跑步機之變速控制及於中風步態復健之應用

Abstract

本論文主要利用慣性量測單元來進行中風患者的步態訓練和分析人體步態行走的指標。內容包括了兩大部分，第一部銜接了先前的研究，針對中風患者開發的自動化神經發展治療(Neuro Developmental Treatment ；NDT)訓練機為基礎，再結合跑步機速度控制可以同時增進中風患者的各項步態指標，包括擺動期對稱性、骨盆側向位移、腰部旋轉幅度、走路速度與跨步步長。第二部分為利用慣性量測單元測量專業瑜伽老師、年長者與一般人走路的狀態，並且定義相關指標來探討不同族群的步態性能。 NDT步態訓練機以最少的介入進行誘導訓練，協助患者恢復運動控制和運動協調的正常神經迴路，以幫助患者恢復行走能力。但在實務上相當地耗費時間和人力，因此也限制了患者的治療效果。為了解決時間和人力成本以及提升NDT復建治療效果，本實驗室先前開發了一套自動化NDT步態復建訓練機，幫助患者改善走路時的擺動期對稱性、骨盆側向位移對稱性、腰部軸向旋轉幅度、走路速度與跨步步長。但是在過去的研究中發現，使用者常常需要配合跑步機的速度會降低NDT訓練效果。因此，為了可以讓患者在跑步機上以最適合自己的走路速度得到治療，本論文進行跑步機的速度控制使其配合不同的患者的走路速度，期望能提升NDT步態訓練的效果。另外，本論文也開發了兩種聽覺回授刺激方式配合NDT治療，結果顯示兩種聽覺回授方法都可以為受測者運動指標帶來正面的影響。 本論文首先用系統識別建立NDT訓練馬達與跑步機馬達的數學模型，並設計控制器與補償器，透過絕對型拉繩式編碼器、慣性量測單元、紅外線測距儀、與跑步機編碼器，回授患者的運動狀態，完成自動化NDT步態訓練機的整合訓練機制。驗證部分，先邀請擬中風受測者進行測試，以確認整體系統可靠性與安全性，再招募中風患者進行訓練，探討對於患者各項步態指標的增益效果。 瑜伽是一項可以增進身體核心力量和平衡性的運動，本論文透過慣性測量單元，探討資深瑜伽老師與年齡相仿的普通對照組在正常行走步態，與串聯式步態(Tandem Gait)的表現。結果顯示核心平衡能力較強的瑜伽老師會比對照組在步態測試來得好。另外也對65歲以上的年長組和65歲以下的年輕中年組進行步態運動的測試，探討他們的步態運動表現差異。結果顯示年輕中年組在肌肉強度較高的情況下串聯式步態(Tandem Gait)會比老年組表現的更好，而正常行走步態卻沒有差異。

This thesis applies inertial measurement units (IMUs) to perform two tasks: gait training for stroke patients and analyzing human gait performance. In the first task, we developed an automated Neuro-Developmental Treatment (NDT) trainer employing a speed control treadmill. NDT could improve the physical function of stroke patients by establishing and restoring neural circuits through minimum interventions. Therefore, our laboratory developed an automated stationary NDT gait trainer to help patients improve their asymmetry of swing phase, asymmetry of lateral pelvic displacement, the amplitude of pelvic rotation, walking speed and stride length. However, during the tests, we found that users must adjust their speeds according to the treadmill. Therefore, we developed a speed-control treadmill and integrated it with the NDT trainer. We identified the systems through experiments and designed controllers so that the treadmill could adjust its speed according to the users. We invited healthy subjects and patients with strokes to conduct experiments. The results show that the speed-control NDT trainer could improve these subjects’ asymmetry of swing phase, asymmetry of lateral pelvic displacement, the amplitude of pelvic rotation, walking speed and stride length. Furthermore, we tried two different voice intervention methods on users during the NDT Treatment. The results showed that two voice intervention methods had a positive impact on all the users. In the second task, we applied IMUs to evaluate the gait performance among the Yoga instructors, the healthy control, and the elders. Yoga is known for improving core strength and balance. We estimated the gait performance of senior yoga instructors and normal healthy subjects of similar age through IMUs. The results showed that yoga teachers performed better gait performance than the control group. We also compared the gait performance between the elder group and the young controls. The results showed that the young controls performed better in Tandem Gait than the older group but with no difference in normal walking gait. Furthermore, the yoga instructors tended to have better gait performance than the young controls despite the age differences. These findings suggest that suitable exercises could be introduced to the elders to improve their gaits.