簡易檢索 / 詳目顯示

回結果列表
研究生： 尤玉琳
You, Yu-Lin
論文名稱： 使用攀爬機進行創新復健介入之生物力學探討
Biomechanical Investigation of Novel Rehabilitation using the Pinnacle Trainer
指導教授： 蘇芳慶
Su, Fong-Chin
學位類別： 博士
Doctor
系所名稱： 工學院 - 生物醫學工程學系
Department of BioMedical Engineering
論文出版年： 2020
畢業學年度： 108
語文別： 英文
論文頁數： 112
中文關鍵詞： 攀爬機 、體重支撐懸吊系統 、踏板寬度 、中風 、退化性膝關節炎 、復健效果
外文關鍵詞： Pinnacle trainer, body weight support system, pedal stance width, stroke, knee osteoarthritis, intervention effects
相關次數： 點閱：156  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

    • 攀爬機為具多平面踩踏軌跡的運動器材，其運動軌跡不僅有上下方向、前後向與髖關節外展等運動方向；另一方面攀爬機也具有可以調整踏板站立寬度的功能。行走時使用不同的步寬會影響足底壓力的分布進而影響力量的傳遞方向，因此調整不同的踏板寬度也可能會影響踩踏時的關節受力與力矩的表現。運動器材結合懸吊系統可以使平衡能力較差的族群使用時較安全，例如結合懸吊系統與跑步機的復健系統；然而對於平衡能力較差或是有嚴重垂足的使用者在跑步機上的復健，可能仍然需要額外的治療師協助以避免跌倒，因此踏板式的運動器材在結合懸吊系統後相對而言較為安全。另一方面，攀爬機運動屬於著重於近端肢段之運動，此類型運動能有效改善平衡能力；而橢圓機運動的軌跡為類步態(gait-like)的軌跡，屬於著重於遠端(踝關節)肢段之訓練方式。
    然而在實際應用於臨床前，探討踩踏此復健機台對使用者關節受力可以提供未來臨床人員根據不同復健(訓練)目的調整懸吊量或踩踏的寬度。另一方面，因攀爬機特殊的踩踏軌跡，使用者在踩踏時會減少膝關節內側受力，然而目前尚未有研究探討攀爬機對於退化性膝關節炎的介入效果；並且也鮮少有研究比較不同介入策略(著重近端肢段的訓練與著重在遠端肢段的訓練)對於中風族群的行走與平衡能力的影響。故本研究首先欲評估使用者在使用結合懸吊系統之攀爬復健系統時之人體下肢關節受力情形。本研究共有17位健康年輕人參與本研究，並藉由三維動作分析系統搭配六軸測力荷重元置於腳踏板下，收取使用者踩踏攀爬機時之力量資料並結合動作分析取得之運動學資料以逆向動力學計算下肢關節之受力情形。受試者在不同的體重比重的懸吊量(0%、20%與40%的體重)以及不同的踏板站立寬度(最寬：44公分、中等寬度：35公分與最窄：27公分)下踩踏攀爬機。主要分析之參數為下肢(包含踝關節、膝關節與髖關節)的關節受力合力與下肢關節力矩。下肢的關節合力與關節力矩均隨著懸吊量的增加而顯著的減少。而膝關節的內翻力矩隨著踏板站立寬度的增加而顯著的增加。
    其次，本研究探討八週的攀爬機介入後對於疼痛強度、膝關節僵硬程度、下肢肌力與踩踏攀爬機時膝關節受力情形的影響；本研究共有20位輕度到中等程度退化性膝關節炎患者參與本研究，分別被分配到訓練組與控制組。所有受測者在介入前與八周後均須接受評估。評估內容包括退化性膝關節炎量表(WOMAC)、功能性評估(包括坐到站測試、爬樓梯測試與40公尺快走測試)、下肢肌力評估(包括股四頭肌、腿後肌、髖外展肌與內收肌)與踩踏攀爬機時的動作分析。在攀爬機介入後，疼痛強度有顯著的下降，而主觀感受之關節僵硬程度下降的趨勢；功能性評估中的坐到站與爬樓梯測試有顯著的改善；下肢肌力的部分則是在介入後股四頭肌的肌力有顯著的增加，而髖外展肌肌力也有增加的趨勢。因此攀爬機對於退化性膝關節炎的復健介入能有效的減少疼痛、改善功能性動作與增加下肢肌力。
    最後，為探討為期八週的攀爬機(著重於近端訓練)與橢圓機(著重於遠端訓練)對於中風患者在行走能力與平衡能力的介入成效。共有36位慢性中風患者被分配到攀爬機組、橢圓機組與控制組接受八週的介入。成效評估參數有步行能力與平衡能力，步行能力包含六分鐘走路與十公尺走路分別評估其行走的距離與速度；而平衡能力的評估是計算跨障礙時患側腳單腳站立時的足底壓力中心在內外側與前後側的位移。在攀爬機與橢圓機介入後其步行能力均有顯著的改善。而攀爬機介入後，中風患者的足底壓力中心在內外側方向的位移有顯著的減少，而橢圓機介入後中風患者的足底壓力中心在前後側方向的位移有顯著的減少。然而控制組在傳統物理治療介入後，僅六分鐘走路有顯著改善，十公尺走路與足底壓力中心位移變化並沒有顯著的改變。中風族群使用創新攀爬機復建系統可以有效增進其行走能力、平衡能力，而中風族群在使用橢圓機復健系統則可以有效增進其行走能力。
    在踩踏攀爬機過程中會產生髖關節伸肌力矩以及髖關節外展肌力矩，因此在攀爬機運動過程中能夠訓練到此兩條肌群。因此攀爬機的介入訓練除了對於內側退化性膝關節炎與慢性中風有臨床上正面效果外，對於髖關節骨折之使用者也能幫助其訓練髖關節伸肌與外展肌群，使其在受傷後的復健，能夠藉由此兩條肌群肌力的增加來提升期癒後的日常生活功能性表現。

    The pedal-type exercise equipment produced relatively lower impact force than level walking. A pinnacle trainer (PT) is a pedal-type exercise equipment and that has a multiplane exercise trajectory (vertical, anteroposterior and mediolateral directions) and an adjustable pedal stance width (PSW). The foot pressure was altered by the various step widths, and further influence the force distribution. The combination of exercise equipment and the body weight support system (BWS) provides safety for individuals with poor balance ability, for instance, the combination of the treadmill and the BWS. However, the additional therapist is needed for stroke survivors with significant drop-foot during treadmill walking with the BWS. The combination of a PT and a BWS system provided individuals with poor balance a safely exercise choice. On the other hand, the core musculoskeletal included the spine, hip and pelvis, and proximal lower limb, and the core was the central to the kinetic chain of various movements and balance ability. Hence, the rehabilitation strategy that emphasized on the proximal part of the body for balance ability regaining is feasible. A PT is a kind of proximal-emphasized exercise which improved balance ability, while the elliptical trainer (ET) is a gait-like trajectory exercise equipment and that is a kind of distal-emphasized exercise.
