研究背景與目的: 對於高齡者而言，步行時踏上一階梯是常見並具有挑戰性的動作，而且在上階梯前採取一個暫停的動作可能會幫助減少平衡的威脅。隨著年紀增加，糖尿病罹病率也逐年增加，此類患者如患有周邊神經病變，可能有感覺動作功能障礙，這也許會導致平衡控制不佳的問題出現，進一步影響活動與步行。本研究的目的在於探討健康高齡者、糖尿病患者和周邊神經病變患者在上階梯前短暫停留的動作，對於上階梯時與之後的平衡控制之影響。

研究方法: 本研究著重於高齡者，包括23位健康、22位糖尿病患者和22位周邊神經病變患者，使用兩種不同的上階梯策略，策略一(直接上階)是請受試者先步行6公尺後直接踏上一個9或18公分高的階梯，並維持站立姿勢；策略二(停下站穩)是受試者步行6公尺後，在階梯前方標記處停下，自覺站穩後再踏上階梯，並維持站立姿勢。上階動作的分期是以慣用腳踏上階梯的過程區分，分別為起始雙腳站立期、擺盪期、第二次雙腳站立期和單腳站立期，共四個時期；上階梯後，自雙腳接觸到階梯面的一秒內每0.25秒為一區間，共四個區間。在研究設備上使用一個三軸加速規，固定在第三腰椎脊突處記錄身體質心在前後、左右及垂直方向的加速度。統計方法使用重複量數多變量變異數分析，比較不同族群、策略和階梯高度在每一時間區間內所得加速度的範圍、均方根和標準差。

結果: 上階梯時，三軸的加速度會隨著階梯高度增加而增加，其中前後向加速度增加的程度在擺盪期與第二次雙腳站立期和單腳站立期有顯著差異，左右向加速度則在擺盪期和單腳站立期有顯著差異，而垂直向加速度在第二次雙腳站立期和單腳站立期有顯著差異。停下站穩策略均較直接上階策略在前三個上階時期有較小的前後向和垂直向加速度，並且在前兩個時期有較小的左右向加速度。此外，在第二次雙腳站立期，當階梯高度較低時，健康高齡者和糖尿病患者採取停下站穩策略會有較小的左右向加速度;而階梯高度增加時，所有受試者皆有較小的左右向加速度。上階梯後的0.75秒內，當階梯高度增加，所有高齡者的前後向加速度顯著增加；而前0.25秒內，當高階梯時，健康高齡者和糖尿病患者使用停下站穩策略比直接上階的左右向加速度顯著較小;而在低階梯時，所有高齡者使用停下站穩策略有較小的左右向加速度。

結論: 對於高齡者而言，在上較高階前先停下來站穩能減少在上階梯過程中的身體晃動，高齡者不論其感覺動作功能如何，在較具挑戰性的情況下可考慮採用此策略。

Background: Ascending to an elevated surface while walking is a common and challenging task for older adults. Having a pause before ascending is a strategy often adopted by older adults and may reduce balance threat. Diabetic patients often have problems with balance control, especially those with neuropathy patients and subsequent sensorimotor impairments. The purpose of this study was to investigate the influence of having a pause before ascending on balance control during and after ascending a step stool in healthy older adults, older diabetic patients with and without neuropathy.

Methods: Twenty-three healthy older adults (CON), twenty-two older diabetic patients without neuropathy (DM-nonNP), and twenty-two older diabetic patients with neuropathy (DM-NP) participated in this study. There were two task conditions. In the walk-step condition (WS), subjects were instructed to walk and then directly step up onto a 9 cm (LOW) or 18 cm (HIGH) step stool which was placed 6 m from the starting position. In the pause-step condition (PS), subjects were instructed to walk, pause briefly in front of the stool to stabilize themselves, and then step up onto the step stool. For both conditions, the subjects were instructed to stand quietly after stepping onto the step stool. During ascending, the motion was divided into four phases based on the motion of the leading limb, including initial double-limb support (IDS), swing (SW), second double-limb support (SDS) and single-limb stance (SLS). An accelerometer was placed at the spinous process of the 3rd lumbar vertebrae to measure the acceleration of the body’s center of mass in the anteroposterior (AP), mediolateral (ML), and vertical (VT) directions. The range, root-mean-square (RMS) and standard deviation (SD) of the acceleration were analyzed using multivariate repeated measures analysis of variance. Also, the acceleration during the first one second after both feet making contact with the step stool was also analyzed.

Results: During ascending, HIGH had significantly greater AP acceleration in the SW, SDS, and SLS phases, greater ML acceleration in the SW and SLS phases, and greater VT acceleration in the SDS and SLS phases, compared to LOW. Compared to WS, PS had significantly smaller AP and VT acceleration in the first three phases, and smaller ML acceleration in the first two phases regardless of the step height. In LOW, PS had significantly smaller ML acceleration than WS in CON and DM-nonNP subjects during the SDS phase, whereas in HIGH, all subjects had smaller ML acceleration than LOW. During quiet standing after ascending, HIGH had significantly greater AP acceleration than LOW during the first 0.75 seconds. Compared to WS, PS had significantly smaller ML acceleration during the first 0.25 s period for all subjects in LOW, whereas in HIGH only CON and DM-nonNP had such a finding.

Conclusion: For older adults, even those with different sensorimotor functions, having a pause before ascending decreased imbalance during the ascending phase. Thus, having a pause before ascending could be recommended for older adults, especially for challenging conditions.

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