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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/79396完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 趙福杉(Fu-Shan Jaw) | |
| dc.contributor.author | Chih-Chao Hsu | en |
| dc.contributor.author | 許智超 | zh_TW |
| dc.date.accessioned | 2022-11-23T08:59:36Z | - |
| dc.date.available | 2022-03-07 | |
| dc.date.available | 2022-11-23T08:59:36Z | - |
| dc.date.copyright | 2022-03-07 | |
| dc.date.issued | 2022 | |
| dc.date.submitted | 2022-02-11 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/79396 | - |
| dc.description.abstract | "背景：我們設計了一種新型足踝輔具 (Ankle Foot Orthosis, AFO)，即理想訓練 AFO (IT-AFO)，通過對偏癱下肢的運動反饋來改善中風相關偏癱患者的行走能力。因此，我們試圖比較有和沒有動態控制的 IT-AFO 與傳統前型 AFO 或無 AFO 之間的步態運動學參數。方法：使用 RehaWatch® 系統測量 7 名偏癱患者（平均 51.14 年）的步態參數。這些參數在四種情況下進行了比較：無 AFO、傳統前部 AFO、無動態控制的 IT-AFO 和具有動態控制的 IT-AFO，每種情況進行 3 次 10 米步行測試。結果：佩戴IT-AFO後，擺動期背屈角增大，動態控制後背屈角變大。這些數據可以確認落腳的改善；然而，在擺動階段，有和沒有 AFO 控制條件的參數之間的差異並不顯著。與傳統 AFO 或無 AFO 相比，有或沒有動態控制的 IT-AFO 在更大程度上增強了偏癱和未受影響下肢之間的負荷響應。與使用傳統 AFO 相比，使用 IT-AFO 和不使用動態控制時，偏癱下肢站立階段的持續時間也更長，從而改善了不對稱性。與其他條件相比，IT-AFO 的用戶舒適度和滿意度更高。結論：具有動態控制的 IT-AFO 改善了步態模式和重心轉移到偏癱下肢，減少了步態不對稱。有無動態控制IT-AFO的差異無統計學意義，受樣本量限制。然而，這項研究顯示了 IT-AFO 在步態訓練中應用正運動反饋的潛力" | zh_TW |
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| dc.description.tableofcontents | "口試委員會審定書 # 誌謝 i 中文摘要 ii ABSTRACT iii 目錄 iv 圖目錄 vi 表目錄 viii 第一章 引言 1 第一節 研究動機 1 第二節 步態週期 1 第三節 足踝輔具（AFO） 4 第二章 動態足踝輔具設計 6 第一節 動態套件足踝代償阻力文獻參考 6 第二節 針對步態控制設計動態套件 10 第三節 針對步態訓練設計動態套件機制 13 第四節 IT-AFO實作與應用機轉 16 第五節 IT-AFO製作 20 第三章 臨床試驗 24 第一節 實驗設計 24 第二節 實驗成果 26 第四章 討論 33 第一節 動態套件應用於步態訓練的原理 33 第二節 實驗結果分析 34 第五章 總結 37 第六章 參考文獻 38 第七章 附錄 48 附錄一. 人體試驗同意函 49 附錄二. 手肌力評估量表（Manual muscle testing, MMT） 51 附錄三. 個案評估報告表（Case report form） 52 圖目錄 圖 1. 步態週期，各時期名稱以及作用肌群對照表。(2) 2 圖 2. 於不同Stance phase時期肌肉作用與力矩，紫色箭頭為力的向量，紫色肌肉為作用中的肌群。(4) 3 圖 3. 於不同Swing phase時期肌肉作用與力矩，紫色箭頭為力的向量，紫色肌肉為作用中的肌群。(4) 4 圖 4. Toshiki Kobayashi, 2015年於研究使用彈簧當阻力的AFO對腳踝關節變化的影響S1至S4代表透過彈簧提供的阻力由小至大(27) 6 圖 5. Toshiki Kobayashi, 2015年於研究使用彈簧S1至S4阻力的AFO對膝關節變化的影響(27) 7 圖 6. S. YAMAMOTO, 2005年於研究調節不同阻尼係數阻力的AFO對踝關節與膝關節變化的影響，1至4代表透過阻尼的阻力由強至弱。(25) 8 圖 7. Yokoyama, 2005年於研究表的gait solution 包含阻尼套件(1)、金屬板(2)和環部(3)。液壓缸 (4) 用作油阻尼器。調節螺釘 (5) 通過改變孔的直徑來控製油流量。彈簧 (6) 有助於背屈。附有桿帽（7）用於設置踝關節的初始角度。(28) 9 圖 8. S. YAMAMOTO, 2005年於研究發表的油壓阻尼AFO(gait solution) 9 圖 9. Yokoyama, 2005年於研究發表的gait solution與蹠曲限制AFO對踝、膝、髖關節變化的影響的圖片。