    However, the investigation of the biomechanical characteristics of the lower extremities during PT exercise with different BWS levels and with various PSWs is needed before the clinical applications. On the other hand, according to the previous investigation, exercise on a PT produced a significant internal knee adduction moment which may reduce the knee joint loadings on the medial side, nevertheless, few studies investigated the intervention effects of the PT for individual with knee osteoarthritis or with chronic stroke. Thus, this study thus firstly investigated the effects of BWS levels and PSWs on the joint loading of the lower extremities during stepping on a PT. This study recruited seventeen healthy adults exercised on the PT with various BWS levels (0%, 20% and 40% of BW) and various PSWs (the widest: 44 cm, medium: 35 cm and the narrowest: 27 cm). The joint resultant forces and joint moments of the lower extremities were calculated according to the kinematic and kinetic data measured via a motion capture system and force transducers on the pedals, respectively. The joint resultant forces and joint moments of the lower extremities significantly decreased with increasing percentage of BWS. The internal knee adduction moment significantly increased with increasing PSW.
    Secondly, this study explored the intervention effects of PT on the physical function, perceived pain intensity, and the biomechanical characteristics of the knee joint for individuals with knee OA. Twenty individual with mild knee OA participated in this study and were allocated in PT training group and the control group randomly. The PT group received an 8-week PT intervention, while the control group remain their exercise habits. The outcome measurements included Western ontario and mcMaster universities osteoarthritis Index (WOMAC), functional tests, muscular strength of the lower extremity that was measured by the hand-held dynamometer and the biomechanical characteristics during exercise on the PT. The outcome measurements were assessed at the baseline and after intervention. A 6-axis force and torque transducer embedded in the pedal and a 3-dimensional motion capture system was utilized to measure biomechanical characteristics of the affected leg. After PT intervention, a significant improvement on the pain intensity, sit-to-stand test, stair-climbing test, and the muscular strength of knee extensor compared to the baseline measurements. The internal knee abduction moment demonstrated a tendency toward to reduce after the PT intervention. Hence, this study suggested that the use of the PT for individual with knee OA is effective on the improvement of pain intensity, physical functions and the muscular strength of the muscular strength of the lower extremity.
    Finally, this study investigated an 8-week intervention effects of the PT (proximal-emphasized intervention) and the ET (distal emphasized intervention) on walking and balance abilities in individuals with chronic stroke. This is a quasi-designed study, thirty-six individuals with chronic stoke were allocated in the PT group, ET group and the control group. The primary outcome measurements included the 6-minute walk, 10-meter walk, and the displacement of center of pressure (COP) represented as balance ability during obstacle crossing while the single leg support period. After intervention, the 6-minute walk and the ten-meter walk test were improved significantly in the elliptical group and the pinnacle group. The COP displacement in the anteroposterior direction was significantly decreased after ET intervention, while the COP displacement in the mediolateral direction was significantly decreased after PT intervention. Nevertheless, after conventional therapy intervention, the only significant improvement was found in the 6-minute walk test, whereas, the ten meter walk and the COP displacement did not have significant changes. Thus, the use of the PT rehabilitation system can effectively improve the walking and balance ability, while, the use of the ET rehabilitation system can effectively improve the walking ability. Exercise on the PT produced the internal hip extensor moment and internal hip abductor moment indicated that the hip extensor and abductor can be trained during PT exercise. Hence, for those individuals with hip fracture, knee OA and chronic stroke, the PT intervention provides an effective intervention but relative lower impact than level walking.

