偏癱中風患者以拐杖助行之步態分析

Analysis of Cane-Assisted Gait in Patients with Hemiplegic Stroke

陳嘉玲(Chia-Ling Chen) ； 陳協慶(Hsieh-Ching Chen) ； 鄧復旦(Fuk-Tan Tang) ； 侯國代(Kuo-Dai Hou) ； 洪維憲(Wei-Hsien Hong) ； 陳榮順(Rong-Shun Chen) ； 呂柏文(Bel-Wen Lu) ； 黃美涓(May-Kuen Wong)

《中華民國復健醫學會雜誌》 28卷4期 (2000/12) Pp. 221-228

摘要

病患在中風偏癱後大多需拐杖輔助下才可行走。因此本篇研究的目的在建立偏癱中風患者以拐杖助行時之步態資料。本研究共收集15位中風患者使用拐杖助行之步態資料，利用整合測力板，動態分析系統及配荷重感應裝置的拐杖之分析系統，分析中風患者以拐杖助行時之步行速度、步長、支撐期，及三軸向之作用力，並計算最大垂直作用力、前進作用力（propulsive force）、煞車作用力（braking force）、推進衝量（propulsive impulse）和煞車衝量（braking impulse）、以及側向剪力。
結果發現以拐杖助行之中風患者其步行速度相當緩慢，平均速度為16.1公分/秒（由4.2至35.8公分/秒），平均步長為38.2公分，三腳支撐期及雙腳支撐期佔了大部分的步態週期，而單腳支撐期只佔了10.6%的步態週期。此外，中風患者施於拐杖之平均最大垂直作用力佔體重之12.3% （由6.9至25.3%），側向剪力平均只占體重之0.7%。當其施於健側之推進衝量較大，相對地施於拐杖及患側之煞車衝量也較大。
由以上結果可顯示中風患者主要依賴健側來推進，而依賴患側及拐杖來煞車。只有當中風患者施於拐杖之最大垂直作用力小於體重之25%時，此時處方拐杖給患者使用較為安全。本研究所提供之資料將有助於瞭解中風患者使用拐杖時之生物力學，並可提供臨床治療策略之擬定。

關鍵字

腦血管意外 ； 步態分析 ； 枴杖

並列摘要

The purpose of this study is first to analyze the temporal-stride parameters and forces applied on the cane, and both feet in stroke patients walking with cane-assistance. Three force plates, six cam-eras, and an instrumented cane were integrated to conduct an analysis of the cane-assisted gait of 15 hemiplegic patients. Temporal-stride parameters, and peak vertical, anterior (propulsive)-posterior (braking) and lateral shear forces, and propulsive-breaking impulses, were analyzed.
All patients walked with a relatively slow walking speed, the average is 16.1 cm/sec, ranging from 4.2 to 35.8 cm/s. The average step length is 38.2 cm. The triple and double support occupied most of the gait cycle (GC), while the single support occupied only 10.6% GC. Patients applied 12.3% body weight (BW) of average peak vertical forces (range: 6.9~25.3%BW) on the cane. The applied average lateral shear forces were 0.7%BW on the cane. They applied greater peak propulsive forces and impulses on the sound foot, while applying greater peak braking forces and impulses on the affected foot and cane.
These results suggest stroke patients rely mostly on the sound limb for propulsion, while using the affected limb and cane for braking. A cane is better prescribed for stroke patients only when peak vertical cane forces are less than 25% BW. Data provided could be useful in understanding cane bio-mechanics and in planning therapeutic strategies.

並列關鍵字

cerebrovascular accident ； gait analysis ； cane