步行功能的喪失，代表病患必須依賴他人照顧，完成生活作息。因此，步態功能訓練是物理治療過程中重要的一環，也是復原程度的重要指標；步態訓練之物理治療理念，採用功能導向型的訓練模式，即動作學習理論，透過重複性方法，反覆地訓練步行過程，以期能重新學習正確的步行動作。早期臨床治療方式，採用平地練走，此種方式造成病患挫折感大、效果不彰。之後，病患使用跑步機結合懸吊系統進行復健缺點包含：腳無法施力抬起放下、踩踏過程膝蓋受到衝擊、跑步機運動步伐曲線不完全符合正常步態及至少需要兩位以上治療人力。
人、機、環系統，是『使用者、操作者＋操作機器＋作業環境』的系統，本研究採用人、機、環系統的分析方式，藉由參與觀察、訪談、問卷得到使用橢圓機復健過程中產生的問題，並歸納成為此系統的功能要素；藉由相關研究資料，歸納出對應的設計準則，並使用AHP對設計準則進行權重分析。
結果得到，橢圓軌跡結合懸吊系統之步態訓練機適合FAC值為1~2之病患，其設計介面首要條件為安全性考量，機構本身要堅固平穩，主機必須提供病患足夠的保護、固定裝置，例如手腳固定帶、轉位扶手等；吊帶、懸吊系統都應具備足夠的安全性、固定性與舒適性，吊帶容易穿脫、調整，減緩病人緊張的心情；治療師協助病患上下機的動線要保持流暢，進行步態訓練時，治療師站立水平面應略低於病患站立水平面。

Stroke patients lose their ambulant ability and depend on other people to take care of their daily life. Therefore, restoration of gait is a major goal in the rehabilitation of stroke patients. Modern concepts favor a task-specific, repetitive approach to walking training, and clear benefit from more intensive therapy has been demonstrated. Therapeutic methods to improve gait include walking with appropriate walking aids and with verbal and manual guidance. However, it needs a lot of therapeutic effort. Stroke patients always feel frustration. Treadmill training with partial body weight support (BWS) enables stroke patients improved their gait ability. The major limitation of treadmill therapy as a daily routine was the effort required by 2 or even 3 therapists in assisting the gait of severely affected subjects, setting the paretic limb, and controlling the trunk movement.
Man-machine-environment system is focus on the interaction of users, operators, machines and environment. By participating observation, interview and questionnaires, we know the interface problems and conclude the design principles. Then we use AHP to weigh the design principles.
Results: The most important principle of gait trainer for stroke patients is safety. The gait trainer should be stable and with enough protection. The harness should be dressed easily and comfortable. The suspension should keep the route of therapeutist unimpeded

1. Akman MN, Bengi R, Karatas M, Kilin S, Szay S, sker R. Assessment of spasticity using isokinetic dynamometry in patients with spinal cord injury. Spinal Cord 1999;37:638-643.
2. Barbeau H, Visintin M, (2003) Optimal outcomes obtained with body-weight support combined with treadmill training in stroke subjects. Arch Phys Med Rehabil; 84:1458-1465.
3. Batte AL, Darling J, Evans J, Lance LM, Olson EI, Pincivero DM, (2003)Physiologic response to a prescribed rating of perceived exertion on an elliptical fitness cross-trainer. J Sports Med Phys Fitness; Sep;43(3):300-5.
4. Bax M., (1991)Walking . Dev Med Child Neurol. 33:471-472
5. Boda Wl, Tapp W, Findley TF. (1994)Biomechanical comparison of treadmill and overground walking. Eighth Biennial Conference, Canadian Society for Biomechanics, Calgary,:88-89.
6. Bohannon R.W.: Variability and reliability of the Pendulum test for spasticity using a Cybex II kinetlc dynamometer. Phys Ther 1987;659-661
7. Bohannon R.W., Strength of lower limb related to gait velocity and cadence in stroke patients, , Physiother Can. (1986) 38:204-6
8. Brown RA, Lawson DA, Leslie GC, et al: Does the Wartenberg test differentiate quantitatively between spasticity and rigidity? A study in elderly stroke and Parkinsonian patients. J Neurol Neurosurg Psychiatry. 1988,1178-1186
9. Burns SP, Golding DG, Rolle WA, Graziani V, Dittunno JF, (1997)Recovery of ambulation in motor-incomplete tetraplegia . Arch Phys Med Rehabil;781169-1172
10. Catherine K, Rachel H, Kate MG, Jenner JR, Stephen K. (2001) Exercising on a treadmill to improve functional mobility in chronic stroke. Physiotherapy 87;5,261-265.
