| 研究生: |
廖松璞 Liao, Sung-Pu |
|---|---|
| 論文名稱: |
鞋內壓力傳感器步態週期分析雛型系統開發與初步臨床應用 Development of In-shoe Pressure Sensor Device Prototype for Gait Cycle Analysis and Its Preliminary Clinical Applications |
| 指導教授: |
方晶晶
Fang, Jing-Jing |
| 學位類別: |
碩士 Master |
| 系所名稱: |
工學院 - 機械工程學系 Department of Mechanical Engineering |
| 論文出版年: | 2021 |
| 畢業學年度: | 109 |
| 語文別: | 中文 |
| 論文頁數: | 159 |
| 中文關鍵詞: | 步態週期分析 、穿戴式裝置 、膝關節炎 、高位脛骨截骨術 |
| 外文關鍵詞: | Gait analysis, portable device, Osteoarthritis, High tibial osteotomy |
| 相關次數: | 點閱:121 下載:0 |
| 分享至: |
| 查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
近年來,步態分析已被廣泛運用於臨床,提供一個可量化的觀察,反應身體狀況所引起的步態週期變化,對於醫師,步態分析可作為診斷病灶的參考,用於觀察患者於治療前後恢復情形。
我們結合自行開發的步態分析軟體、感壓鞋墊、資料擷取器,建立一套穿戴式步態分析週期分析系統。穿戴式系統配置於腰部與腳踝,適合量測日常活動中的步態。我們以感壓鞋墊內的薄膜壓力傳感器,量測行進間的足壓訊號,透過訊號擷取器進行訊號蒐集、處理,再以Wi-Fi無線傳輸至個人電腦上的步態分析軟體。以模糊邏輯(Fuzzy logic method)轉換足壓訊號為可量化步態參數。
初步驗證步態模型的正確性,以健康受試者確認系統可行性,再用於分析膝關節病變患者術前,術後步態變化。針對施行高位脛骨平台截骨術膝關節炎患者的術前與術後兩組,比較不同組間未有顯著差異,因樣本數太少,個體差異大無法看到術前術後兩組的差異。我們更定期追蹤探討同一位患者於高位脛骨截骨術術前、術後數月步態的變化,確認術後的步態數據可反映臨床復原各階段的過程。
Gait analysis has been widely used in clinical applications, providing a quantifiable and observable information that can express the changes in the patient's gait caused by the syndrome on spine, lower limb or nervous system. For physicians, gait analysis can be used as a clinical usage in diagnosis, outcomes of the patient's physical recovery after treatment can be observed.
There are many electronic devices for gait analysis on market in last decade, but most of them are costy. Some medical centers founded the gait analysis laboratory, due to limited budget, regional hospitals may not afford to the cost of the system. With the advancement of electronic technology, the sensors and microcontrollers make self-developed gait analysis systems possible. Our study would develop the pressure-based gait analysis system, includes measured insoles, gait analysis software and portable data collectors. Fuzzy logic method is used to convert the foot pressure during walking into gait clinical parameters, which are applied to clinical.
In this study, 3 groups, including 15 healthy subjects, 11 knee Osteoarthritis(OA) patients, and 6 high tibial osteotomy(HTO) subjects were recruited to find out how HTO vary in gait, results show that there is no significant difference between OA and HTO group, and the healthy subjects are significantly difference from the they on walking speed and stride length. We can not claim that gait would change after HTO, the results only can describe in the subjects recruited in this study. The comparison results will be affected by individual differences in subjects and demographic factors, we still needs to collect more samples to get more convincing comparison results.
And 5 OA patients were recruited to find out personal gait change before and after HTO. The OKS and medical image analysis are used to describe the patient physical condition. The gait results show that the 4 of patients improve walking speed after surgery, and the remaining one slow down. The OKS results show that postoperative recovery of patient who slow down is not ideal, it took more time compare with the others. Medical images showed that the mechanical axis of him was overcorrected, like knee valgus. It can be the reason for the undesirable postoperative recovery and slower walking speed.
[1] Perry, J. and Davids, J. R., Gait analysis: normal and pathological function, SLACK Incorporated, 1992.
[2] Whittle, M. W., Gait analysis: an introduction, Butterworth-Heinemann, 2014.
[3] Hong, Y. and Brueggemann, G.-P., "Changes in gait patterns in 10-year-old boys with increasing loads when walking on a treadmill," Gait & posture, Vol.11, No.3, pp.254-259, 2000.
[4] Winter, D. A., Patla, A. E., Frank, J. S., and Walt, S. E., "Biomechanical walking pattern changes in the fit and healthy elderly," Physical therapy, Vol.70, No.6, pp.340-347, 1990.
[5] Cimolin, V. and Galli, M., "Summary measures for clinical gait analysis: a literature review," Gait & posture, Vol.39, No.4, pp.1005-1010, 2014.
