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系統識別號 U0026-2405201518183600
論文名稱(中文) 輪椅坐姿系統之研發與生物力學評估
論文名稱(英文) Development and Biomechanical Evaluation of Wheelchair Seating System
校院名稱 成功大學
系所名稱(中) 生物醫學工程學系
系所名稱(英) Department of BioMedical Engineering
學年度 103
學期 2
出版年 104
研究生(中文) 李俊廷
研究生(英文) Chun-Ting Li
學號 P88971092
學位類別 博士
語文別 英文
論文頁數 65頁
口試委員 指導教授-張志涵
指導教授-蔡昆宏
口試委員-張立東
口試委員-葉純妤
口試委員-許瑞廷
中文關鍵字 背痛  壓瘡  肺功能  坐姿  輪椅  高齡者 
英文關鍵字 back pain  pressure ulcer  pulmonary function  sitting  wheelchair  elderly 
學科別分類
中文摘要 罹患下肢疾病的高齡族群需要仰賴輪椅代步,然而久坐輪椅會導致許多併發症。目前臨床非常重視的併發症包括:背痛、壓瘡及肺功能降低問題。輪椅坐姿系統是重要的關鍵因素之一,它會影響坐姿時的脊椎角度、背部肌肉活動性、介面壓力、肺功能及主觀不舒適性等。儘管過去許多輪椅坐姿系統被發表,但上述問題仍有改善的空間。為了降低因久坐輪椅導致背痛、壓瘡及肺功能降低之風險。本研究提出一新型的輪椅坐姿系統:胸椎後移結合股骨上移支撐坐姿系統。本研究目的主要是評估胸椎後移結合股骨上移支撐坐姿系統在生物力學的影響,包括脊椎角度、背部肌肉活動性、介面壓力、肺功能及主觀不舒適評比。
本研究共招募二十位高齡者參與相關實驗。胸椎後移結合股骨上移支撐坐姿(TF)會與鬆散坐姿(RS)、平背坐姿(FB)、腰椎前凸支撐坐姿(PL)及胸椎後移支撐坐姿(BT)進行比較。本研究進行脊椎角度(胸椎、腰椎及骨盆角度)、背部肌肉活動性(對側T9等級胸豎脊肌、胸段髂肋腰肌、腰豎脊肌及腰多裂肌之最大自主收縮值)、介面壓力(背墊與坐墊之總接觸面積、平均壓力及尖峰壓力)、肺功能(用力肺活量、一秒用力呼氣量及尖峰呼氣流速)及主觀不舒適評比(頸部、肩部、上背部、中背部、下背部、上臂部、下臂部、臀部、大腿部及小腿部)的測量與比較。
在脊椎角度測量結果方面:TF相較於RS、FB及PL有顯著較大的胸椎後凸及腰椎前凸,相較於BT則無顯著性差異;TF相較於RS及PL有顯著較中立的骨盆角度,相較於FB及BT則無顯著性差異。在背部肌肉活動性測量結果方面:TF相較於RS有顯著較大的背部肌肉活動性,相較於FB及PL有顯著較小的背部肌肉活動性,相較於BT則無顯著性差異。在介面壓力測量結果方面:TF相較於其它坐姿有顯著較大的輪椅背墊之總接觸面積、平均壓力及尖峰壓力;BT相較於其它坐姿有顯著較小的輪椅坐墊之平均壓力及尖峰壓力;然而,TF相較於BT有顯著較小的坐墊後半區及較大的坐墊前半區之總接觸面積、平均壓力及尖峰壓力。在肺功能測量結果方面:TF相較於RS、FB及PL有顯著較高的肺功能參數值,相較於BT則無顯著性差異。在主觀不舒適評比結果方面:TF相較於RS、FB及PL有顯著較小的上背部、中背部、下背部的主觀不舒適,相較於BT則無顯著性差異。TF相較於其它坐姿有顯著較小的臀部及較大的大腿部之主觀不舒適程度。
本研究研發之胸椎後移結合股骨上移支撐系統能維持較大腰椎前凸結合較中立骨盆傾斜、減少背部肌肉活動性、降低坐骨粗隆壓力、增進肺功能及舒緩背臀部主觀不舒適程度,幫助維持較佳的輪椅坐姿進而降低罹患背痛、壓瘡及肺功能降低的風險。本研究成果能幫助使用者、醫師及製造商在購買、治療及設計輪椅坐姿系統時的決策處理過程。
英文摘要 Elderly adults with lower limb disorders sitting on a wheelchair for an extended period of time may experience numerous complications. Critical complications in clinical practice include back pain, pressure ulcers, and decreased pulmonary function. Wheelchair seating system is a key factor that influences spinal angle, back muscle activation, interface pressure, pulmonary function, and subjective discomfort. Although numerous studies on wheelchair seating systems have been conducted, it seems that the aspect of aforementioned problems can still be further improved. For reduce the risks of back pain, pressure ulcers, and decreased pulmonary function in wheelchair sitting posture. This study proposed a novel wheelchair seating system concept: the backward thoracic with upward femur support seating system. The purpose of this study was to evaluate the spinal angle, back muscle activation, interface pressure, pulmonary function, and subjective discomfort when using the backward thoracic with upward femur support seating system in the elderly population.
