Effect of Physiotherapy and Custom-Modified Stabilizing Foot Splint on Standing Balance and Mobility in Children With Hypotonia and Developmental Delay

物理治療與客製化足部穩定支架對低張力發展遲緩幼童之站立平衡與移行功能的成效

徐維憶(Wei-Yi Tsu) ； 蔡方婷(Fang-Ting Tsai) ； 莊頌音(Sung-Yin Chung) ； 羅鴻基(Hong-Ji Luo)

《物理治療》 43卷2期 (2018/06) Pp. 85-94

https://doi.org/10.6215/FJPT.201806_43(2).0004

摘要

Background and Purpose: Foot orthosis is often introduced in conjunction with physiotherapy to correct faulty foot postures and enhance motor function for children with hypotonia; however, the effects of stabilizing foot splints (SFSs) remain largely unexplored. This study aimed to examine the effects of physiotherapy and custom-modified SFSs on standing balance and mobility in children with hypotonia and developmental delay who could stand alone but could not walk independently yet over a three-week intervention period. Methods: Eleven participants (19.4 ± 2.9 months) were prospectively enrolled. All participants were provided 40-minute physiotherapy once a week that aimed at improving their strength, balance, sensorimotor organization, and functional mobility and parents were advised to have their child wear custom-modified SFSs during standing activities at home for at least 2 hours a day. Outcome variables examined included the amount of time that the participants could independently stand, the path length and the area of center of pressure (COP) excursions while standing steadily, the sum of scores on selected standing mobility items of the locomotion subtest of Peabody Developmental Motor Scale-II, and the number of steps that the participants could walk independently without falling. All outcomes measured while barefoot before and after a three-week intervention period were examined and compared. Results: Results of Wilcoxon Signed Rank Test revealed significant improvements in standing balance and mobility after three-week intervention, including a longer duration of standing time, a smaller postural sway area while standing, higher scores on standing mobility, and greater number of steps of independent walking. Conclusions: The present results showed that children with hypotonia and developmental delay who could stand alone but could not walk independently might benefit from the three-week intervention involving use of custom-modified SFSs and physiotherapy and exhibited improved standing balance and mobility even without the subsequent aid of custom-modified SFSs. However, findings of this study were preliminary and we could not exclude the result of developmental maturation; further study with more rigorous study design is warranted. Results obtained may assist physical therapists and parents in making orthotic decision when managing children with hypotonia and developmental delay who could stand alone but could not walk independently.

關鍵字

Hypotonia ； Physiotherapy ； Custom-modified stabilizing foot splints ； Standing balance ； Mobility

並列摘要

背景與目的：探討為期3週之物理治療合併客製化足部穩定支架介入對具備站立能力但尚未具備獨立行走能力之低張力發展遲緩幼童之站立平衡與移行功能的成效。方法：共計11位受試者（19.4 ± 2.9 月）接受每週一次40分鐘的物理治療以改善其肌力、平衡、感覺動作整合與功能性移動能力，並且受試個案的父母親被要求必須讓受試個案在居家站立活動時穿客製化足部穩定支架至少1天達2小時。成效評量包括獨立穩定站立時間、穩定站立時身體壓力中心的移動軌跡長度及面積、皮巴迪動作評量第二版之部分移行能力題項的總分、能獨立連續行走不跌倒的步數。結果：威爾考克森等級符號檢定的結果顯示受試者之站立平衡與移行功能有顯著進步。結論：為期3週之物理治療合併客製化足部穩定支架介入對具備站立能力但尚未具備獨立行走能力之低張力發展遲緩幼童可能有助益。研究結果可以提供作為對具備站立能力但尚未具備獨立行走能力之低張力發展遲緩幼童選用足部支架的參考。

並列關鍵字

低張力 ； 物理治療 ； 客製化足部穩定支架 ； 站立平衡 ； 移行功能