[6] Kuo, A. D. and Donelan, J. M., "Dynamic principles of gait and their clinical implications," Physical therapy, Vol.90, No.2, pp.157-174, 2010.
[7] Astephen, J. L., Deluzio, K. J., Caldwell, G. E., Dunbar, M. J., and Hubley-Kozey, C. L., "Gait and neuromuscular pattern changes are associated with differences in knee osteoarthritis severity levels," Journal of biomechanics, Vol.41, No.4, pp.868-876, 2008.
[8] Jansen, H., Fenwick, A., Doht, S., Frey, S., and Meffert, R., "Clinical outcome and changes in gait pattern after pilon fractures," International orthopaedics, Vol.37, No.1, pp.51-58, 2013.
[9] Benedetti, M., Catani, F., Bilotta, T., Marcacci, M., Mariani, E., and Giannini, S., "Muscle activation pattern and gait biomechanics after total knee replacement," Clinical biomechanics, Vol.18, No.9, pp.871-876, 2003.
[10] Stöckel, T., Jacksteit, R., Behrens, M., Skripitz, R., Bader, R., and Mau-Moeller, A., "The mental representation of the human gait in young and older adults," Frontiers in psychology, Vol.6, p.943, 2015.
[11] Optogait, "OPTOGAIT Gait-Phases," <http://www.optogait.com/Gait-Phases>, accessed on 10/30/2020.
[12] Azevedo Coste, C., Sijobert, B., Pissard-Gibollet, R., Pasquier, M., Espiau, B., and Geny, C., "Detection of freezing of gait in Parkinson disease: preliminary results," Sensors, Vol.14, No.4, pp.6819-6827, 2014.
[13] Muybridge, E., The Horse in motion, Morse's gallery, 1887.
[14] Muybridge, E., Woman walking down stairs, Morse's gallery, 1887.
[15] Muybridge, E., Stepping on and over a chair, Morse's gallery, 1887.
[16] Marinescu, G., Walking Troubles of Organic Hemiplegy. 1898.
[17] Muro-De-La-Herran, A., Garcia-Zapirain, B., and Mendez-Zorrilla, A., "Gait analysis methods: An overview of wearable and non-wearable systems, highlighting clinical applications," Sensors, Vol.14, No.2, pp.3362-3394, 2014.
[18] Horst, F., Lapuschkin, S., Samek, W., Müller, K.-R., and Schöllhorn, W. I., "Explaining the unique nature of individual gait patterns with deep learning," Scientific reports, Vol.9, No.1, pp.1-13, 2019.
[19] Teskscan, "Teskscan," <https://www.tekscan.com/products-solutions/human-gait-analysis>, accessed on 10/30/2020.
[20] Hellström, P. A. R., "Wearable Pedobarography System for Monitoring of Walk Related Parameters," Mälardalen University, School of Innovation, Design and Engineering, Doctoral thesis, 2019.
[21] Abu-Faraj, Z. O., Harris, G. F., Abler, J. H., and Wertsch, J. J., "A Holter-type, microprocessor-based, rehabilitation instrument for acquisition and storage of plantar pressure data," Journal of rehabilitation research and development, Vol.34, pp.187-194, 1997.
[22] Kong, K. and Tomizuka, M., "Smooth and continuous human gait phase detection based on foot pressure patterns," in 2008 IEEE International Conference on Robotics and Automation, pp.3678-3683, 2008.
[23] Kong, K. and Tomizuka, M., "A gait monitoring system based on air pressure sensors embedded in a shoe," IEEE/ASME Transactions on mechatronics, Vol.14, No.3, pp.358-370, 2009.
[24] Cyberdyne, "Cyberdyne," <https://www.cyberdyne.jp/english/>, accessed on 10/30/2020.
[25] Herr, H., Blaya, J., and Pratt, G. A., Active ankle foot orthosis, U.S. Patent No. 8,075,633. Patent Term 13 Dec, 2011 to 13 Dec, 2031.
[26] Ramirez-Bautista, J. A., Huerta-Ruelas, J. A., Chaparro-Cárdenas, S. L., and Hernández-Zavala, A., "A review in detection and monitoring gait disorders using in-shoe plantar measurement systems," IEEE reviews in biomedical engineering, Vol.10, pp.299-309, 2017.
[27] Abdul Razak, A. H., Zayegh, A., Begg, R. K., and Wahab, Y., "Foot plantar pressure measurement system: A review," Sensors, Vol.12, No.7, pp.9884-9912, 2012.
[28] Hegde, N., Bries, M., and Sazonov, E., "A comparative review of footwear-based wearable systems," Electronics, Vol.5, No.3, p.48, 2016.
