整合Kinect與加速規量化臨床Tinetti量表參數

Abstract

高齡者最常發生的事故傷害為跌倒，在臨床上，專業的臨床人員以量表評估動作能力與跌倒風險，臨床量表擁有較完整的評估項目，但評估的過程需由專業且有經驗的臨床人員進行，先前已有研究藉由科學儀器電子傾角器與壓力感測器量化最常用來評估高齡者跌倒風險的Tinetti量表 (Tinetti Performance Oriented Mobility Assessment Scale)，但該研究只有平衡能力的量化，卻沒有量化與最常發生跌倒行之行走過程息息相關的步行能力，因此，本研究希望能藉由生物力學的角度，以簡單且方便的科學儀器量化Tinectti量表的平衡能力與步行能力之目的，達成跌倒風險的評估。科學儀器為景深感測器Kinect與3顆三軸加速規進行同步量測，其中Kinect擷取受測者正面資訊，並使用骨架追蹤系統擷取，擷取量化量表所需的13個特徵點量化所之空間參數，而加速規放置於下背薦骨處與雙腳腳背，藉由薦骨處加速度量化平衡能力、雙腳腳背加速度訊號量化步態時間參數。本研究招募30位健康受測者 (年齡: 23.6 ± 2.68；身高: 1.68 ± 0.06 m) 量測Tinetti量表中平衡能力 (4項指標) 與步行能力 (8項指標) 參數，藉由平均值與3倍標準差制定量化標準與建立評估系統，並以百分比方式呈現量測數值。研究結果用以臨床人員同時進行四位偏癱患者於本研究與量表同時評估，三位受測者結果均完全相符 (總分分別為27、26、27分)，而第四位受測者並非在同時間點由儀器與臨床評估，但也只有一個項目不同，表示本研究提供量化評估標準之準確性是可行的。針對臨床評估使用Kinect結合加速規可完成臨床量表標準評估，期未來此系統可應用於臨床的評估與日常生活照料，建立在家量測與評估平衡與步行能力以達全人福祉。

Falls are often seen in elderly. The professional clinician often use clinical scales for clinical evaluation process. However, using the clinical scales for assessment always requires the experienced and professional clinical. Besides, the evaluation results are inter-rater bias and this assessment method has the manpower shortage problems. In previous studies, the instruments such as inclination and pressure sensors were utilized to quantify the Tinetti scale (Tinetti Performance Oriented Mobility Assessment Scale) which is the most common assessment scale for the falling risk of elderly. However, the aforementioned studies only achieved the quantization of balance ability but did not quantify the gait ability which is closely related to the occurrence of falling. Therefore, this study aims to employ the biomechanics by utilizing the simple and convenient scientific instruments to quantify Tinetti scale. Hence, the view depth sensor Kinect and three accelerometers were used to perform measurements simultaneously in order to assess the gait and balance ability as shown in Tinetti scale. In the experiment, the Kinect was placed at the end of walkway, facing the front of subjects to track their skeleton, and accelerometers were placed near the sacrum and instep of feet of subjects in order to quantify the balance and temporal parameters. This study has recruited 30 young subjects (age: 23.6 ± 2.68; Height: 1.68 ± 0.06 m) to measure the Tinetti scale in terms of balance ability (4 indicators) and gait ability (8 indicators) parameters. The established evaluation system is based on the average value and three times of standard deviation as the quantitative criteria and the results are presented in percentage. The assessment results by the clinician for the four hemiplegic patients in this study, three subjects are fully consistent with that of the developed assessment system: 27, 26, 27 points. Fourth subject were not at the same time by the instrument and clinical evaluation, only different gait symmetry item. Thus, it indicates that the developed clinical assessment system by utilizing Kinect combined with accelerometer can provide an accurate quantitative assessment. I hope that in future this system can be applied to the clinical assessment and daily care, and also has the convenience to be used at home for the assessment of balance and gait ability.