下半身截癱患者以交替式步行支架合併功能性電刺激之步行研究：病例報告

The Study of Ambulation of Paraplegics Using a Reciprocating Gait Orthosis with Functional Electrical Stimulation: A Case Report

陳友倫(Yu-Luen Chen) ； 張傳濱(Chuan-Pin Chang) ； 鄧復旦(Fuk-Tan Tang) ； 張恆雄(Walter H. Chang) ； 黃美涓(May-Kuen Wong) ； 簡鴻暄(Hung-Shiuan Jane) ； 郭德盛(Te-Son Kuo)

《Journal of Medical and Biological Engineering》 20卷2期 (2000/06) Pp. 42-50

摘要

部份的脊髓損傷病患在受傷之後，由於下肢肌力不足，需要穿戴特定的行動輔具以支撐身體以協助步行。在傳統上，大多使用長腿支架（long leg brace; LLB)）來訓練病患行走，但效果並不令人滿意，因為只有支撐而沒有動力輔助。在本研究中，採用目前新型的交替式步行支架（reciprocating gait orthosis; RGO），且結合功能性電刺激器（functional electrical stimulation; FES），除具備了支撐範圍加大、運用機械構造輔助行走等特點外，功能性電刺激的配合使用更能有助於重建癱瘓患者所失去的步行運動功能。本研究係研製一具功能性電刺激裝置之步行輔助器，藉由此功能性電刺激裝置對下半身癱瘓病患的下肢特定肌群（股四頭肌、膕旁肌）進行電刺激，一方面可達到復健物理治療的效益，另一方面亦可藉由該步行輔助器幫助下肢癱瘓病患達到步行移動身體的目的。而該功能性電刺激裝置可由設計於步行輔助器上的按鍵控制，由該患者自行控制所要步行移動的左或右下肢，達到自行控制步行及步行速度之目的。本研究於系統研製完成及實際測試後，針對一位腰髓第一節完全脊髓損傷的25歲下半身癱瘓的女性病患，在分時使用傳統長腿支架、新型交替式步行支架及新型交替式步行支架合併功能性電刺激等三種方式下，來進行步行的復健訓練與臨床評估。結果顯示在步行前後的心率差值、平均血壓差值、步行速度、步長、步數及單位耗氧量上，RGO與RGO＆FES都優於LLB，但前三項參數在RGO與RGO＆FES之間的差異度並不大，主因於患者右腿對於電刺激的反應程度較低。總而言之，RGO能使患者產生較快、較獨立且低耗能的步行方式，而RGO加入FES則能再提升RGO使用上的功效。而這兩種行動輔具在各方面上都優於傳統的長腿支架，提供脊髓損傷患者更佳的步行輔具選擇。

關鍵字

脊髓損傷 ； 長腿支架 ； 交替式步行支架 ； 功能性電刺激

並列摘要

Many patients suffered from spinal cord injury with paraplegia can hardly recover to walk independently. They might need to use some special walking orthoses to support the body to walk properly. Traditionally, long leg braces (LLB) are fitted the patients for walking. Unfortunately, the results are not satisfied due to its support rather than mobile aid. In this study, we used latest reciprocating gait orthosis (RGO) and combined the use of functional electrical stimulation (FES). The combination provides larger support range and applies features of mechanical structures in walking assistant. The coordination of FES especially helps to restore the walking abilities that paralyzed patients lost.This study is to develop a walking orthosis with a FES, using a FES to stimulate specific muscles (quadriceps, hamstring) of paralyzed patients' lower limbs. It can achieve the benefits of physical therapeutics; on the other hand, paralyzed patients can achieve the purpose of walking. The FES is designed with control buttons on the walking orthosis. A patient can decide and control left or right leg that he desires to move to walk, and consequently accomplishes the purposes of walking control and speed via the control buttons.After the completion of the development and several practical tests of the new walking orthosis. A 25-years-old female paralyzed patient (L1 complete spinal cord injury) separately used traditional LLB, RGO, and RGO with FES to proceed with the training of walking rehabilitation and clinical assessment. After comparisons with heart rate difference (HRdifference), mean blood pressure difference (MBPdifference), walking speed, length of steps, number of steps and oxygen consumption before and after walking, the results show that usage of RGO and RGO with FES are both better than LLB. But, the differences between RGO and RGO with FES in HRdifference, MBPdifference, and walking speed are not significant, due to that the reaction of patient's right leg to electrical stimulation is relatively lower. In general, RGO can help the patient to achieve quicker and more independent walking; while the combination of RGO and FES can raise the effectiveness of RGO for more mobile aid. These two walking orthoses are better than traditional LLB, they provide patients suffered from paraplegia with better choices.

並列關鍵字

spinal cord injury ； long leg brace ； reciprocating gait orthosis ； functional electrical stimulation