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標題: | 高功能中風老年人行走跨越障礙物之多目標最佳控制策略 Multi-Objective Optimal Control Strategies of the Locomotor System During Obstacle-Crossing in Highly Functioning Older Patients Post-Stroke |
作者: | Bing-Chang Wu 吳秉璋 |
指導教授: | 呂東武(Tung-Wu Lu) |
關鍵字: | 中風,跨越障礙物,運動控制策略,多目標最佳化方法,動作分析, Stroke,obstacle crossing,motor control strategy,multi-objective optimal control,motion analysis, |
出版年 : | 2013 |
學位: | 碩士 |
摘要: | 由於醫療的進步,減少了中風病患的死亡率以及症狀,但相對的輕微症狀的中風病患卻增加了。目前用於評估中風病患的工具,主要都集中在中度以及嚴重的病患,輕微中風症狀由於天花板效應,在臨床上可能被忽略或是難以評估,而被判定為正常。過去的研究指出輕微中風症狀仍然會對病患的生活品質以及運動功能造成限制。
過去的研究顯示中風會增加病患跌倒的風險,73%的中風病患會在離開醫院六個月內跌倒至少一次,其中有10%是因為跨越障礙物,跨越障礙物是日常生活中不可避免的動作,需要精確的身體控制以及協調性以保持身體平衡來確保能成功跨越障礙物,跨越障礙物也是在復健治療上用以訓練神經受損病患動作之一。過去中風患者跨越障礙物的動作分析研究,著重於其運動參數,如關節角度、關節力矩、身體質量中心與壓力中心傾斜角的差異性,隨著障礙物高度以及受試者改變,有些參數改變,有些參數不變,運動參數確實可以討論關節表現,但無法討論整體動作控制策略, Lu (2012) 提出的多目標最佳控制方法,定義跨越障礙物之目標函數可由最小能量消耗與最大足部間隙妥協組合而成,並可描述跨越障礙物之控制策略。 本研究目的為使用多目標最佳控制方法,比較健康老年人與高功能中風病患跨越障礙物控制策略的差異,以了解高功能中風對病患動作控制的影響。本實驗受試者分為,20名老年高功能中風病患 (Stroke)以及15名健康老年人 (Elderly),分別跨越腳長之 10%,20%以及30%高度的障礙物。結果顯示,跨越障礙物之控制策略並無高度間差異,但有明顯的組間差異;前後腳跨越控制策略只有Elderly有顯著差異;Elderly後腳跨越的控制策略趨於保守,Stroke 前後腳控制策略並無顯著差異,表示視覺回饋在高功能中風病患的控制策略並無影響;Stroke 健側患側控制策略無顯著差異。由結果推論,高功能中風病患已有了新的且具有對稱性的控制策略,跨越障礙物時傾向於增加足部間隙,以較保守的策略跨越障礙物,以確保能成功跨越障礙物。相對於傳統大量運動學參數資訊,本研究能提供一個更簡易且明確的工具,用來描述高功能中風病患跨越障礙物時的控制策略,可以藉此評估以及預防病患跌倒的風險。 With the advance in clinical diagnosis and management, the severity of the consequences of a stroke has decreased, whereas the number of strokes resulting in minimal to moderate deficits has increased. However, available motor assessment tools are applicable mainly for moderately to severely affected patients. For highly functioning adults post-stroke, the deficits that do not become apparent from locomotor behavior may be overlooked or difficult to discover owing to ceiling effects of the functional assessment tools. Patients who have suffered a mild stroke are reported to have diminished quality of life and limitations in higher levels of motor function. From the results of previous literatures, long-term stroke survivors may also have an increased falling risk owning to residual physical disability. 73% patients with stroke fell at least once in the six months after hospital discharged and of these, 10% of these fall were obstacle related. Obstacle crossing, requiring precise control of the swing limb while maintaining body balance through stability of the contralateral stance limb, is one of many complex tasks associated with ambulation in the daily environment and is also one kind of rehabilitation training program for neurological patients. Kinematic and kinetic data, such as joint angle, joint moment, inter-joint coordination and COM-COP inclination angle, is used in motion analysis of patients with stroke during obstacle crossing. Although these data are useful for evaluating the functional performance of patients with stroke, there still exist difficulties in the synthesis of the information to uncover the overall control strategies. Lu (2012) suggested that obstacle-crossing was formulated as an optimal control problem with two conflicting objectives: minimization of mechanical energy expenditure and maximization of foot-obstacle clearance. The purposes of the present study were to compare the control strategy during obstacle-crossing between highly functioning older post-stroke and healthy elderly with a multi-objective optimal control (MOOC) technique. In the present study, 20 high-functioning older patients post-stroke (Stroke) and 15 health elderly subjects (Elderly) were requires to step over obstacles with heights of 10%﹐20% and 30% leg length. Differences of control strategies of obstacle crossing were not found in height effects, but found in group effects. Differences of control strategies in leading and trailing limbs were only found in Elderly group, control strategies of Elderly trailing limb is more conservative, this mean the visual feedback is not effect in patients with Stroke. There were no significant differences of control strategies between contralateral and ipsilateral during obstacle crossing. Therefore, it may be inferred that high-functioning older patients post-stroke appeared to have acquired a specific symmetric kinematic strategy. Stroke patient individuals increase their toe and heel clearance when crossing obstacles, in order to employ a more conservative strategy for successful obstacle crossing. The results of this study can provide a simpler and clearer tool to describe the control strategies during obstacle-crossing in highly functioning older patients post-stroke. It can be used to assess and prevent the risk of a fall. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/60851 |
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顯示於系所單位: | 醫學工程學研究所 |
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