    摘要 I Abstract IV 誌謝 VIII List of Tables XIII List of Figures XIV Chapter 1.Introduction 1 1.1 Research Background 1 1.1.1 Biomechanical characteristics during exercise on exercise equipment 1 1.1.2. Introduction of Knee Osteoarthritis 3 1.1.2.1 Epidemiology and etiology of Knee Osteoarthritis 3 1.1.2.2 The Sign and Symptoms of Knee Osteoarthritis 4 1.1.2.3 Beneficial of exercise for the knee osteoarthritis patients 5 1.1.3 Introduction of Stroke 10 1.1.3.1 Epidemiology of Stroke 10 1.1.3.2 Applications of Exercise equipment on Stroke rehabilitation 11 1.2 Motivations 13 1.3 Specific Aims 15 Chapter 2 Effects of body weight support and pedal width on joint loads during pinnacle trainer exercise 17 2.1 Brief Introduction 17 2.2 Materials and Methods 19 2.2.1 Ethics Statement 19 2.2.2 Participants 19 2.2.3 Instruments 20 2.2.4 Experimental Procedure 20 2.2.5 Data Analysis 22 2.2.6 Statistics 26 2.3 Results 26 2.3.1 Impact force 26 2.3.2 Joint resultant forces of the lower extremity 27 2.3.3. Joint moment of the lower extremity 29 2.3.4 Associations between joint resultant forces of the lower extremity and the extent of body weight support 33 2.3.5 Associations between joint moments of the lower extremity and the extent of pedal stance widths 33 2.4 Discussion 35 Chapter 3 Exercise intervention effects on physical function and knee biomechanical characteristics for knee osteoarthritis 38 3.1 Brief introduction 38 3.2 Methods 40 3.2.1 Ethics Statement 40 3.2.2 Participants 41 3.2.3 Instruments 42 3.2.4 Outcome measurements 42 3.2.5 Intervention 46 3.2.6 Experimental procedures 47 3.2.7 Data analyses 48 3.2.7.1. Coordinate systems 48 3.2.7.2 Kinematics 49 3.2.7.3 Kinetics 50 3.2.8 Statistics 51 3.3 Results 52 3.4 Discussion 60 Chapter 4 Comparisons of proximal versus distal lower limb intervention strategies on gait and balance ability restoration after stroke 65 4.1 Brief Introduction 65 4.2 Materials and Methods 68 4.2.1 Ethics Statement 68 4.2.2 Participants 68 4.2.3 Instruments 69 4.2.4 Intervention 70 4.2.5 Outcome measurements 72 4.2.6 Experimental procedures 73 4.2.7 Data Analysis 74 4.2.8 Statistics 75 4.3 Results 76 4.4 Discussion 83 Chapter 5 Conclusions and Future Work 89 References 92

    1. A., A. (2007). "Painful realities: the economic impact of arthritis in Australia in 2007." Sydney: Arthritis Australia: 1-88.
    2. Aaboe, J., H. Bliddal, S. Messier, T. Alkjaer and M. Henriksen (2011). "Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis." Osteoarthritis and Cartilage 19(7): 822-828.
    3. Aaboe, J., H. Bliddal, S. P. Messier, T. Alkjaer and M. Henriksen (2011). "Effects of an intensive weight loss program on knee joint loading in obese adults with knee osteoarthritis." Osteoarthritis Cartilage. 19(7): 822-828. doi: 810.1016/j.joca.2011.1003.1006. Epub 2011 Apr 1018.
    4. Alnahdi, A. H., J. A. Zeni and L. Snyder-Mackler (2012). "Muscle impairments in patients with knee osteoarthritis." Sports Health 4(4): 284-292.
    5. Altman, R., E. Asch, D. Bloch, G. Bole, D. Borenstein, K. Brandt, W. Christy, T. Cooke, R. Greenwald and M. Hochberg (1986). "Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee." Arthritis & Rheumatism 29(8): 1039-1049.
    6. American Heart Association. (2019). "Heart Disease and Stroke Statistics—2019 Update: A Report From the American Heart Association." Cardiovascular Conditions/Diseases.
    7. Anderson, J. J. and D. T. Felson (1988). "Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I) evidence for an association with overweight, race, and physical demands of work." American journal of epidemiology 128(1): 179-189.
    8. Aoki, O., N. Tsumura, A. Kimura, S. Okuyama, S. Takikawa and S. Hirata (2009). "Home stretching exercise is effective for improving knee range of motion and gait in patients with knee osteoarthritis." Journal of Physical Therapy Science 21(2): 113-119.
    9. Aruin, A. S., T. Hanke, G. Chaudhuri, R. Harvey and N. Rao (2000). "Compelled weightbearing in persons with hemiparesis following stroke: the effect of a lift insert and goal-directed balance exercise." Journal of rehabilitation research and development 37(1): 65-72.
    10. Aruin, A. S., N. Rao, A. Sharma and G. Chaudhuri (2012). "Compelled body weight shift approach in rehabilitation of individuals with chronic stroke." Topics in stroke rehabilitation 19(6): 556-563.
    11. Balasubramanian, C. K., M. G. Bowden, R. R. Neptune and S. A. Kautz (2007). "Relationship between step length asymmetry and walking performance in subjects with chronic hemiparesis." Archives of physical medicine and rehabilitation 88(1): 43-49.
    12. Baliunas, A., D. Hurwitz, A. Ryals, A. Karrar, J. Case, J. Block and T. Andriacchi (2002). "Increased knee joint loads during walking are present in subjects with knee osteoarthritis." Osteoarthritis and cartilage 10(7): 573-579.
    13. Bellamy, N. (1995). "Outcome measurement in osteoarthritis clinical trials." The Journal of rheumatology. Supplement 43: 49-51.
    14. Bennell, K., M. Hunt, T. Wrigley, D. Hunter, F. McManus, P. Hodges, L. Li and R. Hinman (2010). "Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial." Osteoarthritis and Cartilage 18(5): 621-628.
    15. Bennell, K. L., T. V. Wrigley, M. A. Hunt, B.-W. Lim and R. S. Hinman (2013). "Update on the role of muscle in the genesis and management of knee osteoarthritis." Rheumatic Disease Clinics 39(1): 145-176.
