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系統識別號 U0026-2308201213400700
論文名稱(中文) 慢性下背痛中高齡者行走和跨越障礙物之步態表現與動態平衡控制
論文名稱(英文) Gait Characteristics and Dynamic Balance during Walking and Obstacle Crossing in Late Middle-aged Persons with Chronic Low Back Pain
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 101
學期 1
出版年 101
研究生(中文) 江珮孜
研究生(英文) Pei-Tzu Chiang
學號 T66994044
學位類別 碩士
語文別 英文
論文頁數 99頁
口試委員 指導教授-蔡一如
共同指導教授-黃國淵
口試委員-徐阿田
中文關鍵字 動態平衡  跌倒  中高齡者  下背痛  跨越障礙物 
英文關鍵字 Dynamic balance  Late Middle Aged  Low back pain  Obstacle crossing 
學科別分類
中文摘要 背景與目的:跨越障礙物是在日常生活中經常會遇到的挑戰,而因跨越障礙物造成跌倒或絆倒在老年人族群中佔有相當高的比例。另外,下背痛不僅是造成疼痛失能,同時會帶來平衡控制的問題。最近的研究結果更進一步發現,患有下背痛問題的年長者比一般同年齡者,有更高的跌倒風險和跌倒發生率。因此具有下背痛症狀的老年人更可能在行走和跨越障礙物時發生動作控制不精確或動態的不穩定。然而,目前為止還沒有研究針對此議題深入探討或是從預防的角度針對具有下背痛之中高齡者的步態和跨越障礙物進行研究。因此本研究的目的即是為了探討患有下背痛症狀的中高齡者在行走和跨越障礙物時的動作表現和動態平衡控制。研究方法:共15名慢性下背痛患者和16名健康無下背痛症狀的中老年人參與本實驗,受試者在自選速度之下分別執行走路和跨越腳長30%高度的障礙物。並身運動學與動力學的參數則是經由三維動態分析系統和力板收集後,由軟體計算得知。另外並檢測受測者的雙側下肢肌力及床功能性平衡能力。結果:具有下背痛的中老年人在跨越障礙物時,出現身體質量中心與壓力中心的夾角和距離在前後方向變小、左右方向變大的情形。且在平面行走時在前後方向上有相同的表現。另外,在跨越障礙物時下背痛患者會出現軀幹前傾角度和前導腳腳踝蹠屈角度增加;並且前導腳和跟隨腳在跨越障礙物後的水平距離減少的情況。同時,下背痛患者也有較差的下肢肌力和功能平衡測試結果。結論:患有下背痛的中高齡者在行走和跨越障礙物時的動作表現會和無下背痛症狀的中高齡者有所不同。具有下背痛症狀的中高齡者有較差的動態平衡能力。此動態平衡控制力下降可能與疼痛及失能程度有關。
英文摘要 Background and purpose: Tripping over obstacle is one of the most common reasons among the causes of falls in the elderly. Recent studies further revealed that, compared to the healthy elders, a higher fall risk and prevalence of fall was observed among the elders with low back pain. High incidence and prevalence of LBP were reported in older population, which may not only cause pain and disability, but also accompany the problem of balance impairment. The elders with low back pain might suthus have altered movement patterns and dynamic imbalance during walking and obstacle crossing.
