供偏癱患者平衡訓練之功能性電刺激迴饋控制系統設計與臨床評估

對於因腦傷或中風導致身體半側偏癱的患者而言，患側下肢肌肉因肌力減弱張力異常等現象，使得平衡運動控制能力不如以往，造成下肢兩側的載重不平均，重心轉移能力不良，甚致造成健側極大的負擔，影響患者的行走轉位的安全與效益。有鑑於此，本平衡訓練系統將微型加速度計加入整個控制系統的平衡訓練中，並由圖形的紀錄與即時重心視窗顯示，觀察受測者於力板上二維壓力重心(center of pressure；COP)與身體重心(center of gravity；COG)軌跡圖及隨時間變化之三維COP與COG軌跡圖之方向性，並驗證COP與COG於移動過程中，兩者軌跡方向的一致性。　　本研究所設計的控制系統經正常人與偏癱患者的測試，已能得到一些結果；分別由十位正常人前後兩次的測試結果，驗證本控制系統具有極高的再現性，此一說明更提高了本控制系統於臨床研究之測試結果上的可靠性。另外，在臨床測試上將偏癱病患分為視覺迴饋組與視覺迴饋加電刺激組，並針對兩組在訓練前後(1)重心轉移能力(2) COP移動最遠距離(3)患側載重能力之改善程度進行評估比較，發現經過兩週由治療師在旁指導的平衡訓練後，視覺迴饋組與視覺迴饋加電刺激組皆有改善，而在訓練後平衡控制進步幅度的比較上，其視覺迴饋加電刺激組的進步幅度較視覺迴饋組有顯著的差異，加上從問卷調查中病患認為電刺激對於自身平衡控制的恢復程度有實質上的改善，故輔以驗證臨床實驗結果的正確性。　　在本研究之臨床實驗中，亦延伸出膝關節過度伸直及推者症候群為影響偏癱病患平衡訓練結果的重要因素之議題，若增加迴饋控制訊號對病患之生理狀態做更詳盡的描述，可使系統更盡完善，並輔以本研究設計之控制系統，幫助偏癱病患尋找另一改善姿勢控制的模式。

關鍵字

力板；功能性電刺激；加速度計；復健；平衡

並列摘要

In this study , a micro accelerometer is included in this functional balance training control system.This system can capture both the trajectory of 2-dimensional center of pressure(COP) and center of gravity(COG) in real time and 3-dimensional trajectory with time variation for hemiplegia on the force plate .These all can be represented in the forms of graphical demonstrations.It is proved that the direction between COP and COG trajectory are similar . 　　In this study ,some results have been carried out in clinical test of normal persons and hemiplegia .The control system’s reproduction is fine across twice test from ten normal .In addition, we separated Visual Feedback group(Gr V) from Visual Feedback+FES group(Gr V+FES) to hemiplegia in the clinical experiment, and aimed at hemiplegia’s (1)weight-transfer capabilities (2)COP maximum displacement and (3)affected side loading to make objective assessment for improvement condition after training. We find that Gr V and Gr V+FES have been improved after two weeks training. At the increase rate comparison, the improvement of balance control is more prominent in Gr V+FES than Gr V. Otherwise, hemiplegia’s balance control was improved stimulated by FES from questionary. 　　It was found that the back knee and pusher syndrome are important indexes in balance training . To overcome the difficulties, we suggested to increase the numbers of the corresponding feedback signals to gather more physical status of the patients. And using the controller developed by our system, we can help the hemiplegia to find other suitable balance modes.

並列關鍵字

Force plate ； Rehabilitation ； FES ； Accelerometer ； Balance

參考文獻

[32]許鵬飛,“供中風患者步行訓練之膝關節控制器設計”,中原大學醫學工程所碩士論文,2002.

[5] L.E.Smith“Restoration of Volitional Limb Movement of Hemiplegics Following Patterned Functional Electrical Stimulation ”Perceptual and Motor Skills.,Vol.71,p.p.851~861,1990.

[6]H.Kagaya,Y.Shimada,K.Ebata,M.Sato,T.Yukawa ,and G.Obinata,“Restoration and analysis of standing-up in complete paraplegia utilizing functional electrical stimulation ”,Archives of Physical Medicine & Rehabilitation.,Vol.76,p.p.876~881,1995.

to achieve symmetrical standing.” Phy. Ther., vol. 58, pp. 553-559,1978.

capabilities in adults with hemiparesis ”, Physical Therapy, vol. 74,pp.647-657,1994.

國際替代計量

供偏癱患者平衡訓練之功能性電刺激迴饋控制系統設計與臨床評估

未授權

主題瀏覽