    16. Burnfield, J. M., G. M. Cesar, T. W. Buster, S. L. Irons and C. M. Pfeifer (2018). "Walking and Fitness Improvements in a Child With Diplegic Cerebral Palsy Following Motor-Assisted Elliptical Intervention." Pediatric Physical Therapy 30(4): E1-E7.
    17. Burnfield, J. M., S. L. Irons, T. W. Buster, A. P. Taylor, G. A. Hildner and Y. Shu (2014). "Comparative analysis of speed's impact on muscle demands during partial body weight support motor-assisted elliptical training." Gait & posture 39(1): 314-320.
    18. Burnfield, J. M., Y. Shu, T. W. Buster, A. P. Taylor and C. A. Nelson (2011). "Impact of elliptical trainer ergonomic modifications on perceptions of safety, comfort, workout, and usability for people with physical disabilities and chronic conditions." Physical therapy 91(11): 1604-1617.
    19. Chang, S.-Y., Y.-J. Lin, W.-C. Hsu, L.-F. Hsieh, Y.-H. Lin, C.-C. Chang, Y.-C. Chou and L.-F. Chen (2016). "Exercise alters gait pattern but not knee load in patients with knee osteoarthritis." BioMed research international 2016.
    20. Chang, W. H. and Y.-H. Kim (2013). "Robot-assisted therapy in stroke rehabilitation." Journal of stroke 15(3): 174.
    21. Cheing, G. L. and C. W. Hui-Chan (2001). "The motor dysfunction of patients with knee osteoarthritis in a Chinese population." Arthritis Rheum. 45(1): 62-68.
    22. Chien, H.-L., T.-Y. Tsai and T.-W. Lu (2007). "The effects of pedal rates on pedal reaction forces during elliptical exercise." Biomedical Engineering: Applications, Basis and Communications 19(04): 207-214.
    23. Choi, M., J. Yoo, S. Shin and W. Lee (2015). "The effects of stepper exercise with visual feedback on strength, walking, and stair climbing in individuals following stroke." Journal of physical therapy science 27(6): 1861-1864.
    24. Christensen, R., A. Astrup and H. Bliddal (2005). "Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial." Osteoarthritis and Cartilage 13(1): 20-27.
    25. Christensen, R., A. Astrup and H. Bliddal (2005). "Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial." Osteoarthritis Cartilage. 13(1): 20-27.
    26. Cook, T., C. Zimmermann, K. Lux, C. Neubrand and T. Nicholson (1992). "EMG Comparison of Lateral Step-up and Stepping Machine Exercise." The Journal of orthopaedic and sports physical therapy 16(3): 108.
    27. Dault, M. C., M. de Haart, A. C. Geurts, I. M. Arts and B. Nienhuis (2003). "Effects of visual center of pressure feedback on postural control in young and elderly healthy adults and in stroke patients." Human movement science 22(3): 221-236.
    28. Davies, P. M. (1990). Right in the middle: selective trunk activity in the treatment of adult hemiplegia, Springer Science & Business Media.
    29. Dempster, W. T. (1955). Space requirements of the seated operator, geometrical, kinematic, and mechanical aspects of the body with special reference to the limbs, Michigan State Univ East Lansing.
    30. Dickstein, R. and N. Abulaffio (2000). "Postural sway of the affected and nonaffected pelvis and leg in stance of hemiparetic patients." Archives of physical medicine and rehabilitation 81(3): 364-367.
    31. Dobson, F., R. S. Hinman, E. M. Roos, J. H. Abbott, P. Stratford, A. M. Davis, R. Buchbinder, L. Snyder-Mackler, Y. Henrotin, J. Thumboo, P. Hansen and K. L. Bennell (2013). "OARSI recommended performance-based tests to assess physical function in people diagnosed with hip or knee osteoarthritis." Osteoarthritis Cartilage. 21(8): 1042-1052. doi: 1010.1016/j.joca.2013.1005.1002. Epub 2013 May 1013.
    32. Doherty, M., I. Watt and P. Dieppe (1983). "Influence of primary generalised osteoarthritis on development of secondary osteoarthritis." Lancet. 2(8340): 8-11.
    33. Egaña, M. and B. Donne (2004). "Physiological changes following a 12 week gym based stair-climbing, elliptical trainer and treadmill running program in females." The Journal of sports medicine and physical fitness 44(2): 141.
    34. Ettinger, W. H., R. Burns, S. P. Messier, W. Applegate, W. J. Rejeski, T. Morgan, S. Shumaker, M. J. Berry, M. O'Toole and J. Monu (1997). "A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis: the Fitness Arthritis and Seniors Trial (FAST)." Jama 277(1): 25-31.
    35. Ettinger, W. H., Jr., R. Burns, S. P. Messier, W. Applegate, W. J. Rejeski, T. Morgan, S. Shumaker, M. J. Berry, M. O'Toole, J. Monu and T. Craven (1997). "A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST)." JAMA. 277(1): 25-31.
    36. Everaert, D. G., R. B. Stein, G. M. Abrams, A. W. Dromerick, G. E. Francisco, B. J. Hafner, T. N. Huskey, M. C. Munin, K. J. Nolan and C. V. Kufta (2013). "Effect of a foot-drop stimulator and ankle–foot orthosis on walking performance after stroke: a multicenter randomized controlled trial." Neurorehabilitation and neural repair 27(7): 579-591.
    37. Favre, J., J. C. Erhart‐Hledik, E. F. Chehab and T. P. Andriacchi (2016). "General scheme to reduce the knee adduction moment by modifying a combination of gait variables." Journal of Orthopaedic Research 34(9): 1547-1556.
