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研究生：	陳仕彬 Chen, Shih-Bin
論文名稱：	肩關節肌肉在穩定與不穩定平面上進行閉鎖式活動之動力學與肌電學分析探討 Kinetic and EMG Analyses of Shoulder Muscles during Closed Chain Activities on Stable and Unstable Surface
指導教授：	徐阿田 Hsu, Ar-Tyan
學位類別：	碩士 Master
系所名稱：	醫學院 - 物理治療學系 Department of Physical Therapy
論文出版年：	2007
畢業學年度：	95
語文別：	英文
論文頁數：	109
中文關鍵詞：	肩膀承重運動，閉鎖式運動、肩關節、關節力矩、關節作用力、肩關節肌肉
外文關鍵詞：	Joint Torque, Shoulder Muscles, Shoulder joint, Joint Reaction Force, Closed Kinetic Chain exercises, Shoulder Weight-Bearing Exercises
相關次數：	點閱：124 下載：3
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過去的研究大多著重在開放式運動，所以對於上肢的閉鎖式運動並沒有足夠的資訊，因此本實驗的目的在於分析及比較不同的閉鎖式運動及穩定與不穩定狀況下的動力學及肌電學資料，探討當肩關節進行承重運動時的動力學及肌電學特徵。共二十位男性受試者參與本實驗，藉由控制數種因子來讓受試者進行不同的閉鎖式運動訓練，包括海綿墊有無、不同姿勢，支撐點改變及不同肩關節位置，來產生不一樣的閉鎖式運動，每一個受試者執行運動時直接在力板或海綿墊，同時保持手腳或手膝蓋支持姿勢，並合併四點、三點、斜向或單邊支撐，之會會要求受試者將身體往前後左右平移到不同的位置。量測因子包括肩關節角度、肩肌肉的肌電反應、肩關節受力及力矩。在實驗中，海綿墊會使肩關節作用力在往前及往外方向增加但往下的方向減少(P值<0.05)，而對於力矩則無明顯的影響(P值>0.05)，且在有海綿墊的狀況下雖然會造成肌肉活動增加，但沒有達到顯著性的差異(P值>0.05)，而對所有的量測因子，在手腳支持的姿勢下都會顯著大於手膝蓋支持的姿勢，在只有斜向支撐下可以造成最高的肩關節作用力在往前及往外方向，而在三點支撐可以有最高的肩關節作用力在往下方向(P值<0.05)，對於肩屈肌及肩胛肌群在斜向支撐時有最高的活動，而其他大部分的肩膀肌群在單邊支撐時有最大的活動(P值<0.05)，且在肩膀伸展及橫向內收時會有最大的肌肉活動。不同的姿勢及支撐方法是最主要影響的因子，所以利用手腳支持姿勢合併根據不同肌肉選擇斜向或單側支撐，會造成有最大的肌肉活動及肩關節作用力，所以在實驗中獲得有關上肢的閉鎖式運動訓練的訊息包括肌電及力學資料對於物理治療師是有用的，可以合併過去對於開放式運動訓練的資料來設計對病人最適合的運動計畫

Previous studies on shoulder muscle strengthening and rehabilitation emphasized the use of open kinetic chain exercises. However, there is limited information on closed kinetic chain exercises. The purpose of this study was to analyze and compare kinetics and electromyographic (EMG) data during closed kinetic chain exercises, in order to explore the kinetic characteristic and EMG data of the shoulder weight-bearing exercise. Twenty male subjects participated in the study. They performed different shoulder weight-bearing exercises by controlling several factors, including foam, posture, support, and position. Each subject performed exercises directly bearing on the force plate or foam, in hand-sand-knees or hands-and-feet postures combined four point, three point, diagonal, or unilateral support. Then each subject was asked to shift his body forward, backward, leftward, and rightward to different positions. Outcome measures were the angle of the shoulder joint, EMG activities of shoulder muscles, shoulder joint reaction force, and torque. In our study, the foam cause a significant increase of shoulder joint reaction force in anterior and lateral direction but decrease in inferior direction (p value < 0.05), and didn’t have influence for shoulder torque (p value > 0.05). The foam resulted in the EMG slightly increased, but there was on significant difference (p value > 0.05). For all outcome measures, the hands-and-feet posture was significant higher than the hands-and-knees posture (p value < 0.05). The diagonal support resulted in the highest shoulder joint reaction force in anterior and lateral direction, and the three point support resulted in the highest shoulder joint reaction force in inferior direction (p value < 0.05). The shoulder flexor and scapular upward rotator had the highest EMG firing in the diagonal support (p value < 0.05), but other shoulder muscles had the highest EMG firing in the unilateral support (p value < 0.05). However, the hands-and-feet posture could enhance the difference between different supporting methods. The extension and horizontal adduction positions could in highest EMG activities and shoulder reaction force in inferior direction. The posture and support were the primary factors to influence the shoulder joint reaction force, torque, and EMG activities. The hands-and-feet posture combined diagonal support or unilateral for different muscles resulted in the highest muscle loading, and shoulder loading. The information about muscle activities and kinetic data during shoulder weight-bearing exercises was useful for physical therapists to combine open kinetic chain exercises to design appropriate exercises programs for patients.

