建立並評估一以肌肉力量與肌肉張力為準則之 下肢矯具處方邏輯系統

Abstract

根據統計，全台灣約有38萬肢體障礙者，在美國更是有約兩千萬人有步行方面的困擾，下肢功能障礙者常仰賴輪椅等行動輔助裝置，長久下來使下肢功能更加退化。下肢矯具可幫助行動不便者離開輪椅步行，但矯具處方多依賴醫師經驗，僅憑醫師感官評估患者下肢功能再進行處方，缺乏一套完善的邏輯系統做為準則。故本研究建構並評估一數據化肌肉力量(muscle power)與肌肉張力(muscle tone)評估系統，與一下肢矯具處方邏輯系統，協助臨床人員為患者處方合適的矯具。 本研究招募五位受試者(包含腦性麻痺患者、車禍傷者及健康受試者)以建立肌肉力量與肌肉張力評估系統。藉由人體計測資料計算肢段對各關節所形成之力矩以定義評估指標，將量測下肢之肌肉力量換算為評估指標後與常用之臨床量表相比較，所得之肌肉力量量測方法的準確性為96.67%；以擺錘實驗量測踝關節之肌肉張力強度，藉由分析實驗中踝關節的被動關節角度變化情形計算其機械性質，同時觀察角度峰值的遞減情形，根據實驗結果將踝關節之阻尼比(damping ratio)大於0.13與足底屈曲釋放指標(Plantarflexion Relaxation Index, PRI)小於1.25時評估為肌肉張力嚴重。 配合上述下肢功能評估方法，本研究針對不同矯具之分類與特性建立一以下肢肌肉力量與肌肉張力為評估準則之下肢矯具處方邏輯系統，量化下肢矯具之處方依據，以該系統為四位步行能力受損之受試者(病徵包含中風及小兒麻痺)進行矯具處方，並讓其使用三個月後量測其步態表現，由實驗結果可看出所給予的矯具確實能幫助受試者改善其步態在站立間期(stance duration)、步頻(cadence)與對稱性(symmetry)上之能力。 總歸而言，本研究成功的建立了一肌肉力量與肌肉張力評估系統，與一下肢矯具處方邏輯系統，以系統所處方之矯具可改善下肢功能受損患者步行時之穩定性或順暢性。

Among the 23 million population, there were about 380 thousand people with ambulatory disabilities in Taiwan. In America, the number of people suffering ambulatory disabilities will even go up to 20 million. Those who have disabilities on their lower limbs usually rely on wheelchair to help locomotion, which causes their lower limbs much regression. Therefore, doctors usually prescribe orthoses for the patients to help them leave their wheelchair and walk by themselves. In this research, a data-oriented estimation system for muscle power and muscle tone, and a data-oriented orthosis-selecting system are developed and evaluated to help clinician prescribe orthoses. Five subjects (including normal subject and patients suffering cerebral palsy and car accident) were recruited to establish the muscle power and muscle tone estimation system. The torque caused by lower limb weight on each joint was calculated with anthropometric data, and the evaluation indexes for muscle power were then defined. By comparing the evaluation indexes with commonly-used clinical scale, a method for evaluating muscle power was established with 96.67% sensitivity. On the other hand, to develop the method for ankle muscle tone evaluation, the mechanical properties and the decrease of peak angle were obtained from pendulum test. The results show that ankles with damping ration greater than 0.13 and plantarflexion relaxation index (PRI) smaller than 1.25 at the same time should be considered as having serious muscle tone. An orthosis-selecting system was built with the methods evaluating lower limb function, and the classifications and properties of orthoses. The system contained an algorithm indicating when each orthosis was needed. After 4 subjects (including patients suffering stroke and polio) wore the orthoses prescribed by the developed system more than 3 months, improvement in their gait function on stance duration, cadence, and symmetry are obtained. In conclusion, a muscle power and muscle tone estimation system and an orthosis-selecting system are successfully developed. That is, the orthoses prescribed by the system can help patients walk more stably or more fluently.