    38. Felson, D., D. Gale, M. Elon Gale, J. Niu, D. Hunter, J. Goggins and M. Lavalley (2004). "Osteophytes and progression of knee osteoarthritis." Rheumatology 44(1): 100-104.
    39. Felson, D. T., J. J. Anderson, A. Naimark, A. M. Walker and R. F. Meenan (1988). "Obesity and knee osteoarthritis: the Framingham Study." Annals of internal medicine 109(1): 18-24.
    40. Felson, D. T., R. C. Lawrence, P. A. Dieppe, R. Hirsch, C. G. Helmick, J. M. Jordan, R. S. Kington, N. E. Lane, M. C. Nevitt and Y. Zhang (2000). "Osteoarthritis: new insights. Part 1: the disease and its risk factors." Annals of internal medicine 133(8): 635-646.
    41. Goldberg, S. R. and S. J. Stanhope (2013). "Sensitivity of joint moments to changes in walking speed and body-weight-support are interdependent and vary across joints." Journal of biomechanics 46(6): 1176-1183.
    42. Grimston, S. K., J. R. Engsberg, R. Kloiber and D. A. Hanley (1991). "Bone mass, external loads, and stress fracture in female runners." International Journal of Sport Biomechanics 7(3): 293-302.
    43. Heath, E. (2005). "ACSM’s guidelines for exercise testing and prescription." Medicine & Science in Sports & Exercise 37(11).
    44. Heidari, B. (2011). "Knee osteoarthritis prevalence, risk factors, pathogenesis and features: Part I." Caspian J Intern Med 2(2): 205-212.
    45. Helm, E. E. and D. S. Reisman (2015). "The split-belt walking paradigm: exploring motor learning and spatiotemporal asymmetry poststroke." Physical Medicine and Rehabilitation Clinics 26(4): 703-713.
    46. Heyward, V. H. and M. Kotarski (1992). "Advanced Fitness Assessment and Exercise Prescription, ed. 2." Journal of Cardiopulmonary Rehabilitation and Prevention 12(6): 445.
    47. Hinman, R. S., K. L. Bennell, B. R. Metcalf and K. M. Crossley (2002). "Delayed onset of quadriceps activity and altered knee joint kinematics during stair stepping in individuals with knee osteoarthritis." Archives of physical medicine and rehabilitation 83(8): 1080-1086.
    48. Hislop, H. J. and J. Montgomery (2007). "Muscle testing: Techniques of manual examination." Los Angeles.
    49. Hislop, H. J., J. Montgomery and B. H. Connolly (1995). Daniels and Worthingham's muscle testing: techniques of manual examination, WB Saunders Philadelphia, PA.
    50. Hsu, Y.-C. (2014). Comparison of Movement Performance on Pinnacle Trainer vs Stepper Trainer. Master, National Cheng-Kung University.
    51. Hurwitz, D. E., A. B. Ryals, J. P. Case, J. A. Block and T. P. Andriacchi (2002). "The knee adduction moment during gait in subjects with knee osteoarthritis is more closely correlated with static alignment than radiographic disease severity, toe out angle and pain." J Orthop Res. 20(1): 101-107.
    52. Husemann, B., F. Müller, C. Krewer, S. Heller and E. Koenig (2007). "Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke a randomized controlled pilot study." Stroke 38(2): 349-354.
    53. Husemann, B., F. Müller, C. Krewer, S. Heller and E. Koenig (2007). "Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study." Stroke 38(2): 349-354.
    54. Jackson, K., H. Merriman and J. Campbell (2010). "Use of an elliptical machine for improving functional walking capacity in individuals with chronic stroke: a case series." Journal of Neurologic Physical Therapy 34(3): 168-174.
    55. Kahle, N. and M. A. Tevald (2014). "Core muscle strengthening’s improvement of balance performance in community-dwelling older adults: A pilot study." Journal of Aging and Physical Activity 22(1): 65-73.
    56. Kakihana, W., M. Akai, K. Nakazawa, T. Takashima, K. Naito and S. Torii (2005). "Effects of laterally wedged insoles on knee and subtalar joint moments." Archives of physical medicine and rehabilitation 86(7): 1465-1471.
    57. Kaufman, K. R., C. Hughes, B. F. Morrey, M. Morrey and K.-N. An (2001). "Gait characteristics of patients with knee osteoarthritis." Journal of biomechanics 34(7): 907-915.
    58. Kellgren, J. and J. Lawrence (1958). "Osteo-arthrosis and disk degeneration in an urban population." Annals of the Rheumatic Diseases 17(4): 388.
    59. Kellgren, J. H. and J. S. Lawrence (1957). "Radiological assessment of osteo-arthrosis." Ann Rheum Dis 16(4): 494-502.
    60. Kibler, W. B., J. Press and A. Sciascia (2006). "The role of core stability in athletic function." Sports medicine 36(3): 189-198.
    61. Kim, S.-j., H.-y. Cho, Y. L. Kim and S.-m. Lee (2015). "Effects of stationary cycling exercise on the balance and gait abilities of chronic stroke patients." Journal of physical therapy science 27(11): 3529-3531.
    62. Kuan, T.-S., J.-Y. Tsou and F.-C. Su (1999). "Hemiplegic gait of stroke patients: the effect of using a cane." Archives of physical medicine and rehabilitation 80(7): 777-784.
