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The Upper Extremity Load of Children with Spastic Diplegic Cerebral Palsy Using Posterior Walkers at Different Heights

使用不同手把高度之後拉式助行器對痙攣型雙邊腦性麻痺孩童上肢施力之影響

摘要


目的:助行器是腦性麻痺孩童最常使用的步行輔具。目前對於助行器處方的客觀量化準則,相關文獻仍較少。針對腦性麻痺孩童為受測者的相關研究亦仍缺乏。此外,對於使用助行器時上肢垂直施力的研究結論並不一致,同時也缺少對上肢水平施力的探討。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,其上肢垂直和水平施力之情形。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,並使用上肢施力感測系統,擷取其上肢於使用助行器時垂直下壓及水平前推之作用力。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,會有不同的上肢施力情形,但是並未和高度變化呈現線性相關。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,但其中可能缺乏了對上肢長度及張力程度的考量,也忽略了不同個體間的異質性。本實驗提供臨床人員在執行治療計劃時之參考,在給予腦性麻痺孩童助行器處方時,可以更多面向地考量以達到個人化的需求和不同的治療目的。

並列摘要


Objectives:Walkers are the most prevalent assistive device used to help children with cerebral palsy. However, objective and quantitative criteria for the walker prescription are still lacking, and only a few studies in the literature have been directed at children with cerebral palsy. In addition, there is disagreement in terms of results with respect to the sagittal load of the upper extremities during walker-assisted ambulation. Furthermore, the transverse load of the upper extremities has never been discussed. Therefore, the purpose of this study was to determine the effects of posterior walker settings at different heights on the horizontal push (transverse) and vertical downward (sagittal) force applied to the walker by children with spastic diplegic cerebral palsy. Methods: The dataset was collected with the help of four children with spastic diplegic cerebral palsy who used an instrumented walker under five different conditions. These were standard walker height (at the level of the subject’s greater trochanter), 1 inch and 2 inches above the standard high and 1 inch and 2 inches below the standard height. The horizontal push (transverse) and vertical downward (sagittal) force produced by the upper extremities were measured for both left and right sides by means of force transducers. Results: In children with spastic diplegic cerebral palsy, using the walker at different heights resulted in different upper extremity loads, although no linear correlation was found between any pairs of them. Conclusion: Since no consideration of trunk and the upper extremity muscle tone has been made in this study, which relates to the heterogeneity of the individuals studied here, the common standard for walker height setting, namely the level of the user’s greater trochanter, may not be appropriate for all users. Our study provides clinical workers with some background information and suggestions that may help when planning therapeutic intervention. When prescribing a walker for children with cerebral palsy, multidimensional considerations should be taken into account in order to meet the demands of each individual, to fit with the different purposes the child may require and to aid in the choice between the various available therapeutic options.

並列關鍵字

cerebral palsy walker upper extremity load

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