However, to date there are no studies investigating the dynamic balance control during walking and obstacle crossing in patients with low back pain, especially in the late middle-aged persons. From the perspective of prevention, if the imbalance problem of the patient of LBP could be understood, a more effective intervention may be designed and implied before many physical function becomes irrevesible. Therefore, the purpose of this study was to investigate the differences of dynamic balance and the kinematic parameters during walking and obstacle crossing in the late middle-aged adults with and without chronic low back pain. Methods: 15 late middle-aged adults with chronic low back pain and 16 healthy late middle-aged adults were recruited to walk and cross an obstacle with 30% of their leg lengths at their self-selected speed. The total body kinematic and ground reaction force data were recorded using a three-dimensional motion analysis system and a force plate. In addition, bilateral low extremity muscle strength and performance of functional balance tests were assessed. Result: Smaller A/P and greater M/L COM-COP inclination angles and COM-COP distances were found in the CLBP group during obstacle crossing. Moreover, an increased trunk flexion and ankle dorsi flexion angle during obstacle crossing as well as a decrease of horizontal clearance of bilateral limb after obstacle negotiating were found in CLBP group. Similar tendencies in sagittal plane were found during walking. Furthermore, the lower extremity muscle strength and functional balance performances were worse in the CLBP group than the control group. Conclusion: The results suggest that middle aged adults with chronic low back pain have an altered walking and obstacle crossing strategy that might be associated with poor dynamic balance. Also, the conservative strategy during the both tasks may be related to the symptom and severity of low back pain.
論文目次 目錄(Contents)
中文摘要(Chinese Abstract) I
英文摘要(English Abstract) II
致謝(Acknowledgement) IV
目錄(Contents) V
表目錄(List of Tables) VIII
圖目錄(List of Figures) XII
Chapter 1. Introduction 1
1.1. Background 1
1.2. Research Purposes 3
1.3. Hypotheses 4
Chapter 2. Literature Review 6
2.1. Fall Prevalence and Impacts in Older Adults 6
2.2. Human Risk Factors of Falls: Influence of LBP 6
2.3. LBP/CLBP Prevalence and Its Influences 7
2.4. Environmental Risk Factors of Falls 7
2.5. Biomechanical Analysis of Locomotion 8
2.6. Locomotion Performance in Older Adults 8
2.7. Locomotion Performance in Patients with Low Back Pain 9
2.8. Dynamic Balance control in Elderly and Further utilization 11
Chapter 3. Methods 12
3.1. Subjects 12
3.2. Study Instrumentation and Protocol 13
3.2.1. Instrumentation 13
3.2.2. Experimental Design and Protocol 14
3.3. Data collection 15
3.4. Tasks 17
3.5. Muscle Strength tests 19
3.6. Clinical Balance tests 20
3.7. 5-timed sit-to-stand test (STS): 21
3.8. Timed up and go test (TUGT): 21
3.9. Forward reach test (FRT): 22
3.10. Data Analysis 24
3.10.1. Strides Definition 24
3.10.2. Stride Characteristics 26
3.10.3. Foot Clearances Parameters During Obstacle Crossing 26
3.10.4. Critical Time Points Relate to Fall Risk 27
3.10.5. Segmental joint angles 28
3.10.6. COM Definition and related parameters 28
3.10.7. COP Definition and related parameters 29
3.11. Statistic Analysis 32
Chapter4. Results 33
4.1. Clinical balance tests 33
4.2. Lower extremity Muscle Strength 33
4.3. Unobstructed Walking 35
4.3.1. Stride characteristics 35
4.3.2. Thorax and lower extremity joint angles 36
4.3.3. Linear COM excursion motions 37
4.3.4. Peak COM-COP distances, angles and angular velocities 38
4.4. Obstacle crossing 44
4.4.1. Stride characteristics 44
4.4.2. Foot clearance parameters 45
4.4.3. The thorax and lower extremity joint angles 45
4.4.4. Linear COM excursion motions 48
4.4.5. Peak COM-COP distances, angles and angular velocities 50
4.4.6. Measures of interest at T1 to T6 57
4.5. The Comparisons Within Subjects 62
4.5.1. Stride characteristics in the control group 62
4.5.2. Linear COM excursion motions in control group 63
4.5.3. Peak COM-COP distances, angles and angular velocities in control group 65