    63. Kutzner, I., B. Heinlein, F. Graichen, A. Rohlmann, A. M. Halder, A. Beier and G. Bergmann (2012). "Loading of the knee joint during ergometer cycling: telemetric in vivo data." journal of orthopaedic & sports physical therapy 42(12): 1032-1038.
    64. Laufer, Y., D. Sivan, R. Schwarzmann and E. Sprecher (2003). "Standing balance and functional recovery of patients with right and left hemiparesis in the early stages of rehabilitation." Neurorehabilitation and Neural Repair 17(4): 207-213.
    65. Lee, S.-Y., C.-Y. Chou, Y.-Y. Hou, Y.-L. Wang, C.-H. Yang and L.-Y. Guo (2011). "The effects of changes in step width on plantar foot pressure patterns of young female subjects during walking." Journal of Mechanics in Medicine and Biology 11(05): 1071-1083.
    66. Leroux, A., H. Pinet and S. Nadeau (2006). "Task-oriented intervention in chronic stroke: changes in clinical and laboratory measures of balance and mobility." American journal of physical medicine & rehabilitation 85(10): 820-830.
    67. Lewek, M. D., C. E. Bradley, C. J. Wutzke and S. M. Zinder (2014). "The relationship between spatiotemporal gait asymmetry and balance in individuals with chronic stroke." Journal of applied biomechanics 30(1): 31-36.
    68. Lin, C.-W., F.-C. Su and C.-F. Lin (2019). "Kinematic analysis of postural stability during ballet turns (pirouettes) in experienced and novice dancers." Frontiers in bioengineering and biotechnology 7: 290.
    69. Lin, P.-Y., Y.-R. Yang, S.-J. Cheng and R.-Y. Wang (2006). "The relation between ankle impairments and gait velocity and symmetry in people with stroke." Archives of physical medicine and rehabilitation 87(4): 562-568.
    70. Livingston, L. A., J. M. Stevenson and S. J. Olney (1991). "Stairclimbing kinematics on stairs of differing dimensions." Archives of physical medicine and rehabilitation 72(6): 398-402.
    71. Lu, T., H. Chien and H. Chen (2007). "Joint loading in the lower extremities during elliptical exercise." Medicine and science in sports and exercise 39(9): 1651.
    72. Luc-Harkey, B. A., C. E. Safran-Norton, L. A. Mandl, J. N. Katz and E. Losina (2018). "Associations among knee muscle strength, structural damage, and pain and mobility in individuals with osteoarthritis and symptomatic meniscal tear." BMC musculoskeletal disorders 19(1): 258.
    73. Lunnen, J. D., J. Yack and B. F. LeVeau (1981). "Relationship between muscle length, muscle activity, and torque of the hamstring muscles." Physical therapy 61(2): 190-195.
    74. Mündermann, A., C. O. Dyrby and T. P. Andriacchi (2005). "Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking." Arthritis & Rheumatism 52(9): 2835-2844.
    75. Mathers, D. S. C. and B. Pfleger "Global burden of osteoarthritis in the year 2000."
    76. Mazzuca, S. A., K. D. Brandt, B. P. Katz, Y. Ding, K. A. Lane and K. A. Buckwalter (2007). "Risk factors for early radiographic changes of tibiofemoral osteoarthritis." Annals of the rheumatic diseases 66(3): 394-399.
    77. McConnell, S., P. Kolopack and A. M. Davis (2001). "The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties." Arthritis care & research 45(5): 453-461.
    78. McFadyen, B. J. and D. A. Winter (1988). "An integrated biomechanical analysis of normal stair ascent and descent." Journal of biomechanics 21(9): 733-744.
    79. Mercer, V. S., S.-H. Chang, C. D. Williams, K. J. Noble and A. W. Vance (2009). "Effects of an exercise program to increase hip abductor muscle strength and improve lateral stability following stroke: a single subject design." Journal of geriatric physical therapy 32(2): 6-15.
    80. Messier, S. P., D. J. Gutekunst, C. Davis and P. DeVita (2005). "Weight loss reduces knee‐joint loads in overweight and obese older adults with knee osteoarthritis." Arthritis & Rheumatism 52(7): 2026-2032.
    81. Middleton, A., A. Merlo-Rains, D. M. Peters, J. V. Greene, E. L. Blanck, R. Moran and S. L. Fritz (2014). "Body weight–supported treadmill training is no better than overground training for individuals with chronic stroke: a randomized controlled trial." Topics in stroke rehabilitation 21(6): 462-476.
    82. Ministry of Health and Wealth. (2018). "106年國人死因統計結果."
    83. Miyazaki, T., M. Wada, H. Kawahara, M. Sato, H. Baba and S. Shimada (2002). "Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis." Ann Rheum Dis. 61(7): 617-622.
    84. Miyazaki, T., M. Wada, H. Kawahara, M. Sato, H. Baba and S. Shimada (2002). "Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis." Annals of the rheumatic diseases 61(7): 617-622.
    85. Moisio, K. C., D. R. Sumner, S. Shott and D. E. Hurwitz (2003). "Normalization of joint moments during gait: a comparison of two techniques." Journal of biomechanics 36(4): 599-603.
    86. Mossberg, K. A. and E. Fortini (2012). "Responsiveness and validity of the six-minute walk test in individuals with traumatic brain injury." Physical therapy 92(5): 726-733.
    87. Nakamura, R., S. Watanabe, T. HANDA and I. MOROHASHI (1988). "The relationship between walking speed and muscle strength for knee extension in hemiparetic stroke patients: a follow-up study." The Tohoku journal of experimental medicine 154(2): 111-113.
