動態站姿平衡度定量評估之研究

Quantitative Study of Dynamic Postural Stability for Stroke Patients

呂理煌(Li-Hwange Lu)

指導教授 ： 徐業良 ； 李明義

元智大學/工程學院/機械工程學系/碩士(1995年)

摘要

腦血管病變及意外腦傷病患近年來持續高踞國內十大死亡原因之第二位，
由於腦神經組織損傷，在病發後會造成患側肌力(muscle power)下降、肌
肉痙攣性(spasticity)增強、運動失調(ataxia)以及運動控制功能受到干
擾，以致平衡能力發生障礙，當其跨步行走時，常因重心控制不當而跌倒
。因此，平衡控制訓練便成為臨床上重建病患運動控制能力、學習步行及
培養自理生活能力重要的復健訓練項目之一。本研究的第一部份，對正常
人和中風偏癱病患進行動態站立平衡實驗，收集病患在平衡反應時腳壓中
心晃動軌跡進行分析、驗証，以期了解人體站立平衡控制之機制，並進而
改 良站立平衡復健設備功能及發展臨床上評估病患跌倒危險指標之基礎
資料。第二部份之研究重點，便是依照臨床需要設計、開發一台兼具病患
轉身平衡能力評估及訓練功能之復健設備。本項設備在臨床上除可提供醫
療人員對偏癱病患進行動態轉身平衡之評估與訓練，做為定量、客觀評估
療效之依據外；在應用方面，研發試製之產品雛型也將具有申請專利之潛
力，所發展之系統設計理念、軟硬體更可移轉至關產業，藉此喚起國人自
製研發本土化復健醫療器材之興趣，促進國內醫療產業之升級。

關鍵字

平衡控制 ； 轉身訓練 ； 動態姿態平衡度

並列摘要

Postural control is the ability to maintain the body*s center-
of-gravity over the base of support during upright standing. It
is a complex process involving the coordinated actions of
biomechamical, sensory, motor and central nervous system
components. However, postural control like vision and hearing
functions of human body will deteriorated over years. In U.S.A.,
about 30 percent of people older than 65 years of age experience
a fall with approximately half of them havi?OMultiple incidents
due to impairmt of postural control functions. In addition,
people who are at fall risk particularly if they*ve had several
injurious falls, tend to develop a fear of falling, which
restricts their activities. Consequently, they develop lower
extremity dysfunction in the form of disuse atrophy.In Taiwan,
CVA has been ranking as the second column in the leading cause
of death in the past ten years. The brain tissue injured after
CVA can cause vari ous complications such as decreased muscle
power, increase spastic of the affected side, motor control
disturbance and ataxia. As a result, balance control are
affected and fall accident is noted frequently during
ambulation. Therefore, more effective dynamic postural control
stability training protocols and modalities are needed for the
patients with neulogical motor disabilities to regain their
postural control function.Based on the abovementioned
motivation, this research will focus on two issues in the area
of postural control. In the first part of this research, an
quantitative assessment model to evaluation standing postural
stability will be established. The clinical experimental data
(i.e. joint displacements, COP sway patterns) during upright
standing balance tests for 11 stroke patients and 12 normal
subjects will be analyzed. The postural recovery responses in
turn of COP sway distance and latency of postural respse unites
A/P and M/L directional disturbances will be compared between
two test groups. A two dimensional balance responses probability
contour map will be suggested. The shape, size and center
location of balance response contour map representing the degree
of dynamic postural stability can be easily identified for each
test subject group. This graphical balance response contour map
may become an useful quantitative assessment tool for clinical
applications.In the second part of this research, a new body
turning dynamic balance training device will be developed. This
training device consists of instrumented platform, body turning
perturb ation input device, foot pressure sensing device, joint
angular displacement measuring device, EMG measuring interface,
signal processing unit and control software. This new body
turning training device can be incorporated with static/dynamic
postural control training modalities as an quantitative postural
stability assessment d training tools for stroke patients. This
prototype device may provide a news era for future clinical
studies of assessing body turning dynamic stability of stroke
patients.

並列關鍵字

Balance control ； Body turning training ； Dynamic postural stability