The Effects of Posterior Walkers of Different Heights on Gait Performance among Children with Spastic Diplegic Cerebral Palsy

後拉式助行器之手把高度對痙攣型雙邊腦性麻痺孩童步態表現之影響

楊蕙黛(Hui-Tai Yang) ； 池育儒(Yu-Ju Chih) ； 林泓志(Hung-Chih Lin) ； 宋偉豪(Wei-Hao Sung) ； 高木榮(Mu-Jung Kao) ； 游忠煌(Chung-Huang Yu)

《北市醫學雜誌》 8卷2期 (2011/06) Pp. 97-115

https://doi.org/10.6200/TCMJ.2011.8.2.02

摘要

目的：助行器是腦性麻痺孩童最常使用的步行輔具。臨床上我們希望藉由不同的助行器型式和助行器上可調整的參數，來達到個人化的功能性目標及復健性目標。但目前對於助行器的處方，仍缺乏客觀量化的考量準則。以腦性麻痺孩童為受測者的相關研究中，針對助行器可調整參數的研究亦仍缺乏，其中對於助行器手把高度的訂定標準亦較少相關文獻。因此，本實驗目的為探討痙攣型雙邊腦性麻痺孩童，在使用不同手把高度的助行器時其步態表現之情形。方法：本實驗共計4位痙攣型雙邊腦性麻痺孩童參與，平均年齡6.75歲。實驗中調整五種助行器手把高度，包括常用之標準高度（與孩童大轉子高度同高）、比標準高度高及低一吋、比標準高度高及低兩吋。使用動作分析系統分析步態參數表現，包括步行速度、跨步長、步頻、以及髖關節和膝關節之角度變化。結果：對於痙攣型雙邊腦性麻痺孩童，使用不同手把高度的助行器時，會有不同的步態參數表現和不同的髖關節及膝關節角度變化，但是並未和高度變化呈現線性相關。然而四位個案均分別在一特定高度下，有其整體最佳的步態參數表現。結論：臨床上經常以使用者大轉子高度訂為其助行器之標準高度，但其中可能忽略了不同個體間的異質性，因此此高度的訂定並不一定適於所有的個案。臨床意義：對於腦性麻痺孩童，在給予助行器處方時，必須多面向地考量其助行器參數之調整，以達到個人化的需求和不同的治療目的，本實驗提供臨床人員在執行治療計劃時之參考和建議。

關鍵字

腦性麻痺孩童 ； 助行器 ； 步態

並列摘要

Objectives: A walker is the most prevalent assistive device for children with cerebral palsy. Clinically, individualized functionality and rehabilitation goals can be achieved using different types of walker and by adjusting the parameters of the walker. However, the objective and quantitative criteria to be used when prescribing a walker are still lacking. Only few studies in the literature that have been directed at children with cerebral palsy refer to the walker's adjustable parameters. In addition, studies that explore standard measurements in relation to walker height are even less common. Therefore, the purpose of this study was to determine the effects of a posterior walker that is set at different heights on gait performance among children with spastic diplegic cerebral palsy. Methods: Data were collected from four children with spastic diplegic cerebral palsy who used an instrumented walker that had been set at five different conditions. These were standard walker height (at the level of the subject's greater trochanter) together with 1 inch above, 2 inches above, 1 inch below and 2 inches below the standard height. Gait performance was analyzed via a motion analysis system that collected gait velocity, step length, cadence, hip angles and knee angles. Results: In children with spastic diplegic cerebral palsy, using the walker at different heights resulted in different values for the gait variables as well as changes to the different hip and knee angles. However, no linear correlation was found between any of the pairs of variables. Nevertheless, each of the four subjects had his/her best functional gait performance during assisted ambulation at one specific walker height. Conclusion: Since the results show significant heterogeneity across the individuals, the commonly used standard for setting the walker height, which is the level of the user's greater trochanter, will not fit all users. Clinical Significance: To meet individual needs and various different therapeutic purposes, there needs to be multi-dimensional considerations taken into account when adjusting walker parameters after a walker has been prescribed for a child with cerebral palsy. Our study provides clinical workers with some considerations and suggestions when planning such a therapeutic intervention.

並列關鍵字

cerebral palsy ； walker ； gait performance