4.5.4. Stride characteristics in the CLBP group 66
4.5.5. Linear COM excursion motions in CLBP group 67
4.5.6. Peak COM-COP distances, angles and angular velocities in CLBP group 69
Chapter5. Discussion & Conclusion 72
5.1. Stride Characteristics 73
5.1.1. Group effect on stride characteristics 73
5.2. Obstacle Clearance Parameters 74
5.3. Trunk and Low Extremity Joint Angles 76
5.4. Dynamic balance parameters 77
5.4.1. Linear COM excursions 77
5.4.2. COM-COP inclination angles and angular velocities 78
5.5. The Correlations of Balance Performances 80
5.6. Bilateral Comparisons of Two Groups 81
5.7. Limitations 81
5.8. Clinical Relevance 82
5.9. Conclusions 83
Reference 84
Appendix 97
表目錄(List of Tables)
Table 3.1 Subject Demographics 12
Table 4.2. Bilateral hip, knee, and ankle strength 34
Table 4.3. Comparison of left and right hip, knee, and ankle strength between two groups 35
Table 4.3. 1. Stride characteristics during walking between two groups 36
Table 4.3. 2. Thorax, leading limb hip, knee, and ankle angles during walking between two groups 37
Table 4.3. 3. COM displacements and velocities during walking between two groups 38
Table 4.3.4. Peak COM-COP distances, angles and angular velocities during walking between two groups 39
Table 4.3. 5. COM velocities of A/P direction at four key events during walking between two groups: toe-off of leading leg (T1), heel-strike of leading leg (T3), toe-off of trailing leg (T4), and heel-strike of trailing leg (T6). 41
Table 4.3. 6. COM velocities of M/L direction at four key events during walking between two groups: toe-off of leading leg (T1), heel-strike of leading leg (T3), toe-off of trailing leg (T4), and heel-strike of trailing leg (T6). 41
Table 4.3. 7. COM velocities of vertical direction at four key events during walking between two groups: toe-off of leading leg (T1), heel-strike of leading leg (T3), toe-off of trailing leg (T4), and heel-strike of trailing leg (T6). 42
Table 4.3. 8. COM-COP distances, angles and angular velocities of A/P direction at three key events during walking between two groups: toe-off of leading leg (T1), heel-strike of leading leg (T3), toe-off of trailing leg (T4), and heel-strike of trailing leg (T6). 42
Table 4.3. 9. COM-COP distances, angles and angular velocities of M/L direction at three key events during walking between two groups: toe-off of leading leg (T1), heel-strike of leading leg (T3), toe-off of trailing leg (T4), and heel-strike of trailing leg (T6). 43
Table 4.3. 10. Thorax, leading limb hip, knee, and ankle angles at four key events during walking between two groups: toe-off of leading leg (T1), heel-strike of leading leg (T3), toe-off of trailing leg (T4), and heel-strike of trailing leg (T6). 44
Table 4.4. 1. Stride characteristics during obstacle crossing between two groups 45
Table 4.4. 2. Stride characteristics during approaching stride between two groups 45
Table 4.4. 3. Foot clearance parameters during obstacle crossing between two groups 46
Table 4.4. 4.Thorax, leading limb hip, knee, and ankle angles during obstacle crossing between two groups 47
Table 4.4. 5. Thorax, leading limb hip, knee, and ankle angles during approaching stride between two groups 48
Table 4.4. 6. Trailing limb hip, knee, and ankle angles during trailing limb stride between two groups 48
Table 4.4. 7. COM displacements and velocities during obstacle crossing between two groups 50
Table 4.4. 8. COM displacements, velocities during approaching stride between two groups 51
Table 4.4. 9. Peak COM-COP distances, angles and angular velocities during obstacle crossing between two groups 52
Table 4.4. 10. Thorax, leading limb hip, knee, and ankle angles at four key events during obstacle crossing between two groups: heel-strike of leading leg (T3), toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 59
Table 4.4. 11. COM velocities in A/P direction at six key events during obstacle crossing between two groups: toe-off of leading leg (T1), leading toe above the crossbar (T2), heel-strike of leading leg (T3), toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 60
