痙攣型腦性麻痺學童在不同坡度步道行走時步態特徵及影響關係研究

A Study of Spastic Cerebral Palsy Student' Gait Feature and Effects on Different Slopes

蔡淑賢(Shu-Hsien Tsai)

指導教授 ： 王金成

國立臺灣師範大學/運動與休閒學院/體育學系在職進修碩士班/碩士(2002年)

摘要

本研究的目的是探討一、正常的國小學童和痙攣性腦性麻痺的國小學童在不同坡度上行走，對其步態週期、站立期、擺動期、步頻、步速、步寬和頭部左右擺動振幅的變化情形；二、比較正常學童與痙攣型腦性麻痺學童在不同坡度上行走時各步態參數的差異；三、在不同坡度的變化下對痙攣型腦性麻痺的國小學童在步態週期、站立期、擺動期、步頻、步速、步寬和頭部左右擺動振幅等步態參數的影響。實驗以正常國小學童13名及台南市各國小的普通班、特教班中去篩選及患有痙攣型腦性麻痺的學童9位（6男3女），透過復健醫師對腦性麻痺的學童作肌肉痙攣部位與痙攣程度的評估，並能獨立走完10公尺使可參與本實驗。正常學童平均年齡9.88±1.61歲，痙攣型腦性麻痺的學童的平均年齡10.06±1.49歲。實驗使用自製斜坡步道（0度、3度、6度、12度），利用數位攝影機三部加以收集受試者身上反光球之座標位置，經Ariel Performance Analysis System （簡稱APAS）5.5版動作分析系統進行數位化，所得資料以單因子變異數分析（α<.05）作統計處理，達顯著差異時再進行事後比較。
結果發現：1.在上坡行走時，12度的坡度對正常學童的右腳步頻及步速有顯著差異。2.痙攣型腦性麻痺的國小學童的步態週期、站立期、擺動期的時間比正常國小學童較長，步頻和步速較正常學童要慢，跨步長較正常學童要小，正面的步寬及頭部左右擺動振幅較正常學童要大。3.腦性麻痺學童在走下坡時，步態週期（秒）、站立期（秒）會隨著坡度增加而減少，步頻（踏步/分）會隨著坡度的增加而增加，且發現6度及12度的坡度對腦性麻痺學童的下坡行走有顯著的影響。
坡度從6度開始對腦性麻痺在下坡行走時有顯著的影響，顯示國小的腦性麻痺學童在6度以上的坡度下坡行走時會有跌倒之虞。建議未來在設計或興建國小無障礙環境之斜坡道時，能低於6度以下，以免造成腦性麻痺學童行走時的危險。

關鍵字

痙攣型腦性麻痺 ； 步態 ； 步道坡度

並列摘要

The purposes of the study were to show: (1) the effects with different slopes on gait cycle, stance phase, swing phase, stride length, cadence velocity, width between two feet and amplitude of head vibration between normal students and students with spastic cerebral palsy（CP）, (2) the differences between the effects on different slopes of normal students and students with spastic CP respectively, (3) the differences of effects on different slopes（ground, 3, 6 and 12degrees）of gait cycle, stance phase, swing phase stride length, cadence, velocity, width between two feet and amplitude of head vibration of students with spastic CP. Thirteen normal students and nine students with spastic CP participated in the study. The subjects underwent the clinical routine of muscle tone and muscle strength and 10-meter walk. The average age of the normal students was 9.88±1.61 and students with spastic CP was 10.06±1.49. The gait motions of the participants on different slopes were captured with three highly-advanced digital cameras. Ariel Performance Analysis System（APAS） were employed to digitize the gait motions and to acquired the information of temporal-spatial parameters. Analysis of variance (one-way ANOVA) was used for data analysis（α<.05）.
The results were as follow: (1) The effects on different slopes of the normal students’ cadence and velocity were 12 degrees different. (2) Students with spastic CP had longer times of gait cycle, stance phase, and swing phase than the normal students, but the cadence and velocity were slower, the stride length was shorter, and the amplitude of head vibration was much wider than normal children when they walked on the flat ground. (3) When students with spastic-CP walked down the slopes, gait cycle and stance phase would decrease when the pitch increased. The differences between 6 degrees and 12 degrees caused obvious influences on students with spastic-CP.
From these results, it was dangerous for spastic-CP students to walked down the slopes above 6 degrees. Therefore, the perfect non-obstacle facilities should acquire slopes under 6 degrees. Let’s provide spastic-CP students with a safer environment in the future.

並列關鍵字

spastic cerebral palsy ； gait ； degrees of slopes

參考文獻

吳雪玉。（1992）。石膏載重鞋對腦性麻痺兒童膝後頂的治療效果：二病例報告。中華物療誌，第十七卷第一期，41-45頁。

李淑貞、凌汶。〈1994〉。不同類型腦性麻痺患者的時間和空間步態參數之研究。中華物療誌，第十九卷第一期，17-28頁

黃世旭 李淑貞 劉謹緣 李茂昌。〈1996〉。中國青年人步態常模之建立。中華物療誌，第二十一卷第二期，21-35頁。

廖芳華。（1987）。不同類型腦性麻痺兒童之粗動作發展。中華物療誌，12:40-45頁。

王錦滿、陳正岳、梁秋萍、黃美涓。（1992）。南部地區腦性麻痺患童之探討。中華民國復建醫學雜誌，20卷，113-117 頁