[29] Amcube, "Footwalk in-shoe pressure measurement," <https://www.amcube.co.uk/products/in-shoe-pressure-measurement/>, accessed on 12/01/2020.
[30] Escamilla-Martínez, E., Gómez-Martín, B., Fernández-Seguín, L. M., Martínez-Nova, A., Pedrera-Zamorano, J. D., and Sánchez-Rodríguez, R., "Longitudinal Analysis of Plantar Pressures with Wear of a Running Shoe," International Journal of Environmental Research and Public Health, Vol.17, No.5, p.1707, 2020.
[31] Medica, S., "FlexinFit in-shoes analysis," <https://www.sensormedica.com/en/pages/hardware-en/sensorized-insoles>, accessed on 12/01/2020.
[32] Concept, T., "https://technoconcept.com/," <https://technoconcept.com/>, accessed on 12/01/2020.
[33] Moticon, "Moticon Science - Sensor insole for research," <https://www.moticon.de/>, accessed on 12/01/2020.
[34] Wiisel, "Wiisel insole," <https://eurecat.org/en/portfolio-items/wiisel/>, accessed on 12/01/2020.
[35] Tekscan, "Products for Pressure Mapping and Force Measurement," <https://www.tekscan.com/products-solutions>, accessed on 12/01/2020.
[36] Catalfamo, P., Moser, D., Ghoussayni, S., and Ewins, D., "Detection of gait events using an F-Scan in-shoe pressure measurement system," Gait & posture, Vol.28, No.3, pp.420-426, 2008.
[37] Novel, "Pedar system—the quality in-shoe dynamic pressure measuring system," <https://www.novel.de/products/pedar/>, accessed on 12/01/2020.
[38] Ramanathan, A., Kiran, P., Arnold, G., Wang, W., and Abboud, R., "Repeatability of the Pedar-X® in-shoe pressure measuring system," Foot and ankle surgery, Vol.16, No.2, pp.70-73, 2010.
[39] Zequera, M., Stephan, S., and Paul, J., "The PAROTEC Foot Pressure Measurement System and its Calibration Procedures," in 2006 IEEE Annual International Conference of the Engineering in Medicine and Biology Society, pp.4135-4139, 2006.
[40] Paromed, "paroTec: The high-precision foot pressure measurement system," <https://paromed.de/paroTec-3-2.html>, accessed on 12/01/2020.
[41] Medilogic, S., Germany, "Medilogic insole science," <https://medilogic.com/en/medilogic-wlan-insole/>, accessed on 12/01/2020.
[42] Lidstone, D. E., DeBerardinis, J., Dufek, J. S., and Trabia, M. B., "Electronic measurement of plantar contact area during walking using an adaptive thresholding method for Medilogic® pressure-measuring insoles," The Foot, Vol.39, pp.1-10, 2019.
[43] Schmidt, U., Jorsch, C., Guenther, M., and Gerlach, G., "Biochemical piezoresistive sensors based on hydrogels for biotechnology and medical applications," Journal of Sensors and Sensor Systems, Vol.5, No.2, p.409, 2016.
[44] Technologies, O. M., "Orpyx LogR - Real-time measurement of plantar pressure for analysis by researchers," <https://www.orpyx.com/pages/logr>, accessed on 12/01/2020.
[45] Sennotech, "Sennopro insole," <http://www.sennotech.com/en/sennogait/>, accessed on 12/01/2020.
[46] Harte, R., Quinlan, L. R., Glynn, L., Rodríguez-Molinero, A., Baker, P. M., Scharf, T., and ÓLaighin, G., "Human-centered design study: enhancing the usability of a mobile phone app in an integrated falls risk detection system for use by older adult users," JMIR mHealth and uHealth, Vol.5, No.5, p.e71, 2017.
[47] Ko, S.-u., Hausdorff, J. M., and Ferrucci, L., "Age-associated differences in the gait pattern changes of older adults during fast-speed and fatigue conditions: results from the Baltimore longitudinal study of ageing," Age and ageing, Vol.39, No.6, pp.688-694, 2010.
[48] Agostini, V., Balestra, G., and Knaflitz, M., "Segmentation and classification of gait cycles," IEEE Transactions on Neural Systems and Rehabilitation Engineering, Vol.22, No.5, pp.946-952, 2013.
[49] Vos, T., Allen, C., Arora, M., Barber, R. M., Bhutta, Z. A., Brown, A., Carter, A., Casey, D. C., Charlson, F. J., and Chen, A. Z., "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015," The lancet, Vol.388, No.10053, pp.1545-1602, 2016.
[50] Glyn-Jones, S. and Palmer, A., "Agricola, R.; Price, AJ; Vincent, TL; Weinans, H.; Carr," The lancet, Vol.386, No.9991, pp.376-387, 2015.
