2011-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/659195摘要：跌倒通常會造成老人嚴重的後果如死亡、併發症和喪失獨立自主的能力。目前，跌倒在台灣及美國皆是老人最常見的意外死亡原因。為了制定出有效的運動訓練計畫以預防老人跌倒，鑑定出造成老人平衡穩定度缺失的因子是重要的課題。已有研究顯示身體質心 (center of mass) 的控制是平衡能力的關鍵性指標，而此控制過程是多重關節協調運動後的結果 (Hsu et al 2007)。然而，目前的生物力學模型皆無法直接或同時評估多重關節其關節力矩與質心控制的關係。因此，本計畫有三個重要的研究目的：第一年研究目的為發展生物力學模型使其可鑑定出於站立時多重關節的協調模式與質心加速度的控制兩者之間的關係：本研究將建構生物力學模型可直接將多重自由度 (degrees of freedom) 的控制與質心的控制作相連結，並以未限性多元化模組 (Uncontrolled Manifold Analysis: UCM)來分析質心加速度的控制與多關節間力矩之變化及老化對其的影響。本研究也將探究老人與年輕人維持質心在穩定範圍內時的力矩需求比 (torque demand of capacity ratio: TCR)。預計將收案40位年輕人與40位老人並比較其生物力學參數的差異。此外，為了增進老人的平衡控制能力，本計畫之第二年目的將探究客製化的肌力訓練計畫是否能改善老人其平衡的控制能力：本研究以隨機控制研究方法(RCT)將80位老人分成兩組: 老人運動組將接受三個月的客製化肌力訓練，其訓練計畫是根據第一年的研究結果來制定；老人控制組則是維持其日常生活活動。最後以UCM分析法、TCR及臨床平衡測試檢驗老人肌力訓練的效果。本計畫之第三年目的將綜合第一年及第二年所得之UCM分析、TCR與臨床平衡測試結果以預測老人未來跌倒之發生率：本研究將對老人進行1~2年的長期追蹤，建立兩種不同的跌倒發生率模型。本計畫之研究成果將有助於臨床上恢復老人的平衡能力，並提供有臨床意義的生物力學指標以作為未來發展及改善評估與治療方法的基礎。<br> Abstract: Falls have devastating consequences for older adults in terms of mortality, morbidity, and loss of independence. Falls are the leading cause of accidental death in older adults both in Taiwan and in the United States. Identifying the mechanisms by which stability deficits related to falls occur within the elderly population is importance for the development of effective exercise interventions for fall prevention. Studies have shown that the control of whole body center of mass (COM) is a critical indicator for balance control and this control process is a multi-joint coordination pattern (Hsu et al 2007). Nonetheless, current biomechanical models cannot directly assess the relationship between multi-joint torques and balance ability in terms of the control of COM. Therefore, there are three important aims for this proposed research:The aim of the first year is to develop biomechanical models that can identify multi-joint coordination pattern in control of the center of mass acceleration in standing: We will establish biomechanical models which can directly relate the control of multiple degrees of freedom to the control of COM. The Uncontrolled Manifold Analysis (UCM) will be developed and used to investigate the age-related changes in multi-joint torques related to the control of COM acceleration. The torque demand of capacity ratio (TCR) will be identified to determine how much joint torque for each joint is necessary to maintain COM within limit of stability. We will recruit 40 young adults and 40 older adults and will compare the biomechanical parameters between two groups. In addition, in order to improve the balance control in elderly, the aim of the second year is to determine the effects of customized muscles strengthening exercise on balance control in older adults: A randomized control trial (RCT) will be employed to investigate the efficacy of the muscle strengthening exercises which are customized based on the results of balance evaluation from Aim1. The older adults exercise group will receive 3 months of muscle strengthening exercise and the older adults control group will maintain their usual daily life activities. The UCM analysis as well as clinical balance tests will be conducted to evaluate the training effects. The third aim of this study is to predict fall risks in older adults by using the experimental findings from the first and the second parts of the proposed study: After the 3 months of exercise training, 1-2 years follow-up will be performed for older adults to record their fall incidences. We will derive and compare two prediction models for future occurrences of fall.Outcomes of this proposed study will contribute to clinical application for balance recovery in older adults, as well as provides a basis for developing improved tools for evaluation and treatment of patients with balance disorders.