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慢性中風患者使用前葉式足踝支架之平衡效用

Effects of an Anterior Ankle-Foot Orthosis on Static Standing Balance Control in Patients with Chronic Stroke Wearing the Orthosis for a Long Time

摘要


目的:探討中風病人長期穿戴前足踝支架後,其前足踝支架在靜態站立平衡的效用。方法:我們邀請穿戴前足踝支架至少5個月的慢性腦中風患者參加此研究。病人會站Tetrax平衡系統在8個不同姿勢下進行評估:1.頭正睜眼站在力板上面(NO)、2.頭正閉眼站在力板上(NC)、3.頭正睜眼站在泡棉上(PO)、4.頭正閉眼站在泡棉上(PC)、5.頭轉向右邊30度閉眼站在力板上(HR)、6.頭轉向左邊30度閉眼站在力板上(HL)、7.頭向上閉眼站在力板上(HB)及8.頭向下且閉眼站在力板上(HF)。病人會完成穿及不穿前足踝支架的評估,而此評估順序是隨機產生。經Tetrax平衡系統軟體運算得到4個姿勢控制的參數:穩定性、重量分佈、同步性和搖晃強度的傅利葉分析。結果:51位中風病人參與本研究,平均年齡為54歲,34位(67%)為男性,平均中風時間為48個月。與裸足站立相比,前足踝支架可顯著地1.促進整體穩定性(p= 0.01)、2.促進雙足後跟的協同性(p< 0.01)、3.促進同側前後足的協調性(p< 0.01)、4.促使前足承重增加(p< 0.01)、5.降低0.75~1Hz的搖晃程度(p<0.01)。但在無感覺剝奪的情況(NO)或缺乏視覺及本體覺回饋的情況(PC),前足踝支架則不具以上效益。前足踝支架對增加患側腳的承重沒有助益,此外前足踝支架會讓患側的前足承重大於足後跟。結論:長期穿戴前足踝支架的中風患者,處在些許感覺挑戰情況下穿戴支架相較於裸足可以改善身體搖晃的程度、增加體感回饋並促進雙足相關肌肉的協調性收縮。但前足踝支架無法增加患側下肢的承重,也使患側前足承受比後腳跟更多的重量。

並列摘要


Aims: To investigate the effects of anterior ankle-foot orthosis (A-AFO) on static standing postural control in patients with chronic stroke wearing the A-AFO for a long time. Methods: We recruited patients with chronic stroke wearing an A-AFO for at least 5 months. Static standing balance control was evaluated using the Tetrax Balance System in eight positions: (1) eyes open on a solid surface [NO];(2) eyes closed on a solid surface [NC];(3) eyes open on a foam surface [PO];(4) eyes closed on a foam surface [PC];and head turned at 30° to (5) right [HR], (6) left [HL], (7) up [HB], and (8) down [HF] with eyes closed on a solid surface. Each position lasted for 32 seconds. Patients underwent the evaluation with and without A-AFO conditions at random. The system software elaborates four posture control parameters, namely, stability, weight distribution, synchronization, and Fourier analysis of the intensity of sway, as reference. Results: Fifty-one patients (men: 34 (67%) subjects), with a median age of 54 years, participated in the study. The median time since the onset of stroke was 48 months. The A-AFO showed significantly better effects on (1) general stability (p= 0.01), (2) heel-toe synchrony in both the affected and unaffected legs (p<0.01), (3) synchrony between the two heels (p< 0.01), (4) increased weight-bearing on the affected forefoot (p< 0.01), and (5) reduction of medium to high frequency sway (0.75–1.00 Hz; p< 0.01) than standing barefoot. These effects were more apparent under conditions with a mild sensory challenge. However, under conditions of no sensory deprivation (NO) or no vision and vestibular feedback (PC), wearing an A-AFO did not show any benefit for postural control. Wearing an A-AFO did not increase weight-bearing on the affected leg; moreover, it increased weight-bearing on the affected forefoot compared to that on the hindfoot. Conclusion: When patients with stroke wear an A-AFO for a long time, their general stability and heel-toe synchrony can be improved under conditions with a mild sensory challenge. However, weight-bearing on the affected leg is not enhanced.

並列關鍵字

anterior Ankle-foot orthosis stroke stand balance

參考文獻


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Hung JW, Chen PC, Yu MY, et al. Long-term effect of an anterior ankle-foot orthosis on functional walking ability of chronic stroke patients. Am J Phys Med Rehabil 2011;90:8-16.

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