膝屈曲步行腦性麻痺病患穿著踝足部矯具之痙攣與步態特徵

Abstract

背景與目的：腦性麻痺患者有很多不同的病理步態，常常使用各種不同的功能性「踝足部矯具」(Ankle-Foot Orthosis, AFO) 做為步態訓練及功能維持的工具，目前已有許多研究指出這類矯具對於改善步態功能方面有很大的幫助。一般來說，膝屈曲腦性麻痺患者會得到醫師處方以客製化固定式踝關節踝足部矯具(solid AFO, SAFO)或活動式踝關節踝足部矯具(articulated AFO, HAFO)。而腦性麻痺患者通常會伴隨著肌肉痙攣性，但是過去並沒有去探討這兩種踝足部矯具對肌肉痙攣性的影響，因此，本研究將針對膝屈曲腦性麻痺患者穿戴這兩種踝足部矯具對步態以及痙攣性特徵的情形。 方法：本研究招募九位膝屈曲腦性麻痺患者，在下列三種情況下來回行走進行步態分析：(1) 只穿著運動鞋，(2) 雙腳穿著SAFO加運動鞋，(3) 雙腳穿著HAFO加運動鞋。步態分析各項資料及參數藉由OPTOTRAK動作分析系統以及AMTI力板取得，肌肉活動藉由Biomonitor ME6000系統取得，並利用WristOxTM 3100量取走路時的心跳數。 結果：本研究結果顯示，(1) SAFO符合研究假說所提出的改善步態表現之行走速度、步長、比HAFO減少更多的踝、膝、髖關節之角度、減少膝伸肌力矩及減少能量損耗；(2) HAFO 提供更適合的踝足部滾動形狀的弧半徑及提供在質量中心內外側偏移量上更穩定的狀況；(3) 兩種踝足部矯具或許無法提供更好的痙攣性控制。 結論：對於膝屈曲腦性麻痺患者來說，結果是顯示SAFO比起HAFO可以在步態上提供更好的功能，而這些資訊也可以提供給臨床醫師、物理治療師、矯具師做參考，以及提供家長資訊以選擇最合適的矯具。

Objective: The aim of this study is to explore the effects of solid and articulated AFO on spasticity and gait dynamics for spastic diplegic cerebral palsy with knee flexion crouch gait. Design: Experimental gait analysis, one-way repeated ANOVA analysis and non-parametric repeated measure analysis. Participants: Nine spastic diplegic cerebral palsy patients with knee flexion crouch gait (seven boys and two girls) anticipated in this study. And their Gross Motor Function Classification System is level 2. Setting: Rehabilitation Engineering Research Center in National Taiwan University with instrumented gait laboratory. Interventions: Three conditions: shoes only, shoes with the solid AFOs, and shoes with articulated AFOs. Results: 1.The SAFOs was found to be consistent of hypotheses, which improved the stride length, walking velocity, decreased batter than HAFOs in knee and hip angle, knee extensor moment, and reduce energy consumption. 2.The HAFOs provided more appropriate arc radius of ankle-foot roll-over shape and more stable in medio-lateral excursion of COM. 3.It seems that both of AFOs would not offer better control in spasticity. Conclusion: For spastic diplegic CP patients with knee flexion crouch gait, overall results showed that SAFOs would provide better functions than HAFOs. Furthermore, these results could provide useful information for orthotists, clinicians, physical therapists, and parents so that could choose the best opinion for their children.