步態訓練對社區重覆跌倒老人往前及往後步態之成效探討

Gait Training on Improvement of Forward Walking and Backward Walking among Recurrent Falls Community-Dwelling Elderly

蔡宗棋(Zong-Ci Cai) ； 曾櫻枝(Ing-Jy Tseng)

《新臺北護理期刊》 21卷2期 (2019/09) Pp. 53-63

https://doi.org/10.6540/NTJN.201909_21(2).0005

摘要

跌倒所造成的傷害為老人失能和罹病的主要原因，其相關傷害加重醫療保健成本與死亡率攀升，重覆跌倒的主要原因是內在因素造成，步態紊亂是其中之一，而合理推理步態紊亂可以藉由步態分析進而矯正並預防跌倒，為此，本研究目的為探討社區重覆跌倒老人施予八週步態訓練後對往前往後步態之成效。本研究採單組前後測設計，立意取樣（purposive sampling），共收案30位社區重覆跌倒老人，研究對象接受以結構式問卷訪談，在GAITRite®電子步道系統之步道上裸腳向前走及向後走分析，進行為期八週共16次的步態訓練，使用SPSS19.0版進行資料建檔及統計分析。分析基本屬性與往前往後步態參數之相關或差異，進一步分析步態訓練前後改善成效。結果發現往前相關步態參數：步行速度（271.69 vs 189.68）及步頻（329.71 vs 246.24）顯著下降（p＜0.0001）；擺盪期（37.29 vs 35.49）顯著下降（p＜0.0001），跨步長（105.47 vs 94.97）有顯著下降（p＜0.001），而步寬（8.98 vs 12.66）有顯著增加（p＜0.0001），顯示八週步態訓練後，對於社區重覆跌倒老人其大部分步態參數能有效地改善。建議未來可針對社區重覆跌倒老人可延長步態訓練時間或增加每週訓練頻率。

關鍵字

老人 ； 重覆跌倒 ； 步態訓練 ； 往前步態 ； 往後步態

並列摘要

Fall-related injuries are major reasons for disability and morbidity among elderly. Its related injuries increase healthcare-related costs and mortality. The main reason for recurrent falls is caused by internal factors. As gait disturbance is one of them, it would be rational to hypothesize that gait analysis may correct and prevent the falls on gait disturbances. Hence, the purpose of this study is to explore the improvement on the forward and backward gait after the eight-week gait training on the recurrent falls in the community-dwelling elderly. One-group pretest-posttest design with purposive sampling method was used in this study, and thirty participants who met the selection criteria were recruited. The questionnaire used for the interviews was structured. The GAITRite® electronic system was employed to evaluate forward and backward walking. All eligible participants were required to complete gait training using FW consisting of 16 sessions for 8 consecutive weeks. SPSS 19.0 for Windows was used to analyze the correlation or difference between the basic attributes and the gait parameters. Comparisons of the improvement between baseline and after exercise training were evaluated by Wilcoxon signed ranks test within group. The results revealed forward walking with decreased velocity (271.69 vs 189.68, p ＜ .0001), decreased cadence (329.71 vs 246.24, p ＜ .0001), decreased swing phase (37.29 vs 35.49, p ＜ .0001), shortened stride length (105.47 vs 94.97, p ＜ .001), and increased base of support (8.98 vs 12.66, p ＜ .0001). The results have demonstrated that the 8-week gait training program could effectively improve the spatiotemporal gait parameters in elderly with recurrent fall. It is suggested that gait training duration and frequency can increase for recurrent falls in the community-dwelling elderly in future.

並列關鍵字

elderly ； recurrent falls ； gait training ； forward walking ； backward walking

參考文獻

Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). The Medical costs of fatal falls and fall injuries among older adults. Retrieved from https://stacks.cdc.gov/view/cdc/58102

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