互動式動態平衡干擾訓練對老人之影響

Abstract

背景：跌倒是威脅老人健康的潛在危險因子，因為跌倒可能會造成挫傷、骨折甚至是頭部外傷的風險，且行走是日常生活中常發生跌倒的日常生活活動，但目前臨床的平衡訓練中，較難以模擬於行走跌倒之情境，故我們開發了一種新穎的動態平衡訓練，使用雙帶平衡干擾跑步機，可在行走期間產生向前，向後和側向的平衡干擾，在安全的環境中，針對個案調整適合的平衡干擾參數，提供有安全防護措施的跌倒經驗模擬訓練，藉此增進老人之身體平衡穩定能力與反應。 目的：本研究目的為探討互動式動態平衡干擾訓練對老年人之影響。 假設：老年人接受互動式動態平衡干擾訓練後會增進其靜態及動態平衡表現。 設計：單組前後測介入型設計 方法：本研究召募60至80歲之老人，接受為期八周每周兩次之互動式動態平衡訓練。在訓練前後將進行生物力學與臨床表現之評估，評估項目包括自選速度行走、功能性前伸，以及平靜站姿下接受平衡干擾後之表現。使用三維動作分析系統擷取動作學及動力學之訊號，如身體質心與足底壓力中心之傾角及功能性前伸距離，並量測受試者之身體組成成分以及身高體重等基本資料。統計分析使用成對t 檢定 (Paired-t Test) 檢定前後測之參數，顯著程度設定在0.05。 結果：共有17位受測者 (12 女性，年齡: 68.33 ± 5.80 歲) 參與本研究，在接受八周互動式平衡干擾運動訓練後，其功能性表現的計時起走測試 (8.15 ±0.79 秒， p = 0.02)與生物力學參數干擾下之身體質心控制 (89.51 ± 45.83， p = 0.02) 都有顯著性的進步。 結論：八周之互動式動態平衡干擾訓練可增進老人的一般功能性測試能力與生物力學表現。臨床治療師可以依照本篇研究所提供之訓練方法及雙帶平衡干擾跑步機設定之參數，對於老人進行任務取向之平衡干擾訓練，預防跌倒的發生。未來之研究計畫可以將雙帶平衡干擾跑步機結合虛擬實境系統，更能模擬日常生活之情境。此雙帶跑步機可以將兩邊跑帶調整不同速度，未來研究可以應用在兩腳步伐不協調的患者，像是截肢、中風、小腦損傷患者之步態訓練。

Background: Falling is an important issue in older adults because they have a high risk of bruises or fracture after falls. Previous balance training studies for older adults focus on muscle strengthening and clinical outcome measurements than biomechanical parameters to quantify the training effect. Walking is one of the fall-related movements in daily living. However, during balance training, it is difficult to simulate the balance treat during walking. Therefore, to investigate the dynamic balance control during walking is important. Purpose: This study investigated the changes in the balance performance of older adults after they received 8-week interactive perturbation-based balance training twice weekly. Design: Single group intervention with pretest-posttest design study Methods: Participants aged between 60 to 80 years old were recruited to receive a twice a week, eight-week interactive perturbation-based balance training. The biomechanical and clinical assessment were conducted before and after training. The three-dimensional motion analysis system was used to collect kinematic and kinetic data. The participants performed quiet standing, the Timed Up and Go Test. the Functional Reach Test, and level-ground walking. Biomechanical parameters such as the inclination angle between the center of mass (COM) and the center of pressure (COP), the trajectory of the COP, and the distance of the Functional Reach Test were calculated. A paired-t test was used to compare the difference of variables between pre-test and post-test. The significant level was set at 0.05. Results: A total of 17 participants (12 female, 5 male; Age: 68.33 ± 5.80 years) were included in this study. After they received 8-week interactive perturbation-based balance training, their performance of Timed Up and Go test (8.15 ± 0.79 sec, p = 0.02) and their center of mass stability during quiet standing with perturbation (89.51 ± 45.83, p = 0.02) improved significantly. Conclusion: This interactive perturbation-based balance training exerted a positive effect on performance-based balance function and dynamic postural control in older adults. This translational research contributes necessary information on the critical factors of balance control in older adults. The findings provide a new paradigm of treatment approaches for balance control. The research findings can be applied to persons with poor balance who have a high risk of falling.