎的神經肌肉電刺激方式相較於現有的裝置,能更快的提升血壓,且有效的改善姿勢性低血壓的暈厥。此外根據主觀量表的統計,新型裝置也更符合臥姿轉換為站姿的情境,給予受測者更佳的舒適性與便利性。
英文摘要 During healthy people promptly rising from supine to stand (STS), their contraction of leg muscle probably squeezes blood from the lower limbs to the chest, increasing venous return and contributing to a compensatory increase in blood pressure (BP) in order to compensate for gravitational effect. Nevertheless, as a result of functional deficiency of the circulatory responses and of the skeletal muscle pump (SMP) in elders, this mechanism can be postponed or ineffective. This phenomenon may bring about orthostatic hypotension (OH). OH has been associated with falls, fractures, transient ischemic attacks, syncope, and myocardial infarction. Therefore, improvement of OH will enable patients to better safety and independence.
SMP is called a human of the second heart. When skeletal muscles in the leg contract, they compress the blood ejected from the veins towards the heart within and around veins. As a result, some existing non-pharmacological Interventions to better OH are stimulating the SMP to heighten venous return. However, many researches point out that most present non-medication ways aren’t effective and immediate. Besides, these non-pharmacological methods don’t suit everyone.
Currently, some studies show that neuromuscular electrical stimulation (NMES) can facilitate contraction of SMP and enhancement BP. Even so, most existing setting of self-adhering electrodes of NMES concurrently provide electrical discharge for subjects. In fact, the physiological motion of SMP in calf facilitates a sequence of unfolding and folding of venous valves. The venous valves don’t simultaneously operate; contrarily, their actions are in bottom-up order. Therefore, this research innovates a new device of NMES whose sequence of electric stimulation is bottom-up alternation to simulate natural exercise of SMP in order to more efficiently mend OH.
Finally, the conclusion of this research illustrates that the innovative NMES is more efficient at increasing BP and faster activates SMP than the existing one. Furthermore, according to the outcome of Likert scale, the new device is more suitable for scenario of subjects carrying out STS. It provides subjects with more comfort and convenience.
論文目次 摘要 I
SUMMARY II
ACKNOWLEDGEMENTS III
TABLE OF CONTENTS IV
LIST OF TABLES VII
LIST OF FIGURES IX
LIST OF SYMBOLS AND ABBREVIATIONS XI
CHAPTER 1 INTRODUCTION 1
1.1 Background 1
1.1.1 The Decline in ability to Execute STS 1
1.1.2 Orthostatic Hypotension 2
1.2 Motivation 5
1.3 Objective 6
1.4 Overview of This Study 7
CHAPTER 2 LITERATURE REVIREW 9
2.1 Physiology of Lying and Standing 9
2.2 The Existing Non-Pharmacological Management of OH 12
2.2.1 Expanding Blood Volume and Inducing a Pressor Response 12
2.2.2 Compression Hosiery 12
2.2.3 Physical Counter-Maneuvers 13
2.3 Skeletal Muscle Pump 14
2.4 Physical Therapy 15
2.4.1 Therapy on Temperature 16
2.4.2 Therapy on Vibration 16
2.5 Neuromuscular Electrical Stimulation 17
2.6 Methods of Evaluation 18
2.6.1 Blood Pressure 19
2.6.2 Center of Pressure 19
2.6.3 Heart Rate Variety 20
2.6.4 Temperature of Instep and Calf 21
2.6.5 Subjective Evaluation 21
CHAPTER 3 METHOD 22
3.1 Outline of the Experiment 22
3.1.1 Experiment process 22
3.1.2 Framework of The Experiment 23
3.2 Study 1-Development if Concept 24
3.2.1 Naturalistic Observation 24
3.2.2 Focus Group 25
3.2.3 Expert Interview 26
3.2.4 Related Works 26
3.2.5 Prototyping 27
3.2.6 Evaluation of Concept 28
3.3 Study 2 - Development of Product 54
3.3.1 Co-design 54
3.3.2 Study 2 - Evaluation of Product 56
CHAPTER 4 Results 62
4.1 Blood Pressure 62
4.2 Instep and Calf Skin Temperature 73
DISCUSSION 76
4.3 Development of Concept 76
4.4 Development of Product 78
CHAPTER 5 CONCLUSION 80
5.1 The Future Work 80
5.2 The Limitation of Research 81
REFERENCES 82
Appendix A The trajectory of COM of the 1st Subject 88
Appendix B The trajectory of COM of the 2nd Subject 89
Appendix C The trajectory of COM of the 3rd Subject 90
Appendix D The trajectory of COM of the 4th Subject 91
Appendix E The trajectory of COM of the 5th Subject 92
Appendix F The original BP data in the 1st experiment 93
Appendix G The original BP data in the 2nd experiment 94
Appendix H VAS questionnaire 95
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