    88. Nguyen, C., M. M. Lefevre-Colau, S. Poiraudeau and F. Rannou (2016). "Rehabilitation (exercise and strength training) and osteoarthritis: A critical narrative review." Ann Phys Rehabil Med. 59(3): 190-195. doi: 110.1016/j.rehab.2016.1002.1010. Epub 2016 May 1015.
    89. Park, B.-S., M.-Y. Kim, L.-K. Lee, S.-M. Yang, W.-D. Lee, J.-W. Noh, Y.-S. Shin, J.-H. Kim, J.-U. Lee and T.-Y. Kwak (2015). "Effects of conventional overground gait training and a gait trainer with partial body weight support on spatiotemporal gait parameters of patients after stroke." Journal of physical therapy science 27(5): 1603-1607.
    90. Park, S. J., Y. M. Kim and H. R. Kim (2016). "The effect of hip joint muscle exercise on muscle strength and balance in the knee joint after meniscal injury." Journal of physical therapy science 28(4): 1245-1249.
    91. Patterson, K. K., I. Parafianowicz, C. J. Danells, V. Closson, M. C. Verrier, W. R. Staines, S. E. Black and W. E. McIlroy (2008). "Gait asymmetry in community-ambulating stroke survivors." Archives of physical medicine and rehabilitation 89(2): 304-310.
    92. Patterson, S. L., L. W. Forrester, M. M. Rodgers, A. S. Ryan, F. M. Ivey, J. D. Sorkin and R. F. Macko (2007). "Determinants of walking function after stroke: differences by deficit severity." Archives of physical medicine and rehabilitation 88(1): 115-119.
    93. Røgind, H., B. Bibow-Nielsen, B. Jensen, H. C. Møller, H. Frimodt-Møller and H. Bliddal (1998). "The effects of a physical training program on patients with osteoarthritis of the knees." Archives of physical medicine and rehabilitation 79(11): 1421-1427.
    94. Ramnemark, A., M. Nilsson, B. Borssén and Y. Gustafson (2000). "Stroke, a major and increasing risk factor for femoral neck fracture." Stroke 31(7): 1572-1577.
    95. Ramnemark, A., L. Nyberg, B. Borssén, T. Olsson and Y. Gustafson (1998). "Fractures after stroke." Osteoporosis International 8(1): 92-95.
    96. Rannou, F. and S. Poiraudeau (2010). "Non-pharmacological approaches for the treatment of osteoarthritis." Best practice & research Clinical rheumatology 24(1): 93-106.
    97. Reid, D. A. and P. J. McNair (2011). "Effects of a six week lower limb stretching programme on range of motion, peak passive torque and stiffness in people with and without osteoarthritis of the knee." New Zealand Journal of Physiotherapy 39(1): 5.
    98. Riley, P. O., M. L. Schenkman, R. W. Mann and W. A. Hodge (1991). "Mechanics of a constrained chair-rise." Journal of biomechanics 24(1): 77-85.
    99. Roddy, E., W. Zhang and M. Doherty (2005). "Aerobic walking or strengthening exercise for osteoarthritis of the knee? A systematic review." Annals of the rheumatic diseases 64(4): 544-548.
    100. Roddy, E., W. Zhang, M. Doherty, N. Arden, J. Barlow, F. Birrell, A. Carr, K. Chakravarty, J. Dickson and E. Hay (2005). "Evidence-based recommendations for the role of exercise in the management of osteoarthritis of the hip or knee—the MOVE consensus." Rheumatology 44(1): 67-73.
    101. Rogers, M. W. and M.-L. Mille (2003). "Lateral stability and falls in older people." Exercise and sport sciences reviews 31(4): 182-187.
    102. Roth, E. J., C. Merbitz, K. Mroczek, S. A. Dugan and W. W. Suh (1997). "Hemiplegic gait: Relationships between walking speed and other temporal parameters1." American journal of physical medicine & rehabilitation 76(2): 128-133.
    103. Schipplein, O. and T. Andriacchi (1991). "Interaction between active and passive knee stabilizers during level walking." Journal of Orthopaedic Research 9(1): 113-119.
    104. Shakoor, N., M. Sengupta, K. C. Foucher, M. A. Wimmer, L. F. Fogg and J. A. Block (2010). "Effects of common footwear on joint loading in osteoarthritis of the knee." Arthritis care & research 62(7): 917-923.
    105. Sharma, L., D. E. Hurwitz, E. J. Thonar, J. A. Sum, M. E. Lenz, D. D. Dunlop, T. J. Schnitzer, G. Kirwan-Mellis and T. P. Andriacchi (1998). "Knee adduction moment, serum hyaluronan level, and disease severity in medial tibiofemoral osteoarthritis." Arthritis Rheum. 41(7): 1233-1240.
    106. Shim, S., J. Yu, J. Jung, H. Kang and K. Cho (2012). "Effects of dual-task performance on postural sway of stroke patients with experience of falls." Journal of Physical Therapy Science 24(10): 975-978.
    107. Simon, S. R., I. L. Paul, J. Mansour, M. Munro, P. J. Abernethy and E. L. Radin (1981). "Peak dynamic force in human gait." Journal of biomechanics 14(12): 817-822.
    108. Slemenda, C., K. D. Brandt, D. K. Heilman, S. Mazzuca, E. M. Braunstein, B. P. Katz and F. D. Wolinsky (1997). "Quadriceps weakness and osteoarthritis of the knee." Annals of internal medicine 127: 97-104.
    109. Sullivan, K. J., D. A. Brown, T. Klassen, S. Mulroy, T. Ge, S. P. Azen and C. J. Winstein (2007). "Effects of task-specific locomotor and strength training in adults who were ambulatory after stroke: results of the STEPS randomized clinical trial." Physical therapy 87(12): 1580-1602.