11. Corcos DM, Gottlieb GL, Penn RD, Myklebust B, Agarwal GC. Movement deficits caused by hyperexcitable stretch reflexes in spastic humans. Brain 1986;109:1043-1058.
12. Dietz V. Spastic movement disorder. Spinal Cord 2000;38:389-393.
13. Edelle C, Field-Fote, (2001)Combined use of body weight support, functional electric stimulation, and treadmill training to improve walking ability in individuals with chronic incomplete spinal cord injury. Arch Phys Med Rehabil; 82:818-824.
14. Fung J, Barbeau H. A dynamic EMG profile index to quantify muscular activation disorder in spastic paretic gait. Electroencephalogr Clin Neurophysiol 1989;73:233-244.
15. Funch L,Barbeau H. (1986) Hemiplegic gait: New treatment strategies. Physiother Can. 38(1):36-40.
16. Green JM, Crews TR, Pritchett RC, Mathfield C, Hall L, (2004) Heart rate and ratings of perceived exertion during treadmill and elliptical exercise training. Percept Mot Skills Feb;98(1):340-348.
17. Grillner S, (1975)Locomotion in vertebrates: central mechanisms and reflex interaction. Physiol Rev;55:247-304.
18. Hesse S, Bertelt C, Schaffrin A,et al. (1994)Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support. Arch Phys Med Rehabil; 75:1087-1093.
19. Hesse S, Bertelt C, Jahnke MT, et al. (1995)Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. Stroke; 26:967-981.
20. Higgins S, Higgins J.R, (1995)The emergence of gait . In Craik RL, Oatis OA ed. Gait Analysis:theory and application . 3rd.Ch4. Mosby Inc. Missouri, USA
21. Hooker S. P., et al: (1992) Physiologic effects of electrical stimulation leg cycle exercise training in spinal cord injured persons. Arch Phys Med Rehabil (73): 470-476
22. Hussey RW, Stanffer ES, (1973)Spinal cord injury: requirement for ambulation. Arch Phys Med Rehabil 54:544-547
23. Ivanenko Y.P., Grasso R., Macellari V., Lacquaniti F. (2002) Control of foot trajectory in human locomotion : Role of ground contact forces in simulated gravity. J Neurophysiol 87:3070-3089
24. Ivanenko Y.P., Dominici N., Cappellini G., Dan B., Cheron G., Lacquaniti F. (2004) Develporment of pendulum mechanism and kinematic coordination from the first unsupported steps in toddlers. The journal of experimental biology207,3797-3810
25. Katz R.T. Rymer W.Z.: Spastic hypertonia: mechanisms and measurement. Arch Phys Med Rehabil 1989. 144-155
26. Katz R.T., et al: Objective quantification of spastic hypertonia correlation with clinical findings. Arch Phys Med Rehabil 1992. 339-348
27. Kosak MC, Reding MJ, (2000)Comparison of partial body weight-supported treadmill gait training versus aggressive bracing walking post stroke. Neurorehabil Neutral Repair;14:13-19.
28. Levin M.F. and Hui-Chan C.: Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity? J Neurol 1993.63-71
29. Maynard FM, Karunas RS, Waring WP. Epidemiology of spasticity following traumatic spinal cord injury. Arch Phys Med Rehabil 1990;71:566-569.
30. Malouin F, Potvin M, Prevost J, et al. (1992) Use of an intensive task-oriented gait training program in a series of patients with acute cerebrocascular accidents. Phys Ther; 72:781-793.
31. Misiaszek, J. E.. The H-reflex as a tool in neurophysiology : Its limitations and uses in understanding nerous system function. Muscle Nerve 2003. 28, 144-160.
32. Murray MP, Spurr GB, Sepic SB, Gardner GM, Mollinger LA. （1985）Treadmill vs. floor walking: kinematics, electromyogram, and heart rate. J Appl Physiol. Jul;59(1):87-91.
