| Summary: | 博士 === 國立成功大學 === 醫學工程研究所碩博士班 === 97 === Most stroke survivors suffered from residual neurological deficits, and remains awkward motions such as hemiplegia and hypertonia after recovery from disease. Manual wheelchair is the most popular tools stroke survivors choose as their mobility device. A manual wheelchair was designed for patients with both healthy upper limbs; however, its asymmetrical propel pattern would force the wheelchair deviate toward the affected side and causing strait for stroke patients. Existent motor function impairments not only reduce exercise ability, consume much more energy, but also constipate the independent of daily life.
10 stroke patients with hemiplegia were recruited to participate in observation survey. The tester observed the patients operating manual wheelchairs and analyzed their propulsion characteristics to obtain their requirements of mobility devices. From the hemiplegic patients’ requirements, we developed a functional electrical stimulation-assisted leg-cycling wheelchair (FES-LW). Subjects can propel the FES-LW by unaffected leg and affected leg with the assistance of FES. Subjects can also propel the LW without FES.
Three field tests (i.e. propels wheelchair along an oval pathway for 200 m) were conducted to evaluate the controllability, energy cost and effects of leg muscle tone of the FES-LW, LW comparing to the manual wheelchair (MW). In the controllability test, 20 stroke patients were recruited to evaluate the finish time, deviation frequencies, and deviation percentage of each wheelchair. The results showed subjects can propel the FES-LW and LW with 40% less finish time; 23% lower deviation frequencies and 36% lower deviation percentage than the MW.
In the energy cost evaluation, 16 stroke patients were recruited to evaluate the cardiopulmonary responses including, heart rate (HR), oxygen consumption (VO2), carbon dioxide production (VCO2), minute ventilation (VE,), respiratory exchange ratio (RER); and energy cost including physiological cost index (PCI) and oxygen index (OI), of each wheelchair. The results showed the HR, VO2, VCO2, VE and RER were significantly higher in the FES-LW and LW than the MW. The PCI and OI recorded from applying FES-LW and LW were significantly lower than those from MW. Yet; no dramatic difference was found in cardiopulmonary responses and energy cost between FES-LW and LW.
In the leg muscle tone evaluation, 17 stroke patients were recruited to evaluate the modified Ashworth Scale (MAS), H/M ratio and relaxation index (RI) of each wheelchair between pre- and post test. Changes of MAS (MASc), changes of H/M (H/Mc) and changes of RI (RIc) were then compared between FES-LW and LW. The results showed MAS and H/M ratio decreased a lot and RI increased huge immediately after the FES-LW and LW usage. For subjects with higher muscle tone, significant lower of MASc, H/Mc and higher of RIc were found by using FES-LW compared to the LW.
For stroke patients, FES-LW and LW showed better controllability than MW. In addition, higher cardiopulmonary responses and lower energy cost was found in the LWs with or without FES compared to the MW. The situation of leg spasticity is reduced after propulsion of the FES-LW and the LW. The application of FES doesn’t help improve controllability and reducing energy cost but reduce subjects’ spasticity with higher muscle tone.
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