Table 4.4. 12. COM velocities of M/L direction at six key events during obstacle crossing between two groups: toe-off of leading leg (T1), leading toe above the crossbar (T2), heel-strike of leading leg (T3), toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 60
Table 4.4. 13. COM velocities of veritcal direction at six key events during obstacle crossing between two groups: toe-off of leading leg (T1), leading toe above the crossbar (T2), heel-strike of leading leg (T3), toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 61
Table 4.4. 14. COM-COP distances, angles and angular velocities of A/P direction at four key events during obstacle crossing between two groups: heel-strike of leading leg (T3), toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 62
Table 4.4. 15. COM-COP distances, angles and angular velocities of M/L direction at four key events during obstacle crossing between two groups: heel-strike of leading leg (T3), toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 63
Table 4.5. 1. Stride characteristics during walking between DS and NS in the control group 64
Table 4.5. 2. Stride characteristics during obstacle crossing between DS and NS in the control group 64
Table 4.5. 3.COM displacements and velocities during walking between DS and NS in the control group 65
Table 4.5. 4.COM displacements, velocities during obstacle crossing between DS and NS in the control group 66
Table 4.5. 5.Peak COM-COP distances, angles and angular velocities during obstacle crossing between DS and NS in the control group 67
Table 4.5. 6. Stride characteristics during walking between AS and SS in the CLBP group 68
Table 4.5. 7. Stride characteristics during obstacle crossing between AS and SS in the CLBP group 68
Table 4.5. 8.COM displacements and velocities during walking between AS and SS in the CLBP group 70
Table 4.5. 9.COM displacements, velocities during obstacle crossing between AS and SS in the CLBP group 71
Table 4.5. 10.Peak COM-COP distances, angles and angular velocities during obstacle crossing between AS and SS in the CLBP group 72
Table 4.6. 1. The correlation between balance performances and the Sex, VAS, and ODQ 73


圖目錄(List of Figures)
Figure3. 1. Visual Analogue Scale (VAS) 13
Figure 3.3. The marker set 17
Figure 3.4. Walking paradiam 17
Figure 3.5. Obstacle paradigm 18
Figure 3.6. 5-timed sit-to-stand test (STS) 21
Figure 3.7. Timed up and go test (TUGT) 22
Figure 3.8. Forward reach test (FRT) 23
Figure 3.10. Three strides in the obstacle crossing task 25
Figure 3.11. Foot Clearances Parameters (a) Horizontal foot clearances (b) Vertical foot clearances 27
Figure 3.12.Critical time points of fall risk from T1 to T6 27
Figure 3.13. The COM position calculated by 15 body segments model 29
Figure 3.14. The COM-COP distances in the sagittal and frontal plane (a) Anterior and Posterior COM-COP distances (b) M/L COM-COP distances 30
Figure 3.15. The COM-COP inclination angle in the sagittal and frontal plane 31
Figure 4. 1. Representative plots of A/P and M/L COM-COP separation distances between the leading limb heel strike (T3) and the trailing limb heel strike (THS). Toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 53
Figure 4. 2. Representative plots of A/P and M/L COM-COP inclination angles between the leading limb heel strike (T3) and the trailing limb heel strike (THS). Toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 54
Figure 4. 3. Representative plots of A/P and M/L COM-COP inclination angular velocities between leading limb heel strike (T3) and trailing limb heel strike (THS). Toe-off of trailing leg (T4), trailing toe above the crossbar (T5), and heel-strike of trailing leg (T6). 55
Figure 4. 4. Ensemble-averaged A/P COM-COP inclination angles and angular velocities between leading limb heel strike (T3) and trailing limb heel strike (THS) during obstacle crossing in the CLBP and control group. 56
Figure 4. 5. Ensemble-averaged M/L COM-COP inclination angles and angular velocities between leading limb heel strike (T3) and trailing limb heel strike (THS) during obstacle crossing in the CLBP and control group. 57
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