2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645112摘要：腦性麻痺是常見的疾病，伴隨患者失常的關節力學與神經控制，造成全身在站立、走路、跨越障礙物以及由坐到站等日常功能性活動中之力學與控制的改變，使這些日常生活常見的動作，成為腦性麻痺兒童無可避免之挑戰，往往需要手術之介入解決執行動作的困難。然而，即便手術被認定為有效的治療方式，並且能夠解決腦性麻痺兒童之異常動作及機能。過去文獻多只比較步行來看術前及術後表現的差異，且受試者多沒有經由手術類別作分組，但不同的手術方式及不同的功能性動作對力學與神經控制方面的影響本質上就很不一樣，所以透過動作分析技術，對於腦性麻痺兒童與同年齡兒童規劃完善的動作分析評估，必須要在步行之外，將由坐姿到站立及跨越障礙物等多種日常生活功能性動作納入手術決策過程中的考量動作。再者，關節與全身的控制與協調有賴於成熟的中樞動作控制路徑，儘管腦性麻痺兒童之中樞神經損傷會引起控制機制嚴重異常，卻少有任何關於腦性麻痺如何影響關節與全身的控制與協調之研究。綜合以上所述，本三年期計畫的目的是針對84名接受手術之腦性麻痺兒童，於術前、術後三、六、九及一年做功能性活動中關節生物力學、關節間協調性及全身控制之研究，以利手術決策及探討其立即與長期影響。具體而言三年分配內容分述如下：第一年：將針對20名正常發展兒童以及即將接受手術之腦性麻痺兒童(第一年預計42名)進行站立、平地走路、坐到站及跨越障礙物的動作分析。本研究不僅利用下肢生物力學模型產生運動學與力動學資訊以進行生物力學分析，配合相關臨床檢測，分析資料將會同骨科、復健科與生物力學專家及治療師共同討論，進而介入手術矯正之決策，紀錄手術因而改變的數量及改變內容，將針對常見手術將病患分組進行研究。透過各組分別比較術前及術後三個月內功能性動作之關節生物力學，並評估關節的控制與協調。此階段目的在於介入術前手術矯正之決策，並驗證分析資訊對手術矯正決策的影響及其於術後表現之立即效應。在此時期本研究並發展評估動態穩定性的技術，以供後續評估動態穩定性之探討。第二年：將持續地增加收案個數(第二年預計再收42名)，對接受手術之腦性麻痺兒童進行動作分析、相關臨床檢測、進而介入手術矯正之決策、驗證步態分析資訊對手術矯正決策的影響及其於術後表現之效應。此階段並持續針對前兩年所有病患進行術後三、六、九及一年做動作分析追蹤，同時將第一年所發展之評估動態穩定性的技術加以運用，希望可藉動作及統計分析之結果了解手術對於不同功能性活動中肢體的關節生物力學、關節間協調性及全身控制之影響。第三年：前半階段針對前兩年接受手術之腦性麻痺兒童(收滿84名)，完成所有術後之追蹤（術後三、六，九及一年後），以了解手術介入的長期效果，並期未來可提出手術執行與否的普遍性準則，並藉由統計分析建立手術之長期影響及患者功能性回復的趨勢。並藉由關節生物力學、全身的控制與協調動態穩定性的分析，能夠對腦性麻痺兒童於手術前後運動系統之生物力學與控制能有全面的認識，有助於引導出對這些病人更有效的治療方式。<br> Abstract: Cerebral Palsy (CP) is a disorder with impaired motor control affecting movement and posture with bony deformities and changes in the joint and muscle properties. Apart from the changed joint mechanics, neurological disorders are accompanied with CP, both leading to altered mechanics and control of the whole body during functional activities of daily living, such as quiet standing, level walking, sit-to-stand (STS), and obstacle-crossing. As a result, these daily activities become challenging for children with CP and therefore surgical intervention is required. Information provided by gait analysis significantly alters surgical decision making and reduces the amount of surgery that CP children undergo. Several reasons cause inconsistent outcomes of surgical management shown on previous report. Therefore, a complete three-dimensional gait analysis on patient groups that were selected based on surgical intervention methods would be necessary for getting a complete set of gait variables for surgical decision making. Beside gait, the inclusion of STS and obstacle-crossing for surgical planning and decision making in the treatment of children with CP may help improve surgical outcome. The altered motion patterns due to CP can be variable depending on the lesion as the mechanics and neurological control and its surgical interventions are fundamentally different. Owing to the limitation of sensitivity of clinical assessment tools, it remains unclear as to how the surgical intervention affects the control and coordination of the joints and the whole body, and the long term effects of surgery on the performance of functional activities of daily living. Therefore, this project will be carried out in three parts (years) with the following goals:In the first part (year) of the project, motion analysis experiments including quiet standing, level walking, STS, and obstacle crossing will be performed on patients with CP. The results of which will be compared to the normal controls to identify the indicators for the selection and recommendation of musculoskeletal surgical interventions to achieve better movement performance in children with CP. It is hoped to understand changes in joint mechanics in patients with CP pre- and post-operation. The dynamic analysis technique will be developed in this period. In the second part (year) of the project, similar to the first year, dynamic analysis will be included. Motion analysis experiments will be performed on patients with CP before and 3, 6, 9 and 12 months after surgery, the results of which compared to the normal controls. The performance between pre- and post-operation will also be compared to understand the effect of the treatment. In the last part (year), follow up assessments of patients with CP will be completed. The long term effects of surgery and the trend of functional recovery on patients with CP will be established. It is hoped that the present project will help to establish a preoperative decision making process using a complete three-dimensional gait analysis with the inclusion of various daily activities. Moreover, the influence of surgery on the performance will be clarified. Results of this project will help us understand not only the patterns and stability of the inter-joint coordination but also the dynamic stability. This knowledge will be helpful for the design of fall-prevention devices and for the planning of rehabilitative interventions.腦性麻痺手術決策動作分析步行坐到站跨越障礙物手術效應動態平衡關節協調能力CPsurgical decision makingmotion analysisgaitsit to standobstacle crossingsurgical outcomesstabilitycoordination