膝關節伸張輔助裝置對股四頭肌肌力不足中風病患步態之改善研究

Abstract

中風病患的死亡率逐年下降，但中風病患的生還者將近一半會有殘餘的身體生理殘障。生還者在不同系統，包括感覺，肌與骨骼，知覺，和認知上的不足，均有可能減少患者姿勢的穩定度。在住院治療、急性看護、復健階段或是已經出院以後，缺乏姿勢的穩定度會導致跌倒。姿勢的不穩定度是在這個族群的重要的問題。 肌力的不足可能是姿勢上的不穩定的主要的原因。有證據顯示肌肉強度在中風之後，在身體機能的恢復中扮演重要的角色。所以我們將利用動力計量化膝關節伸張與彎曲的力矩的值。膝關節彎曲肌與伸直肌的扭矩的量化在步行的訓練上是非常重要的。 參與實驗的受試者是左側伸張肌力不足的病患，而膝踝足輔具(KAFO)被用在處裡下肢肌肉與骨骼系統的偏差，受傷或者紊亂的一份治療器具。對於病患來說，日常生活最重要的活動就是走路。所以實驗將採取步態實驗，而且步態實驗更貼近病患日常生活的活動。在實驗中，膝踝足輔具(KAFO)加上伸張輔助的單軸膝關節裝置被用在控制膝關節的運動，並且改進在步態期間的安全。由實驗得到能量消耗、空間時間參數和下肢關節的運動及動力的資料，並分析各類型伸張輔助膝踝足矯具對於中風病人在步態時動作表現的影響與效果。

Approximately two thirds of stroke patients survive an initial stroke and about half of the survivors have residual physical disabilities which decrease postural stability. The lack of postural stability can lead to falls during hospitalization, both in the acute care and rehabilitation stages, and after discharge. Postural instability is importance in this population. Muscle weakness may be a major cause of postural instability. There is evidence that muscle strength plays an important role in functional recovery after stroke and that muscle strengthening is functionally relevant. Quantification of knee flexion and extension torque would be done by Cybex dynamometer. The important activity for daily living in stroke patients is walking. Walking test clearly correspond closely to the demands of patients’ everyday activities. A KAFO with a single-axis knee plus extension assist can control motion at the knee, and improve the gait. Our intention was to study the effectiveness of the extension assist by looking into its performance in energy consumption, temporal-distance parameters, joint kinematics and kinetics.