【論文摘要】Effect of Approximation on Tension Inhibition of Affected Lower Extremity in Patient With Left Middle Artery Infarction: A Case Report

【論文摘要】擠壓患側下肢對左側中大腦動脈梗塞患者張力的抑制效果：個案報告

楊喬安(Chiaoan Yang) ； 洪嘉洵(Chia-Hsun Hung)

《物理治療》 44卷4期 (2019/12) Pp. 311-312

https://doi.org/10.6215/FJPT.201912.P31

摘要

Background and Purpose: Approximation is a basic principle for facilitation in proprioceptive neuromuscular facilitation (PNF). It can be used to facilitate motion and stability. The patient with hemiplegia usually has flaccid extremities and cannot ambulate due to the inability to maintain knee extension in stance phase. Therefore, a gaiter is commonly used to maintain the affected knee in extension for bearing weight in stance phase. The purpose of this case report was to investigate the effect of approximation with a gaiter in a patient with left middle artery infarction and right hemiplegia. Methods: This case was an 82-year-old female with right hemiplegia and aphasia. She was afraid of weight-bearing over the affected side and did not dare to stand without hand support after 15 weeks of stroke onset. A gaiter was used to maintain knee joint in extension. First, the therapist brought the affected leg forward. Then, the therapist gave approximation to the affected leg when the patient moving the sound leg forward. At the same time, the therapist needed to keep the affected leg in a toe-out position to avoid ankle joint inversion during stance phase. Ambulation training was 15 min per day. The ambulation function, walking distance during training, and muscle tone of the right ankle joint were recorded. Results: Before ambulation training, her Brunnstrom's stage over the right side was II in the upper extremity and III in the lower extremity. Balance was good in static sitting, fair in dynamic sitting, and poor in static standing. The right ankle plantar flexor was hypertonic, and the Modified Ashworth Scale was 1+. This case completed 14 training sessions. At the 12th training session, the ankle joint excessive inversion during stance phase was improved, and the therapist did not need to keep the toe-out position. At the last training session, she could walk 30 m with quadricane, but she still needed a gaiter, and the therapist had to assist the affected leg weight-bearing and moving forward. Also, she needed assistance on the sound hand to give the timing to advance. The Modified Ashworth Scale of right ankle plantar flexor was lowered to 1. Conclusion: Approximation for facilitation is possible to regulate muscle tone of the ankle plantar flexor which could be applied to ambulation training. Clinical Relevance: It is efficient to integrate the basic principle of PNF in a task-oriented training.