應用功能性電刺激改善中風患者步行與垂足症狀之研究

Application of Functional Electrical Stimulation for Improving Walking and Foot Drops of Cerebral Vascular Accident Patients During the Locomotion

翁崇豪(Chong-Hao Weng)

指導教授 ： 張恆雄 ； 游忠煌 ； 陳適卿

中原大學/工學院/醫學工程研究所/碩士(2002年)

https://doi.org/10.6840/cycu200200601

摘要

對於腦中風的病患而言，常因為垂足的症狀而使得行動能力受到阻礙。垂足的原因是因為小腿上之肌肉無足夠的力量使足部從地面上抬，因此，行走時足部會有拖地的現象，並且容易產生絆倒的情況。除此之外，不同的中風患者皆有不同的步行缺陷，因此也需要不同的行走輔助方式予以各別矯正。而功能性電刺激已經被證實在偏癱患者的行動機能恢復上具有良好之效果。因此在本研究我們發展一套步態分析系統，即使用電子量角器量測行進間下肢關節之角度變化。我們量測正常人與各別中風患者行走時下肢關節角度變化並分析之間的差異性，以評定各別中風患者之步行缺陷並選擇出所需電刺激之肌肉位置。透過功能性電刺激使下肢肢體產生適當的動作以及使下肢關節能有較適當之角度。我們期望藉由這套系統中風患者能走得更安全、更方便、更迅速也更輕鬆，進而改善日常生活之行動能力。

本研究主要包含三個階段：系統架構、進行臨床測試實驗以及使用效果之評估與探討。在硬體部分我們建立一套步態分析系統與功能性電刺激系統。在臨床部分我們提供中風患者使用上的各項效果評估。並藉由行走測試來記錄患者使用各種行走方式之行走速率、步長步幅、下肢各關節平均角度以及心率差值，即能有效顯示出增進效果。同時亦分析訓練上之效果並在測試結束時設計一份問卷提供受測患者填寫。最後，根據以上各種的評估方法，我們即可清楚瞭解各方面的使用效果和病患的接受程度。

關鍵字

功能性電刺激 ； 垂足 ； 腦中風 ； 偏癱 ； 電子量角器

並列摘要

For the cerebral vascular accident (CVA) patients, walking ability is often hampered by a dropped foot. This occurs when the muscles of the lower leg are not strong enough to lift the foot upwards when bringing the foot forwards off the ground. As a result, the foot catches resulting in stumbling and even falling. In addition, each CVA patients have other different walking handicaps, so they need different help to reform it. The functional electrical stimulation (FES) has been demonstrated to be effective in restoring locomotion in hemiplegia. In this study, we developed a gait analysis system, and used goniometer to measure degree variety of lower joint angle during locomotion. Then we identified the variation between normal subjects and CVA patients to assess which muscle needs to be stimulated, to make lower extremities perform proper motion and lower joint perform proper angle. We expect to make CVA patients walking safer, more convenient, quicker, easier, and to improve walking abilities of daily livings by using this system.

This study has three main phases: constructing the system, collecting the clinical experiment data and evaluating objectively. In the hardware portion, we set up a gait analysis system and a FES system. In the clinical portion, we provide objective estimate of the therapy effect. Improvements are reflected in clinical trials, recording the speed of walking, step length, stride length, the average angles of the lower joint during locomotion and the effort of walking by measuring the heart rate. Carry-over of these improvements is also analyzed, indicating a training effect of stimulation, and at the end of the test period subjects were given a short questionnaire. Finally, according to these kinds of the evaluation methods, we can distinctly understand the effect and patient acceptance.

並列關鍵字

Goniometer ； Cerebral Vascular Accident ； Functional Electrical Stimulation ； Drop Foot ； Hemiplegia

參考文獻

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