輪椅推進時省力把手對上肢生物力學之影響

Effects of Efficient Handles on the Biomechanics of the Upper Extremities during Wheelchair Propulsion

李佳達(Jia-Da Li)

指導教授 ： 呂東武

國立臺灣大學/工學院/醫學工程學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.03279

摘要

手輪推進式輪椅是最為常見與常用的輪椅，過去許多文獻指出，追蹤長期使用手輪的患者，有很高的比例產生上肢骨骼肌肉系統的病變，有鑑於過去手輪在力學上的施力條件不佳，使用者施予手輪的力量並不能完全轉換為驅動輪椅前進的正向推力，在過去有一項省力把手的專利設計(呂東武 2004)，突破手輪施力機械效益不彰的窠臼，提供一個具有高度機械效益的施力條件。然而這創新思維的產物過去並沒有任何研究可以佐證它的功效，本研究藉由經由客觀的實驗，從運動學、力動學一系列的分析，比較並探討省力把手與一般手輪在輪椅的推進過程中對人體上肢造成的影響。
對於人體上肢的分析，過去的研究已獲致良好的成果，本研究延伸過去的研究成果，運用過去累積改良的上肢多連桿生物力學模型，並結合全面性皮膚移動誤差最佳化的方法，將上肢之生物力學分析運用在輪椅推進的議題上，藉由完整的生物力學分析，比較省力把手與常見手輪推進式輪椅之差異，驗證省力把手之實質功效。
五位正常受試者，藉由ViconMX 系統與測力輪椅，於實驗過程拍攝22顆反光球及量測手部施力，記錄其運動學與力動學資料，省力把手與手輪各收取五次的推進行程，於實驗開始前讓受試者練習至熟悉推進方式後始進行實驗。
結果顯示，省力把手有助於降低推進週期中之施力大小，並在軸向產生較大之力矩，具有較高的推進效率。增加在橫解剖平面（Transverse Plane）的關節活動度。減少上臂內旋角度。改變施力方式讓腕關節在推進過程由橈側偏移旋回正中位置。降低沿肢段長軸方向之關節受力，增加肘關節的活動度與屈曲/伸展力矩，增加腕關節橈/尺側偏移力矩，大幅減少肩關節外展/內收方向力矩。

關鍵字

上肢模型 ； 輪椅推進 ； 省力把手 ； 動作分析

並列摘要

Manual wheelchair is the most familiar wheelchair and is most common in use. According to the research, high percentage of long-term manual wheelchair users may have complications of muscular-skeletal system problems in upper extremities. In consideration of poor stroke efficiency during pushrim propulsion, force applied on pushrim couldn’t fully transform to axial moment to drive wheelchairs. Dr. Lu brought up a patent design of efficient handles in 2004 to improve the shortcomings of pushrim. This study performed biomechanical analysis including kinematics and kinetics to validate efficacy of the efficient handles. Upper limb model and global optimization method were involved to evaluate accurate and complete kinematics data. Five able-bodied volunteer subjects were recruited. ViconMX system and instrumented wheelchair were used to capture twenty-two infrared-retroreflective markers and measure the applying force during wheelchair propulsion. Five trials were captured during efficient handle and pushrim propulsion, respectively. The subjects were well practiced before the experiments. The results showed less applying force and larger axial moment during efficient handle propulsion. Efficient handle’s stroke efficiency is higher than pushrim. According to the results of kinematics, increasing range of joint rotation in the transverse plane and reducing internal rotation of humerus were found at this study when using efficient handle. Efficient handle also reduces longitudinal joint force and joint moment along the abduction/adduction axis.

並列關鍵字

upper extremity model ； wheelchair propulsion ； efficient handle ； motion analysis

參考文獻

呂東武 (2004). 輪型車帶動結構改良. 中華民國經濟部智慧財產局. 台灣.

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Li, G.-J. (2002). Kinematic Geometry of the Shoulder Complex. Institute of Biomedical Engineering, National Taiwan University. Master.

Lin, Y.-S. (2004). Biomechanical Analysis of Human Upper Extremity during Wheelchair Propulsion, National Taiwan University. Master.

Lu, T. W., J. J. O'Connor, et al. (1999). "Bone position estimation from skin marker co-ordinates using global optimisation with joint constraints." Journal of Biomechanics 32(2): 129-34.