新式踝足矯具對中風患者踝關節及姿勢控制的影響

Effects of A New Designed Ankle Foot Orthosis on Ankle Joint and Postural Control in Patients with Stroke

陳美羽(Mei-Yu Chen)

指導教授 ： 葉純妤

中山醫學大學/醫學科技學院/物理治療學系碩士班/碩士(2017年)

摘要

研究背景：中風屬上運動神經元損傷，接受復健治療後，患者還是有可能會有殘留的症狀，因此臨床上常使用踝足矯具輔助病患。過去研究指出傳統踝足矯具可以提供踝關節穩定度，進一步改善平衡及行走能力。但傳統踝足矯具因提供穩定度，降低踝關節附近肌肉的使用、且因包覆性太高而使病患感到不舒適。研究目的：本研究設計一新式踝足矯具，探討新式踝足矯具對中風患者平衡及步行能力之影響。研究方法：本實驗納入15位受測者，使用Noraxon肌電儀於行走測試時收集踝關節內翻角度以及脛前肌與外側腓腸肌之肌電訊號，另外以Zebris 測力板做靜止站立測試以及穩定限度測試。以魏克生符號檢定分析比較受測者在穿戴新式踝足矯具前後，步行時患側腳踝關節內翻角度變化、脛前肌與外側腓腸肌肌電圖電位強度、靜止站立時患側腳承重量、壓力中心移動距離以及穩定限度之差異。結果與討論：穿戴新式踝足矯具後，步行時踝關節內翻角度顯著下降；步行時站立期之外側腓腸肌肌電圖電位強度顯著降低；往患側邊之穩定限度顯著增加。結論：穿戴新式踝足矯具後，在步行時踝關節內翻角度、站立期之外側腓腸肌肌電圖電位強度、與往患側邊之穩定限度達到統計上之顯著差異。對於新式踝足矯具來說，雖然塑料包覆範圍較小，亦能提供踝關節穩定度，減少步行時踝關節內翻角度，改善往患側腳方向之穩定限度能力。

關鍵字

中風 ； 踝足矯具 ； 平衡 ； 步態

並列摘要

Background: Stroke belongs to upper motor neuron injury. After rehabilitation, patients may still have residual disability. In clinical, therapists often use ankle-foot orthosis (AFO) to assist patients. Previous studies have suggested that traditional AFO can provide ankle stability and further improve balance and walking ability. However, the traditional AFO provides stability leading to reduce the use of muscle surrounding ankle joint. Besides, patients are uncomfortable because of its high coverage. The aim of the present study was to evaluate the effects of new designed AFO on ankle and postural control in patients with stroke. Methods: Fifteen patients with stroke were administered the walking test, static standing test and limit of stability test. Statistical Analysis: Wilcoxon signed-rank test was used to test for statistical significance (p<0.05). Results: When compared with using no AFO, the new designed AFO significantly decreased the maximal ankle inversion angle at heel strike (p=.001), subjects exhibited significantly less lateral gastrocnemius muscle electromyography during the stance phase of gait (p=.044), and the limit of stability on the affected side was improved significantly (p=.031). Conclusion: Based on our outcomes, new designed AFO can also support ankle providing stability.

並列關鍵字

stroke ； balance ； postural control ； gait ； ankle foot orthosis

參考文獻

19. Wu SH. (1992) An Anterior Direct Molding Ankle-Foot Orthosis. J Occup Ther Assoc ROC. 10:75-82.

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