33. Mutton DL., et al: Physiologic responses during functional electrical stimulation leg cycling and hybrid exercise in spinal cord injured subjects. Arch Phys Med Rehabil. 78(7): 712-8, 1997.
34. Rack P.M.H., Ross H.F. and Thilmann A.F.: The ankle stretch reflexes in normal and spastic subjects. Brain 1984.637-654
35. Roth EJ, Heart Disease in Patients with Stroke: Incidence, Impact, and Implications for Rehabilitation. Part I: Classification and Prevalence. Arch Phys Med Rehabil 1993; 74:752-760.
36. Powers R.K., Meyer J.M. and Rymer W.Z.: Quantitative relations between hypertonia and stretch reflex threshold in spastic hemiparesis. Ann Neurol 1988. 115-124
37. Philips CA, et al: (1984) Functional electrical exercise: a comprehensive approach for physical conditioning of the spinal cord injured patients. Orthopedics. (7): 1112-1123
38. Schieppati, M. The Hoffman reflex: a means of assessing spinal reflex excitability and its descending control in man. Progress in Neurobiology, 1987. 28, 345-376.
39. Silver KH, Macko RF, Forrester LW, Goldberg AP, Smith GV, (2000) Effects of aerobic treadmill training on gait velocity, cadence, and gait symmetry in chronic hemiparetic stroke : a preliminary report. Neurorehabil Neural Repair ;14: 65-71.
40. Strathy GM, Chao F, Laughman RK. （1983）Changes in knee function associated with
treadmill ambulation. J Biomech; 16:517-522.
41. Somers MF. Incomplete lesions. Spinal cord injury. Norwalk: Appletion & Lange. 1992;269-273.
42. Spasticity: current and future management. Hospital Medicine 1998;59:61-69.
43. Skld C, Levi R, Deiger  . Spasticity after traumatic spinal cord injury: nature, severity, and location. Arch Phys Med Rehabil 1999;80:1548-1557.
44. WY Tsai, CY Yeh, CT Li, KH Tsai, HH Chang, HC Lo, GL Chang, (2007) Design and Development of A New Type Gait Training System , Annual Symposium on Biomedical Engineering and Technology, P.10, National Taiwan University, Taipew, Taiwan
45. Tsai KH, Chen KH, Yeh CY, Li CT, Tsai WY, Chang HH, (2006) A study on the man-machine-environment interface design of the gait trainer for stroke patients ，Annual Conference on Biomedical Engineering and Technology, P.120, National Taiwan University, Taipei, Taiwan
46. Toft E., et al: mechanical and electromyogrophic responses to stretch of the human ankle extensors. J Neuro Neurosurg Psychiatry 1991.134-139
47. Visintin M, Barbeau H, (1989)The effects of body weight support on the locomotor pattern of spastic paretic patients. Can J Neurol Sci; 16:315-325.
48. Wainberg M, Barbeau H, Gauthier S. The effects of cyproheptadine on locomotion and on spasticity in patients with spinal cord injuries. J Neurol Neurosurg Psychiatry 1990;53;754-763.
49. Waters RL, Adkins R, Takura J, Vigil D, (1994) Prediction of ambulation performance based on motor scores derived from standards of the American spinal injury association.Arch Phys Ned Rehabil;75:756-760.
50. Williams and Wilkins, ACSM’s guidelines for exercise testing and prescription. American College of Sports Medicine. PA. 2000.
51. Yeh CY, Tsai WY, Li CT, Chang HH, Chen KH, Wang TP, Tsai KH, (2006), The clinical satisfaction survey of interface design for two gait training ，Annual Conference on Biomedical Engineering and Technology, P.121, National Taiwan University, Taipei, Taiwan
52. Young RR. Spasticity: a review. Neurology 1994;44(Suppl 9):S12-S20.
53. Zehr, E. P. Considerations for use of the Hoffman reflex in exercise studies. Eur J Appl Physiol, 2002. 86, 455-468.
54. 王金成，徐婉靜，邱靖華，地面上與原地跑步機上的二度空間步態比較, 中華民國體育學會體育學報第十三輯,12,pp.211-222 ,(1991)
55. 吳英黛，呼吸循環系統物理治療，第十三章肌肉活動與運動反應，1999： 181-196。
56. 劉虣虣 , 王西勝,橢圓機最佳軌跡研究. 經濟部科技專案成果產業技術網站 www.runride.com.（2002）