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Title: | 巴金森症患者行走與跨越障礙物之動作分析 Movement analysis in patients with Parkinson's disease during walking and obstacle crossing |
Authors: | Zhi-You Chen 陳致佑 |
Advisor: | 呂東武(Tung-Wu Lu) |
Keyword: | 巴金森症,動作分析,運動控制,動作異常偵測, Parkinson’s disease,motion analysis,motor control,detection of movement deviation, |
Publication Year : | 2012 |
Degree: | 碩士 |
Abstract: | 巴金森症為老人三大疾病之一,因為管理動作的基底核黑質緻密部之多巴胺神經元退化導致多巴胺不足而出現動作異常,並造成人體於靜態站立、走路、跨越障礙物等日常功能性活動中之力學與控制的改變。由於目前缺乏有效且敏感的臨床功能性活動細部評估工具,因此早期巴金森患者不同動作異常進展如何影響關節與全身的控制與協調是非常值得探討的。本研究運用三維動作分析系統,配備以6台紅外線攝影機量測分析巴金森症患者與正常受試者在日常生活中常見的靜止站立、走路、跨越障礙物之運動學資料,及利用2塊測力板量測地面反作用力並計算力動學資料。本研究顯示第一期輕度巴金森症患者於行走站立期時患側有顯著較大踝外翻角度及膝屈曲角度,健側於站立末期有顯著較小髖外展角度,力矩於健側代償增加髖外展肌、髖屈曲肌、膝屈曲肌之需求,這些動作異常應可為早期動作異常偵測之方向,而增加的力矩需求則為早期重點訓練肌群,在患側跨越障礙物時,顯著較大的身體質量中心傾角可能增加風險,需要盡早進行單腳站立平衡訓練。第二至三期中度巴金森症患者於用藥後,在靜態站立時因為異動症而增加擺盪面積跟左右方向位移,基底支撐面積變小時則以較趨圓形之擺盪面積而較用藥前為佳,於行走時用藥後較用藥前減少關節角度及力矩與控制組之差異,於跨越障礙物時用藥後跨越時有顯著較少膝屈曲角度,站立腳之膝-踝相對相位角與用藥前顯著接近控制組,後跨越腳跨越時先跨越腳髖-膝偏差相位角與後跨越腳膝-踝偏差相位角顯著接近控制組,用藥後關節角度有較多差異但是關節協調性較接近正常受試者,中度患者用藥前後大致呈現第一期之異常關節角度及力矩進展,仍需要加強與輕度巴金森症患者相同之重點訓練肌群及平衡訓練。 Parkinson’s disease is the three universal concomitants of human aging and major cause of morbidity among the elderly. It’s characterized by the predominant degeneration of dopaminergic neurons in the substantia nigra pars compacta, eventually leading to altered mechanics and control of the whole body during functional activities of daily living, such as quiet standing, level walking, obstacle crossing. Owing to the limitation of sensitivity of clinical functional activities assessment tools, it remains unclear as to how the progress of movement deviation of Parkinson’s disease affects the control and coordination of the joints on the performance of activities of daily living. Motion data including quiet standing, level walking and obstacle-crossing were measured using a three-dimensional computerized motion analysis system equipped with 6 ultra-high resolution infrared cameras and 2 force plates. In the 1st grade of patients, there were greater ankle eversion and knee flexion angle on affected side during the stance phase of gait cycle. There was lesser hip abduction angle on un-affected side during terminal stance phase. Greater hip abductor, hip flexor and knee flexor moment was compensated on un-affected side. These deviations of motor were maybe used to detect in early stage. There were significantly greater COM-COP inclination angle on affected side during crossing. After taking mediation, the 2nd-3rd stage of patients perform greater sway area and medial-lateral side displacement during quiet standing. There was greater motor deviation but lesser coordination deviation than before taking mediation. The motor deviation progression was similar with the 1st stage of patients. The muscle strengthening of hip abductor, hip flexor and knee flexor and balance training maybe was important in both groups. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/66264 |
Fulltext Rights: | 有償授權 |
Appears in Collections: | 醫學工程學研究所 |
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