前葉式踝足矯具對偏癱步態之效應

Effects of an Anterior Ankle-Foot Orthosis on Hemiplegic Gait

陳瓊玲(Chiung-Ling Chen) ； 楊國德(Kwok-Tak Yeung) ； 吳鑫漢(Shin-Han Wu) ； 江炳焱(Ping-Yen Chiang)

《中華民國復健醫學會雜誌》 26卷3期 (1998/09) Pp. 119-128

摘要

中風後之偏癱患者，常以踝足矯具來矯正踝關節以提高穩定度及增進行走安全。踝足矯具已漸由塑膠式取代鐵鞋，因為鐵鞋過重不美觀。而以高溫、打模成型之後葉式塑膠踝足矯具，則製作費時，且矯正偏癱患者內翻足之效果，似乎亦不甚理想。吳鑫漢設計以低溫成型塑材製作之前葉式踝足矯具，普遍應用於國內偏癱患者的踝足矯正上。
本研究以24位中風之偏癱患者為對象，男性17名，女性7名，平均年齡為58.9±9.5歲，年齡分佈範圍由43歲到76歲。發病至研究期間平均為26.4±32.7個月，分佈範圍由3個月至10年。利用足底壓步態分析儀評估穿戴及未穿戴前葉式踝足矯具對步態的影響。步態分析包括步行速度、步幅數、步幅長度及對稱性等時間變項，及動力分析腳跟著地期腳底壓力分佈、著地期平均腳底壓力分佈及離地期之垂直作用力。結果顯示穿戴前葉式踝足矯具時，步行速度增加（15.62±6.33公尺/分鐘vs 14.36±6.62公尺/分鐘，p＜0.05）、步幅數增加（29.58±8.17次/分鐘vs 28.30±8.94次/分鐘，p＜0.05）；腳跟著地期前足載重減少（30.22±12.33% vs 34.35±10.07%，p＜0.05），但步態對稱性、著地期外側腳底壓力及離地期地面垂直作用力則沒有顯著差異。

關鍵字

偏癱患者 ； 步態 ； 踝足矯具

並列摘要

Ankle-foot orthoses (AFOs) are frequently prescribed for hemiplegia to correct the ankle joint, provide mediolateral stability and improve ambulatory safety.
Metal orthoses have gradually been replaced by plastic AFOs because metal orthoses are heavy and have a poor cosmetic appearance. Conventional plastic AFOs are designed in posterior leaf type and fabricated by a lamination or vacuum-forming technique over a positive plaster model of the limb. It takes time to fabricate a plastic AFO, and the effect of correcting for inversion of a hemiplegic foot is not obvious.
Wu designed a low-temperature anterior direct molding AFO called an anterior AFO. It is fabricated quickly and easily, and is custom fit. The anterior AFO is commonly used for hemiplegia with spasticity in Taiwan.
The purpose of this study was to examine the effects of this anterior AFO on hemiplegic gait. A total of 24 post-stroke hemiplegic patients (17 male and 7 female, their mean age was 58.9 yeas and the duration of their disability averaged 40.3 months.) were included in this study. The Computer DynoGraphy (CDG) of the Infotronic Ultraflex System was used to collect gait data with and without an AFO. Gait analysis comprised of the temporal components of the walking cycle: walking velocity, cadence, stride length and gait symmetry. Kinetic analysis included foot pressure distribution at heel strike, pressure distribution of the lateral border of the foot during stance phase, and vertical ground reaction force at push off.
The results revealed that when wearing the anterior AFO, walking velocity increased (15.62±6.33m/min vs 14.36±6.62m/min, p＜0.05), cadence increased (29.58±8.17strides/min vs 28.30±8.94strides/min, p＜0.05) and the forefoot’s weight bearing at heel strike decreased (flatfoot weight bearing instead of forefoot weight bearing)(30.22±12.33% vs 34.35±10.07%). There was no significant difference in gait symmetry, lateral foot weight bearing during stance phase and vertical reaction force at push off.

並列關鍵字

hemiplegia ； gait ； AFO