| Summary: | 博士 === 國立成功大學 === 醫學工程研究所碩博士班 === 96 === Ascending and descending stairs is a common and important activity of daily living. Since stair locomotion challenges muscle strength, range of motion, balance and muscular coordination, it is not surprising that elderly people and individuals with physical disabilities both report formally and informally that they experience difficulty with stair negotiation. Several kinematic and kinetic measures of stair locomotion have been undertaken in the normal and knee pathological conditions in young population. Due to age-related changes in the sensory, vestibular, and musculoskeletal systems, this baseline biomechanical information is not generalized to elderly population, and a thorough quantitative examination of the performance of the older people is needed. Based on these clinical and theoretical needs, this study was proposed to use motion analysis system and force platforms to investigate baseline kinematic and kinetic data during stair ascent (SA) and stair descent (SD). The specific aims of the study were followings: (1) To investigate and compare three-dimensional joint motions of the trunk and lower extremities; (2) To investigate and compare joint force and moment of the ankle, knee and hip joints in the young and elderly adults during stair climbing; (3) To determine sole effect of gender and interacting effect of gender and age on all measured kinematic and kinetic parameters; (4) To investigate and compare center of mass (COM) displacement, center of pressure (COP) excursion and their spatial relationship in the young and elderly adults during SA and SD. In addition, the heel height of shoes were used to challenge the balance of female participants since footwear has been considered one of major factors disturbing balance and contributing to falls either level or stairs walking. Same kinemtaic and kinetic parameters will be measured and compared under the condition wearing low-heels shoes (LHS) and high-heeled shoes (HHS) to determine the effect of shoe heel height on balance strategies in the young and elderly women during SA and SD.
Twenty eight young healthy adults (16 women, 12 men, age 22~38 years) and 21 elder healthy adults (11 women, 10 men, age 65 ~ 80 years) were included in this study. Kinematic and kinetic data were collected when the subjects ascended stairs reciprocally with their preferred speed. The results reveal that the elder group demonstrated longer stride cycle duration, stance phase and double support stance (DS) in SA, and longer cycle duration but shorter DS in SD. More kinematic and kinetic differences between young and elder group were found at the knee and hip joints. In SA, besides significant larger peak hip flexion, the internal extensor moment of the hip joint was greater than young individuals while the knee extensor and ankle plantarflexion moments were lower. In SD, The elder groups had significantly larger peak hip and knee flexion, and larger hip extension moment than the younger groups, less knee extension and abduction moments than the younger groups. The COM displacement in lateral-medial (LM) direction and COM-COP divergence was larger in the elderly either in SA or SD.
For heel height effect test, significant differences in peak angle of the ankle, knee and hip joints were found in sagittal and transverse planes between shoe conditions in young and elder female groups in SA. The differences in motion profiles between groups were more apparent than between shoe conditions, but the findings in kinetic data were opposite. Heel height seemed have a greater effect on the kinetic data in young group, particularly in the frontal plane. And, it might account for the differences at the hip joint moment between two groups while wearing HHS. In SD, more adjustments in the temporal gait parameters and range of the motions were observed in the elderly; the younger adults demonstrated more changes in forces and moments at the knee and hip.
The findings of this study provide basic biomechanical information of the elderly in stair locomotion, and may help clinicians develop treatment protocol for aged individuals.
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