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研究生：	陳秀慧 HUE, TRAN TU
論文名稱：	探討輪椅推進姿勢與肩峰下空間的關係 Investigation of the relationship between the posture during wheelchair propulsion and subacromial space
指導教授：	蘇芳慶 Su, Fong-Chin
學位類別：	碩士 Master
系所名稱：	工學院 - 生物醫學工程學系 Department of BioMedical Engineering
論文出版年：	2018
畢業學年度：	106
語文別：	英文
論文頁數：	89
外文關鍵詞：	shoulder pain, subacromial space, wheelchair propulsion, ultrasound
相關次數：	點閱：110 下載：0
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Shoulder pain, specifically shoulder impingement syndrome, is a common injury for manual wheelchair users. Although previous studies investigated the nature of subacromial space and its narrowing, the relationship between subacromial space and wheelchair activities is not fully known. Imaging techniques have been applied to determine the width of subacromial space, and ultrasound has been used to determine the acromio-humeral distance (AHD).
This thesis examines the changes of subacromial space and the characteristics of such changes for shoulder motions at various angles, including abduction, flexion, and extension. It was found that shoulder motion and joint angle directly influenced AHD in 15 healthy subjects. Specifically, the AHD decreased during flexion and abduction from neutral to 90°. Additionally, flexion motion reduced the width of subacromial space more than did abduction motion for a given angle. Moreover, change in AHD were largest from neutral to 60° flexion, but got highest value from neutral to 30° abduction. AHD tended to increase during extension; the trend was opposite for flexion and abduction. These results were used as reference values in the experiments of this thesis.
Additionally, the change of AHD in various postures with and without a pushrim force from wheelchair propulsion was investigated. The width of subacromial space was defined and the relationship between this width and posture during wheelchair propulsion, including 30°, 90°, 120° of hand contact, and weight relief task, was confirmed. Additionally, the forces and moments for various postures during wheelchair propulsion were calculated and statistically analyzed. The relationship between force and change in AHD for various postures and various level forces was established. Finally, the change of AHD for wheelchair propulsion postures was compared to that in the neutral position. The results showed that posture and pushrim force during wheelchair propulsion affect AHD significantly. Moreover, weight relief is considered the highest risk factor for shoulder impingement; other wheelchair propulsion postures may also cause the narrowing of the subacromial space.
The results of this thesis may help clinical experts understand the mechanism of the narrowing of the subacromial space during wheelchair propulsion. Manual wheelchair users should be asked to limit overhead activities and reduce weight-bearing tasks to prevent the reduction of subacromial space and protect the rotator cuff.

Abstract	I
ACKNOWLEDGEMENT	III
Contents	V
List of Figure	IX
List of Table	XII
Chapter 1	Introduction	1
1 Background	1
2 Mechanisms of shoulder pain and shoulder impingement syndrome	2
2.1 Shoulder impingement syndrome	2
2.2 Subacromial space and subacromial impingement	3
3 Imaging of subacromial space	5
3.1 Overview	5
3.2 Using ultrasonography to measure subacromial space	7
4 Biomechanics of wheelchair propulsion	10
5. Shoulder pain in manual wheelchair users	13
6. Motivation	14
7 Purpose	15
Chapter 2	Methods and Materials	16
1 Subject	16
2 Instruments	17
2.1 Motion capture system	17
2.2 Ultrasound system.	17
2.3 Smartwheel.	18
3 Experiment procedure	20
3.1 Protocol for investigating effect of shoulder motion on subacromial space	20
3.2 Protocol for investigating relationship between subacromial space and posture during wheelchair propulsion	23
4 Data analysis	28
4.1 Subacromial space variables calculation	28
4.2 Kinematic variables of wheelchair propulsion	28
5 Statistical analysis	30
Chapter 3	Results	32
1 Overview of AHD for various shoulder motions	32
1.1 Change of AHD during forward flexion	32
1.2 Change of AHD during abduction.	36
1.3 Change of AHD during extension	38
2 Reliability of ultrasound measurement in AHD of current study.	40
3 Kinematic of shoulder and elbow in different posture of wheelchair propulsion.	41
4 Mean AHD and change in AHD (ΔAHD) on various postures of wheelchair propulsion	44
4.1 Mean AHD on postures of wheelchair propulsion	44
4.2	Change in AHD (ΔAHD) on postures of wheelchair propulsion	45
5	Mean AHD and change in AHD (ΔAHD) with various level of forces	46
5.1 Mean AHD for various levels of force of wheelchair propulsion	46
5.2 Change in AHD (ΔAHD) for various levels of force on postures of wheelchair propulsion	47
6 Correlation between mean AHD and wheelchair propulsion’s parameters	48
6.1 In 30 degree of hand contact	48
6.2 In 90 degree of hand contact	50
6.3 In 120 degree of hand contact	52
6.4 In weight relief postures	54
7 Correlation between ΔAHD and wheelchair propulsion’s parameters	56
7.1 In 30 degree of hand contact	56
7.2 In 90 degree of hand contact	58
7.3 In 120 degree of hand contact	60
7.4 In Weight relief lifting	62
8 Effect of postures and effect of forces on AHD during wheelchair propulsion postures	64
Chapter 4	Discussion	66
1 Effect of shoulder motion and shoulder angle on AHD in flexion and abduction	66
2 Comparison AHD in ultrasonography method and other imaging method	70
3 Relationship between AHD and postures during wheelchair propulsion.	71
4 Relationship between forces and AHD and change in AHD during wheelchair propulsion	76
5 Comparison of the effect of forces to AHD between propulsion postures and weight relief	78
6 Clinical implication	80
7	Limitation	81
8	Future implication of current study	81
Chapter 5	Conclusion	82
References	82

                                    

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校內：2023-02-02公開
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