國立陽明大學 醫學工程研究所 復健工程實驗室 網址 rehab.ym.tw/

1. 不同足弓墊設計對於老年人姿勢穩定性控制之效益Efficacy of different design insoles in the dynamic postural control for the elderly 劉姸廷1.2(Yen Ting Liu)楊世偉1(Sai Wei Yang) Institute of Biomechanical Engineering, National Yang-Ming University1 Department of Physical Medicine & Rehabilitation, Taipei Medical University- Municipal Wan fang Hospital2 一、Introduction Aging is a serious health problem on the global village. Age-related changes in the older adults can affect their balance and increase an older adult’s risk for falls . These changes specifically affect the sensory system and motor system, which are responsible for good balance. After a fall, an older adult can experience psychologic, physical, social, economic, and sometimes fatal effects. The injuries can reduce an older adult’s mobility as well as independence and influence quality of life. As a result, decreasing the risk for falls in older adults is an important topic of medical care. In addition to age-related changes, diseases, and medications, improper foot care and insufficient foot support can increase the risk for falls among older adults. Many older adults also have a result of fall-related injuries resulting from insufficient arch support system. A longitudinal arch support mechanism of a insole resists depression of the foot’s arch, and it can provide an adequate insole arch control mechanism. Thus, the elderly with appropriate insole may increase postural stability and decrease the risk of fall. 二、Materials and Methods Fifteen faller elderly and eighteen non-faller elderly were recruited in this study. The elderly were subjected to an exhaustive examination including the collection of demographic data, proprioceptive test, static standing balance test, and Berg Balance Scales, and dynamic standing balance assessment using the perturbation system. The dynamic balance assessment included barefoot and four insoles with eye open and closed . Each trial had 20 seconds, and each condition had three trials. During each test, the participants’ foot pressure and the center of pressure (CoP) were recorded and analyzed. Statistical analysis was performance using SPSS v. 17.0 software. Figure 1 Different design insoles 三、Results and Discussion The faller elderly showed greater postural instability scores in static balance tests and 3-related Berg balance scores than the non-faller elderly. Otherwise, we also found 3-related Berg Scores and single left leg stance had a high correlations with dynamic balance scores. The faller elderly had greater maximal CoP excursion in medial-lateral direction than the non-faller elderly(Barefoot: 53.3% ; Other insoles 47.9~50.6%). The faller and non-faller elderly with Footdisc® Proactive insoles had the best postural stability in medial-lateral direction. With Footdisc® Proactive insoles, the faller elderly decreased 35.1% maximal CoP excursion in M/L direction, and the non-faller also decreased 28.6% maximal CoP excursion in M/L direction, compared with barefoot. The faller with Dr. Kong insoles had the smallest sway area of CoP excursion in four insoles and barefoot, however, the non-faller elderly with Footdisc® Proactive insoles had the smallest sway area of CoP excursion. With Dr. Kong insoles, the faller elderly decreased 28.6 % sway area of CoP excursion. Otherwise, the non-faller with Proactive insoles decreased 69.5 % sway area of CoP excursion , compared with barefoot. Institute of biomedical Engineering, National Yang-Ming University Figure 2 Correlation of static and dynamic balance tests Figure 3. Maximal CoP excursion in M/L direction (eye open)_between faller and non-faller elderly 四、Conclusion The assessment of postural control systems in recurrent fallers were essential to design the prevention measures needed to minimize physical consequences of falls in the elderly. The CoP measures during dynamic perturbation were able to explain the variance of postural stability between the faller and non-faller elderly. Greater CoP trajectories, ellipse area were found in the non-faller elderly. Of the four insoles and barefoot tested, the Footdisc® Proactive insoles had stable longitudinal arch support and heel criddle mechanisms that significantly reduced postural sway. Therefore, for the reasons discussed above, these results indicated the insoles, such as Footdisc® Proactive insoles, had the control capabilities of dynamic postural stability. Figure 4 Maximal CoP excursion in M/L direction (eye open)_with barefoot and four insoles 國立陽明大學 醫學工程研究所 復健工程實驗室 網址 http://rehab.ym.edu.tw/ 2011 BME Rehab Lab