- 學位論文
生理訊號回饋監控傾斜床之系統開發與脊髓損傷病患直立性暈眩量化之研究
Development of Physiological Signal Feedback Control Tilt Table System for Physiotherapy and Quantification of Orthostatic Syncope in Patient with Spinal Cord Injury
摘要
傾斜床訓練術常用於治療脊髓損傷病患起坐性暈眩的物理治療方法，但目前傾斜床之傾斜角度與變化速度的控制，仍需依賴醫護人員的經驗與手動控制。如何避免脊髓損傷病患在傾斜床訓練中，暈眩時過低的血壓造成生理的傷害，已成為脊髓損傷病患復健上重要的課題。因此，本研究嘗試研究起坐性暈眩程度與生理訊號值之間的關係，設計一生理訊號回饋監控式傾斜床系統以增加傾斜床訓練的安全性與治療效率。生理訊號回饋監控式傾斜床系統設計成三個閉迴路自動控制程序：傾斜角度與時間訓練程序、生理訊號取得監控與病患暈眩程度回饋控制傾斜床面角度。結果顯示，起坐性暈眩程度（level of presyncope symptoms）、損傷程度（ASIA grade）與傾斜角度(tilt angle)會影響脊髓損傷病患的生理訊號值。平均血壓(mean blood pressure)、血氧濃度SpO2(oxygen saturation)與心率變異高低頻比（LF/HF ratio of heart rate variability）為較合適回饋控制傾斜床之生理訊號，其中血氧濃度SpO2 於不同暈眩程度上的差異表現最好。血氧濃度在短時間表現暈眩程度有良好的辨識度，但血氧濃度無法表示病患整體起坐性暈眩的程度或病患起坐性暈眩復原程度。瞭解病患暈眩的復原情況在復健治療中具有相當重要的意義，因此本研究開發一復原指數演算法，利用目前血氧濃度值、復原後血氧濃度值、病患最低血氧濃度值與接受訓練時間等參數，計算每次脊髓損傷病患接受傾斜床訓練之起坐性暈眩狀態。復原指數研究結果顯示，復原指數演算法證實有效可行，本演算法計算之復原指數值與病患真實的臨床訓練表現比較極為相符，而復原指數值的變化趨勢也可提供預估療程與完全復原所需時間的資訊。因此本研究提供血氧濃度與復原指數之參數，能提供物理治療師安全與有效的資訊與標準，協助物理治療師能針對每個病患的生理狀況，設計合適個人的療程。此參數亦為生理訊號回饋監控式傾斜床設計之重要依據。本研究發展生理訊號回饋監控式傾斜床與臨床成果，相信能增加傾斜床之附加價值與提升台灣醫療產業的競爭力。
並列摘要
Tilt-table training is commonly used in clinical physiotherapy to overcome orthostatic syncope in patient with spinal cord injury (SCI), but this also relies on careful manual control of the tilt angle and training time by the experience of therapist. To estimate the symptoms of orthostatic syncope to avoid the physiological damage by excessive hypotension is an important issue in rehabilitation of the patient with SCI. For these reasons, we attempted to investigate the relationship between the levels of orthostatic presyncope symptoms (PS) and the physiological signals, and to develop a physiological signal feedback control tilt table system to increase the safety and efficiency during tilt-table training. The feedback tilt-table was designed with automatic training maneuvers and three closed feedback loops that included controlling the tilting maneuvers, monitoring the acquisition of physiological signals from patients, and monitoring the feedback of presyncope symptoms to regulate the angle of tilt. The results showed that the levels of PS, tilt angle and ASIA grade (level of injury) could affect the physiological signals during head-up tilting in quadriplegic SCI patients, and the mean blood pressure (MBP), Oxygen satureation (SpO2) and ratio of hent rate variability (LF/HF) ratio are the suitable signals to determine the threshold of physiological feedback for the physiological feedback control tilt table system. Although the appears to be the most sensitive factor in the determination of PS, it is necessary to consider the complex effects of tilt angle and severity of the SCI, and it could only provide the transient information of PS. For reason, we developed a mathematical formula for the calculation of the recovery index which was proven workable and capable of estimating the orthostatic syncope status of SCI patients during tilt-table training. The results showed that the recovery index accurately estimated the process of recovery from orthostatic syncope of SCI patients and might provide the information required to forecast the training course that could be required for complete recovery from orthostatic hypotension. The parameters of SpO2 and recovery index should provide safe and efficient normative data for the physiotherapist, and help in the design of the training courses in the feedback-controlled tilt-table system.
參考文獻
延伸閱讀
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