[51] Birmingham, T. B., Giffin, J. R., Chesworth, B. M., Bryant, D. M., Litchfield, R. B., Willits, K., Jenkyn, T. R., and Fowler, P. J., "Medial opening wedge high tibial osteotomy: a prospective cohort study of gait, radiographic, and patient‐reported outcomes," Arthritis Care & Research: Official Journal of the American College of Rheumatology, Vol.61, No.5, pp.648-657, 2009.
[52] Börjesson, M., Weidenhielm, L., Mattsson, E., and Olsson, E., "Gait and clinical measurements in patients with knee osteoarthritis after surgery: a prospective 5-year follow-up study," The Knee, Vol.12, No.2, pp.121-127, 2005.
[53] Lind, M., McClelland, J., Wittwer, J. E., Whitehead, T. S., Feller, J. A., and Webster, K. E., "Gait analysis of walking before and after medial opening wedge high tibial osteotomy," Knee Surgery, Sports Traumatology, Arthroscopy, Vol.21, No.1, pp.74-81, 2013.
[54] Morin, V., Pailhé, R., Duval, B. R., Mader, R., Cognault, J., Rouchy, R.-C., and Saragaglia, D., "Gait analysis following medial opening-wedge high tibial osteotomy," Knee Surgery, Sports Traumatology, Arthroscopy, Vol.26, No.6, pp.1838-1844, 2018.
[55] Wiik, A. V., Aqil, A., Tankard, S., Amis, A. A., and Cobb, J. P., "Downhill walking gait pattern discriminates between types of knee arthroplasty: improved physiological knee functionality in UKA versus TKA," Knee Surgery, Sports Traumatology, Arthroscopy, Vol.23, No.6, pp.1748-1755, 2015.
[56] Pap, G., Machner, A., Nebelung, W., and Awiszus, F., "Detailed analysis of proprioception in normal and ACL-deficient knees," The Journal of bone and joint surgery. British volume, Vol.81, No.5, pp.764-768, 1999.
[57] Teskscan, "FlexiForce A201 Sensor," <https://www.tekscan.com/products-solutions/force-sensors/a201>, accessed on 10/30/2020.
[58] Tekscan, "FlexiForce® Sensors User Manual," <https://www.tekscan.com/support/faqs/flexiforce-user-manual>, accessed on 10/30/2020.
[59] Stacoff, A., Diezi, C., Luder, G., Stüssi, E., and Kramers-de Quervain, I. A., "Ground reaction forces on stairs: effects of stair inclination and age," Gait & posture, Vol.21, No.1, pp.24-38, 2005.
[60] Caravaggi, P., Giangrande, A., Lullini, G., Padula, G., Berti, L., and Leardini, A., "In shoe pressure measurements during different motor tasks while wearing safety shoes: The effect of custom made insoles vs. prefabricated and off-the-shelf," Gait & posture, Vol.50, pp.232-238, 2016.
[61] SPRINGLOADED, "Guide to Severe Knee Arthritis (Osteoarthritis)," <https://springloadedtechnology.com/guide-to-severe-knee-osteoarthritis/>, accessed on 12/01/2020.
[62] AMBOSS, "Collection of orthopedic conditions," <https://www.amboss.com/us/knowledge/Collection_of_orthopedic_conditions>, accessed on 12/01/2020.
[63] Brinkman, J.-M., Lobenhoffer, P., Agneskirchner, J., Staubli, A., Wymenga, A., and Van Heerwaarden, R., "Osteotomies around the knee: patient selection, stability of fixation and bone healing in high tibial osteotomies," The Journal of bone and joint surgery. British volume, Vol.90, No.12, pp.1548-1557, 2008.
[64] Dawson, J., Fitzpatrick, R., Murray, D., and Carr, A., "Questionnaire on the perceptions of patients about total knee replacement," The Journal of bone and joint surgery. British volume, Vol.80, No.1, pp.63-69, 1998.
[65] Noyes, F. R., Barber, S. D., and Simon, R., "High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees: a two-to seven-year follow-up study," The American journal of sports medicine, Vol.21, No.1, pp.2-12, 1993.
[66] Miniaci, A., Ballmer, F., Ballmer, P., and Jakob, R., "Proximal tibial osteotomy. A new fixation device," Clinical orthopaedics and related research, No.246, pp.250-259, 1989.
[67] Fujisawa, Y., Masuhara, K., and Shiomi, S., "The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints," The Orthopedic clinics of North America, Vol.10, No.3, pp.585-608, 1979.
[68] Lee, D.-H., Park, S.-C., Park, H.-J., and Han, S.-B., "Effect of soft tissue laxity of the knee joint on limb alignment correction in open-wedge high tibial osteotomy," Knee Surgery, Sports Traumatology, Arthroscopy, Vol.24, No.12, pp.3704-3712, 2016.