Twenty elderly people were recruited for this study. the backward thoracic with upward femur support sitting (TF) was compared with the relaxed slouching sitting (RS), flat back support sitting (FB), prominent lumbar support sitting (PL), and backward thoracic support sitting (BT). Spinal angle (thoracic, lumbar, and pelvic angles), back muscle activation (maximal voluntary isometric contraction of the thoracic erector spinae at T9, iliocostalis lumborum pars thoracis, lumbar erector spinae, and lumbar multifidus on both sides), interface pressure (total contact area, average pressure, and peak pressure on backrest and seat), pulmonary function (forced vital capacity, forced expiratory volume in 1 second, and peak expiratory flow), and subjective discomfort (neck, shoulder, upper-back, mid-back, lower-back, upper-arm, lower-arm, buttock, thigh, and leg) were measured and compared.
The results of spinal angle measurement: the TF showed relatively higher thoracic kyphosis and lumbar lordosis when compared with the RS, FB and PL, no significant difference when compared with the BT; and it also showed a relatively neutral pelvic tilt when compared with the RS and LP, no significant difference was observed when compared with the FB and BT. The results of back muscle activation measurement: the TF showed relatively higher back muscle activity when compared with RS and lower back muscle activity when compared with the FB and PL in all tested muscles, no significant differences when compared with the BT. The results of interface pressure measurement: the TF showed relatively higher total contact area, average pressure and peak pressure on backrest when compared with the other sitting postures; and the BT showed relatively lower average pressure and peak pressure on seat when compared with the other sitting postures; nevertheless, the TF showed relatively lower total contact area, average pressure, and peak pressure on the back part of seat and higher total contact area, average pressure, and peak pressure on the front part of seat when compared with the BT. The results of pulmonary function test: the TF showed relatively higher pulmonary function values when compared with the RS, FB, and PL in all tested parameters, no significant differences were observed when compared with the BT. The results of subjective discomfort evaluation: the TF showed relatively lower subjective discomfort in upper-back, mid-back, and lower-back when compared with the RS, FB, and PL, no significant difference when compared with the BT; and it also showed relatively lower subjective discomfort in buttock and higher subjective discomfort in thigh when compared with other sitting postures.
The backward thoracic with upward femur support seating system concept was suggested because it maintains an increased lumbar lordosis with rather neutral pelvic tilt, decreased back muscle activation, diminished pressure on the ischial tuberosities, improved pulmonary function, and lessened subjective discomfort in back and buttock which may help maintains a better wheelchair sitting posture for reduce the risks of back pain, pressure ulcers, and pulmonary function decline. The achievements of this study contribute to the decision-making processes of wheelchair seating systems for consumers, clinicians, and manufacturers.
論文目次 摘要 I
ABSTRACT III
誌謝 VI
CONTENTS VII
LIST OF TABLES IX
LIST OF FIGURES X
ABBREVATIONS XII
CHAPTER 1 INTRODUCTION 1
1.1 Population ageing and wheelchair sitting complications 1
1.2 Sitting related to back pain 2
1.3 Sitting related to pressure ulcers 7
1.4 Sitting related to pulmonary function decline 11
1.5 Existing wheelchair seating system 13
1.6 Motivation and purposes 16
CHAPTER 2 MATERIALS AND METHODS 17
2.1 Participants 17
2.2 Wheelchair seating system design 17
2.3 Experimental protocol 20
2.4 Spinal angle measurement 22
2.5 Back muscle activation measurement 25
2.6 Interface pressure measurement 27
2.7 Pulmonary function test 28
2.8 Subjective discomfort evaluation 30
2.9 Statistical analysis 31
CHAPTER 3 RESULTS 32
3.1 Recruited participants 32
3.2 Outcome of spinal angle measurement 32
3.3 Outcome of back muscle activation measurement 35
3.4 Outcome of interface pressure measurement 37
3.5 Outcome of pulmonary function test 41
3.6 Outcome of subjective discomfort evaluation 43
CHAPTER 4 DISCUSSION 46
4.1 Investigation of spinal angle with each sitting posture 46
4.2 Investigation of back muscle activation with each sitting posture 47
4.3 Investigation of interface pressure with each sitting posture 48
4.4 Investigation of pulmonary function with each sitting posture 49
4.5 Investigation of subjective discomfort with each sitting posture 51
4.6 Limitations 52
CHAPTER 5 CONCLUSION 53
5.1 Achievements 53
5.3 Future works 53
REFERENCES 55
APPENDIX: HUMAN STUDY APPROVAL 65
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