Ａ：Gait solution, B：posterior plantarflexion stop AFO.在步態週期中initial contact以及late stance時A組增加了蹠曲○1，並降低了膝蓋彎曲○2○3，同時在Middle stance時期沒有出現過度的膝蓋伸直（hyperextension）○4, 在swing phase亦沒有過度的蹠曲○5，同時髖關節彎曲的最大角度在Ａ組增加而Ｂ組減少了○6。(28) 10 圖 10. 設計代償型AFO需要考量到的相關參數，藍字為機構，橘字為個時期主要影響腳踝的力，白字為腳踝矢狀面角度的變化以及原因。 12 圖 11. IT-AFO外型與綁帶控制力方向，A為綁帶固定於IT-AFO小腿處的位置，B為綁帶固定於IT-AFO腳底處的位置，O為IT-AFO關節處，FOA與FBO將合成合力FBA控制腳踝，對側亦然。 13 圖 12. IT-AFO Dynamic device的設計相關參數與機轉，橘框內為Dynamic device的主要集購與作用阻力方向（綠色箭頭），橘字為個時期主要影響腳踝的力，白字為腳踝矢狀面角度的變化以及原因，藍字為步態過程中IT-AFO的作用機制。 15 圖 13. 正常行走足底受力的曲線與體重之相關性，紅色箭頭為地面反作用力方向。(3) 16 圖 14. 腳部質心位置以及腳部控制力矩計算，左表為個身體部位之長度與重量對應身高與體重的比例。(3) 17 圖 15. 腳部質心位置以及腳部控制力矩計算，左表為個身體部位之長度與重量對應身高與體重的比例。(3) 18 圖 16. IT-AFO示意圖，(A)結構和動態套件，(B)在擺動期提供蹠屈阻力，(C)在站立期當重心充分轉移到患側時機構恢復，(D)在站立期當重心轉移到患側不足時，動態套件未恢復。（圖片下方的顏色標記，對應不同步態時期，腳踝角度與機構的相對關係。(1) 19 圖 17. 腳部骨骼名稱與相對位置，以及動作軸線（紅線處）(3) 20 圖 18. 腳部骨性標記與IT-AFO結構對應位置。 21 圖 19. 掃描完成後OBJ腳膜 22 圖 20. 本研究所開發3D輔具客製化生成軟體介面。 22 圖 21. MMT與MAS分數轉換圖表 27 圖 22. Rehawatch定義的腳踝最大（maximum angle）與最小角度（minimum angle） 27 圖 23. Rehawatch數據分析結果(A) Affect minimum angle, (B) Affect Maximum angle, (C)Affect loading response, and (D)Loading score. 29 圖 24. Rehawatch測得10公尺平均行走速度. 30 圖 25. Rehawatch測得患側Ａ. 站立期比例與B. 站立期兩腳相差值 31 圖 26. 舒適度與輔助性能問卷分數統計 32 表目錄 表 1. Deanna J. Fish, 2001年於文獻中提出的中腦血管意外相關步態特徵，與輔具使用考量。(5) 5 表 2. Toshiki Kobayashi, 2015年於研究時採用Gao於2011年發表的AFO彈簧S1至S4於不同蹠曲（PF）角度時所產生的力矩平均數值(27) 7 表 3. Ultimaker 3D列印機列印集盛4611 Nylon 尼龍線材所設定之參數。 23 表 4. 受試者基本資料 26 " | |
| dc.language.iso | zh-TW | |
| dc.title | 針對步態訓練的三維列印動態足踝輔具- 設計與臨床試驗 | zh_TW |
| dc.title | Dynamic 3D printing AFO for gait training- Design clinical trial | en |
| dc.date.schoolyear | 110-1 | |
| dc.description.degree | 博士 | |
| dc.contributor.coadvisor | 陳適卿(Shih-Ching Chen) | |
| dc.contributor.oralexamcommittee | 陳右穎(Te-Sheng Hsiao),康峻宏(Jia-Yush Yen),施博仁 | |
| dc.subject.keyword | 足踝輔具,偏癱,中風,步態訓練,三維列印, | zh_TW |
| dc.subject.keyword | Ankle foot orthosis,Hemiplegia,Stroke,Gait training,3D printing, | en |
| dc.relation.page | 57 | |
| dc.identifier.doi | 10.6342/NTU202200503 | |
| dc.rights.note | 同意授權(全球公開) | |
| dc.date.accepted | 2022-02-13 | |
| dc.contributor.author-college | 工學院 | zh_TW |
| dc.contributor.author-dept | 醫學工程學研究所 | zh_TW |
| 顯示於系所單位： | 醫學工程學研究所 | |
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