CONTENTS
ABSTRACT ------------------------------------------------------------------------------------- i
中文摘要 --------------------------------------------------------------------------------------- iii
致謝---------------------------------------------------------------------------------------------- v
CONTENTS ------------------------------------------------------------------------------------ vi
FIGURE LIST ----------------------------------------------------------------------------------- x
TABLE LIST ---------------------------------------------------------------------------------- xv
Chapter I  Introduction                                      1
1	Introduction ------------------------------------------------------------------------------ 1
2	Literature Review ----------------------------------------------------------------------- 3
2.1	Stability of Shoulder Complex --------------------------------------------- 3
2.2	Rehabilitation Programs ----------------------------------------------------- 5
2.3	Open Versus Closed Kinetic Chain Exercises ---------------------------- 6
2.4	Shoulder Weight-Bearing Exercises --------------------------------------- 7
3	Purposes --------------------------------------------------------------------------------- 10
3.1	Specific Aims----------------------------------------------------------------- 10
3.2	Hypothesis ------------------------------------------------------------------- 10
Chapter II  Methods and Materials                            12
1	Participants ----------------------------------------------------------------------------- 12
2	Instrumentation ------------------------------------------------------------------------- 12
3	Subject Preparation -------------------------------------------------------------------- 15
4	Data Processing and Analysis -------------------------------------------------------- 18
5	Experimental Procedure --------------------------------------------------------------- 23
6	Statistical Analysis --------------------------------------------------------------------- 29
Chapter III  Results                                        32
1  The relationship between Shoulder EMG activities and joint reaction force --- 32
2  Shoulder Joint Angle during Shoulder Weigh-bearing Exercises --------------- 33
3  Shoulder Joint Reaction Force during Shoulder Weigh-bearing Exercises ---- 35
3.1  Shoulder Joint Reaction Force in Anterior/Posterior Direction ------------- 35
3.2  Shoulder Joint Reaction Force in Medial/Lateral Direction ----------------- 37
3.3  Shoulder Joint Reaction Force in Superior/Inferior Direction -------------- 40
4  Shoulder Joint Torque during Shoulder Weigh-bearing Exercises ------------- 42
4.1 Shoulder Horizontal Abduction / Adduction Torque --------------------------- 42
4.2 Shoulder Flexion / Extension Torque --------------------------------------------- 44
5 Electromyography of Shoulder Muscles during Experimental Exercises -------- 46
5.1  Rotator Cuff ----------------------------------------------------------------------- 46
5.2  Shoulder Flexor ------------------------------------------------------------------- 50
5.3  Shoulder Extensor ---------------------------------------------------------------- 54
5.4  Shoulder Abductor ---------------------------------------------------------------- 56
5.5  Shoulder Horizontal Abductor -------------------------------------------------- 60
5.6  Shoulder Horizontal Adductor -------------------------------------------------- 62
5.7  Scapular Upward Rotator -------------------------------------------------------- 65
5.8  Deltoid ----------------------------------------------------------------------------- 73
Chapter IV  Discussion                                     75
1	Shoulder Joint Reaction Force during Shoulder Weigh-bearing Exercises ---- 75
1.1	 The Influence of Foam ------------------------------------------------------------- 75
1.2	 The Influence of Posture ---------------------------------------------------------- 76
1.3	 The Influence of Support ---------------------------------------------------------- 77
2	Shoulder Joint Torque during Shoulder Weigh-bearing Exercises -------------- 80
2.1	 The Influence of Foam ------------------------------------------------------------ 81
2.2	 The Influence of Posture ---------------------------------------------------------- 82
2.3	 The Influence of Support ---------------------------------------------------------- 83
2.4	 The Influence of Position --------------------------------------------------------- 84
3  Closed Kinetic Chain Exercises of Shoulder --------------------------------------- 85
3.1  Rotator Cuffs ----------------------------------------------------------------------- 86
3.2  Shoulder Flexors ------------------------------------------------------------------- 88
3.3  Shoulder Extensors ---------------------------------------------------------------- 89
3.4  Shoulder Horizontal Abductors -------------------------------------------------- 90
3.5  Shoulder Horizontal Adductors -------------------------------------------------- 91
3.6  Shoulder Abductors --------------------------------------------------------------- 93
3.7  Scapular Upward Rotators ------------------------------------------------------- 94
3.8  Deltoid ------------------------------------------------------------------------------ 96
4  Open versus Closed Kinetic Chain Exercises -------------------------------------- 97
5  Study Limitation ----------------------------------------------------------------------- 98
Chapter V  Conclusion                                    100
REFERENCES --------------------------------------------------------------- 102
                                    

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校內：2008-08-21公開
校外：2008-08-21公開

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