    110. Sullivan, K. J., B. J. Knowlton and B. H. Dobkin (2002). "Step training with body weight support: effect of treadmill speed and practice paradigms on poststroke locomotor recovery." Archives of physical medicine and rehabilitation 83(5): 683-691.
    111. Suri, P., D. K. Kiely, S. G. Leveille, W. R. Frontera and J. F. Bean (2009). "Trunk muscle attributes are associated with balance and mobility in older adults: a pilot study." PM&R 1(10): 916-924.
    112. Tetsworth, K. and D. Paley (1994). "Malalignment and degenerative arthropathy." Orthopedic Clinics of North America 25(3): 367-378.
    113. Thorp, L., M. Wimmer, K. Foucher, D. Sumner, N. Shakoor and J. Block (2010). "The biomechanical effects of focused muscle training on medial knee loads in OA of the knee: a pilot, proof of concept study." J Musculoskelet Neuronal Interact 10(2): 166-173.
    114. Thorstensson, C., M. Henriksson, A. von Porat, C. Sjödahl and E. Roos (2007). "The effect of eight weeks of exercise on knee adduction moment in early knee osteoarthritis–a pilot study." Osteoarthritis and Cartilage 15(10): 1163-1170.
    115. Toda, Y. and N. Tsukimura (2008). "Influence of concomitant heeled footwear when wearing a lateral wedged insole for medial compartment osteoarthritis of the knee." Osteoarthritis and Cartilage 16(2): 244-253.
    116. Tsai, Y.-J., B.-J. Hsue, C.-J. Lin and F.-C. Su (2011). "Biomechanics During Exercise with a Novel Stairclimber." International journal of sports medicine 32(09): 712-719.
    117. Tsai, Y. J., B. J. Hsue, C. J. Lin and F. C. Su (2011). "Biomechanics during exercise with a novel stairclimber." Int J Sports Med. 32(9): 712-719. doi: 710.1055/s-0031-1275670. Epub 1272011 May 1275611.
    118. Tyson, S. F., M. Hanley, J. Chillala, A. Selley and R. C. Tallis (2006). "Balance disability after stroke." Physical therapy 86(1): 30-38.
    119. Varady, P. A., U. Glitsch and P. Augat (2015). "Loads in the hip joint during physically demanding occupational tasks: A motion analysis study." Journal of biomechanics 48(12): 3227-3233.
    120. Vaughan CL, D. B., O'Connor JC. (1992). Dynamics of human gait . 2nd ed. Illinois. Champaign IL, Human Kinetics Publishers.
    121. Visintin, M., H. Barbeau, N. Korner-Bitensky and N. E. Mayo (1998). "A new approach to retrain gait in stroke patients through body weight support and treadmill stimulation." Stroke 29(6): 1122-1128.
    122. Vogels, E., H. Hendriks, M. Van Baar, J. Dekker, M. Hopman-Rock, R. Oostendorp, W. Hullegie, H. Bloo, W. Hilberdink and M. Munneke (2001). "Clinical practice guidelines for physical therapy in patients with osteoarthritis of the hip or knee." Amersfoort: KNGF.
    123. Wade, D., V. Wood, A. Heller, J. Maggs and R. H. Langton (1987). "Walking after stroke. Measurement and recovery over the first 3 months." Scandinavian journal of rehabilitation medicine 19(1): 25-30.
    124. Winter, D. A. (2009). Biomechanics and motor control of human movement, John Wiley & Sons.
    125. World Health Organization. (2019). "Stroke, Cerebrovascular accident."
    126. Yang, Y.-R., M.-P. Tsai, T.-Y. Chuang, W.-H. Sung and R.-Y. Wang (2008). "Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial." Gait & posture 28(2): 201-206.
    127. You, Y.-L., S.-Y. Lee, Y.-J. Tsai, C.-F. Lin, L.-C. Kuo and F.-C. Su (2019). "Effects of body weight support and pedal stance width on joint loading during pinnacle trainer exercise." Gait & posture.
    128. Zhang, W., G. Nuki, R. W. Moskowitz, S. Abramson, R. D. Altman, N. K. Arden, S. Bierma-Zeinstra, K. D. Brandt, P. Croft, M. Doherty, M. Dougados, M. Hochberg, D. J. Hunter, K. Kwoh, L. S. Lohmander and P. Tugwell (2010). "OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence following systematic cumulative update of research published through January 2009." Osteoarthritis Cartilage. 18(4): 476-499. doi: 410.1016/j.joca.2010.1001.1013. Epub 2010 Feb 1011.
    129. Zhang, Y. and J. M. Jordan (2010). "Epidemiology of osteoarthritis." Clin Geriatr Med 26(3): 355-369.
    130. Zhao, D., S. A. Banks, K. H. Mitchell, D. D. D'Lima, C. W. Colwell Jr and B. J. Fregly (2007). "Correlation between the knee adduction torque and medial contact force for a variety of gait patterns." Journal of orthopaedic research 25(6): 789-797.
    131. Zimmermann, C. L., T. M. Cook, M. Bravard, M. Hansen, R. Honomichl, S. Karns, M. Lammers, S. Steele, L. Yunker and R. Zebrowski (1994). "Effects of stair-stepping exercise direction and cadence on EMG activity of selected lower extremity muscle groups." The Journal of orthopaedic and sports physical therapy 19(3): 173-180.

    下載圖示 校內：2025-02-28公開
    校外：2025-02-28公開
    QR CODE