2015-08-012024-05-14https://scholars.lib.ntu.edu.tw/handle/123456789/660450摘要：人口老化已經成為全球性的議題，而跌倒是老年人生活中普遍的隱憂，可導致骨折、受傷或死亡。研究顯示肌肉品質和良好的姿勢控制，是老年人平衡控制的關鍵；老化的過程常伴隨肌肉含量降低及無力或骨質減少，導致脊柱曲度改變逐漸形成駝背，進而影響平衡能力。因此本研究之長期目標是改善退化的肌肉功能及提升平衡控制能力，以降低老人跌倒的風險。本研究成果可提供老年人平衡控制能力評估的工具及改善的對策，並可應用在有平衡缺失且具高跌倒風險之病人族群上。本研究為三年期計畫，研究目標如下：目標一：量化平衡動作控制和肌肉品質之間的關係，及探究這兩者與社區老人跌倒史之關聯因子。肌肉品質定義為所量測的肌肉力量除以身體中骨骼肌的成分比例，是利用三維動作分析於功能性活動中所計算出之生物力學參數，以及透過生物電阻抗分析儀測量到之身體中骨骼肌重量來計算。另外，將使用臨床功能性的評估，檢測動作控制的能力與平衡表現，過去跌倒的歷史也將回溯並記錄。目標二：探究社區老人在受到動態平衡干擾時，其肌肉使用能力與平衡恢復表現之間的關係。利用雙帶平衡干擾跑步機於行走時提供側向及前後向的平衡干擾，以誘發出平衡恢復的反應，其肌肉使用能力將以任務需求之肌力除以該肌肉之最大肌力為指標。肌肉使用能力指標可量化個人的肌肉力量與其使用該肌肉的能力，透過與平衡恢復表現之相關性探討，可用以評估受平衡干擾後其恢復能力的表現。目標三: 檢測為期兩個月個別化動態式平衡訓練與肌力訓練計畫改善社區老人平衡表現之效果。動態式平衡訓練和肌力訓練的項目將根據生物力學分析結果個別訂定。訓練內容將利用平衡干擾雙帶跑步機和模組化互動式遊戲踏墊搭配使用。運動組將接受一週兩次，為期兩個月的運動訓練，而年紀相仿的控制組則是在這兩個月中維持原本的日常活動。所有動作分析之生物力學測試及評估，將會在訓練前和訓練後一週執行，電話訪談則在訓練後6、9、12 個月進行追蹤。此轉譯研究將提供老年人平衡控制之關鍵因素的資訊，並開發個別化之運動訓練介入以改善老年族群的平衡能力。本研究之獨特性為結合生物力學分析及臨床評估測試以解釋相關的臨床問題。本研究之成果將對老人平衡控制提供新的改善對策，日後亦可應用在有平衡缺失且為高跌倒風險之病人族群。<br> Abstract: Aging populations have become a worldwide concern. Falling is a prevalent problem among aging adults thatcan cause fracture, injury or mortality. Identifying the factors related to falls occurring within this agingpopulation is essential for developing effective regimes for fall prevention. Therefore, the long-termobjectives of this study is to prevent falls in older adults by improving the function of degenerativemuscles and balance control. Three specific aims for this 3-year research project are described as follows:Aim 1: Identify the relationship between balance performance and muscle quality, as well as anyassociation with fall history in community-living older adults.Muscle quality will be calculated using information on muscle strength and body composition (strength/leanmuscle mass). We will compute the joint torque during functional activities using biomechanical data fromthe 3-dimentional motion analysis, whereas the lean skeletal muscle mass will be determined usingbioelectrical impedance analysis. Uncontrolled manifold analysis will be used to identify multijointcoordination ability. Clinical and functional assessments of balance performance will also be conducted. Fallhistory prior to testing will be recorded retrospectively.Aim 2: Determine the usage of muscle force capacity during dynamic balance perturbation incommunity-living older adults.Lateral and forward/backward perturbation while walking will be used to elicit balance recovery responsesusing a split-belt balance perturbation treadmill. The degree of necessary joint force and how this relates to aperson’s functional capacity at specific joint levels will be determined using the torque demand-to-capacityratio. The ratio provides a joint-specific unified scalar quantity representing the balance recovery demandnormalized according to the maximal muscle strength capacity of person. The ratio indicates whether aperson can recover balance and the extent to which his or her maximal capacity is taxed.Aim 3: Examine the efficacy of a novel 2-month personalized dynamic balance training andstrengthening exercise on improving balance performance in community-living older adults.Dynamic balance training and strengthening exercise will be personalized on the basis of results ofbiomechanical assessments by using the split-belt balance perturbation instrumented treadmill and themodular interactive tiles system. The exercise group will receive training 2 times per week for 2 months andthe age-matched control group will maintain their typical daily life activities. All assessments will beperformed at the baseline and 1 week after training. Follow-up telephone interviews will be conducted at 6, 9,and 12 months following the training period.Significance and Clinical ApplicationThis translational research will contribute necessary information on the critical factors of balance control inolder adults. The unique contribution of the proposed research lies in integrating physical examination andbiomechanical approach to a relevant clinical problem into a translational model. The findings will provide anew paradigm of treatment approaches for balance control and will reduce the risk of falling and fracture.This research can potentially be applied to persons with poor balance who are at a high risk of falling.姿勢控制平衡動作控制老人復健生物力學postural controlbalancemotor controlgeriatric rehabilitationbiomechanics