- 期刊
Functional Performances for Paraplegia with Three Different Types of Walking Orthoses: A Case Report
下肢癱瘓患者穿著三種不同型態行走輔具之功能表現
摘要
大部分的下肢癱瘓患者常以輪椅為他們的代步工具，但受到環境的限制卻是相當大的，因為環境並沒有針對他們的需求而改善。在本研究中，介紹新型的行走輔助系統給下肢癱瘓患者及復健團隊。我們從此次臨床經驗中學會如何製作、修改行走輔具、及訓練患者的經驗。Isocentric Reciprocal Gait Orthosis(IRGO)是一種髖膝足踝裝具(HKAFO)，它是利用控制髖關節及身體伸展來輔助對側之髖關節彎曲。它包含兩側膝踝足裝具(KAFOs)和兩邊外側髖關節，連接到一個硬式胸腰椎裝具上。而Walkabout Orthosis(WO)包含兩側膝踝足裝具(KAFOs)，由一個內側單軸髖關節連接在一起，位於會陰部下方，可以很簡單將髖關節從裝具上拆卸下來。 我們針對一位胸髓第12節以下完全損傷的脊髓損傷患者，穿著IRGO , WO及傳統的膝踝足裝具接受物理治療訓練後，來進行臨床測試，獲得下列結果。(1)在平坦路面上行走之速度(IRGO=0.39m/sec, WO=0.14m/sec, and KAFOs=0.14m/sec)(2)步長(IRGO=58.82cm/step, WO=24.82cm/step, and KAFOs=18.63cm/step)(3)步頻(IRGO=39.96steps/min, WO=33.17steps/min, and KAFOs=45.61steps/min)(4)生理耗能指數(IRGO=1.36beats/m, WO=3.28beats/m, and KAFOs=4.47beats/m) 在功能性評估項目上：(1)此患者可以在輪椅上自行穿脫三種裝具，穿著裝具時也可以自行從輪椅上站立起來及坐回輪椅上，而在平坦路面上行走也不需任何幫助。(2)上下斜坡時：IRGO為在旁督看輔助，WO and KAFOs為輕微輔助。(3)上下樓梯部份：IRGO， WO，及 KAFOs 均為在旁督看輔助。 (4)上下三公分高的台階： IRGO為在旁督看輔助；WO和KAFOs需要中等程度的輔助。 簡單而言，IRGO可以使患者有較快及較獨立的步態，WO可以提供一個較穩定的站姿和較簡便自行穿脫的優點。而這兩種行走輔具均可提供比傳統膝踝足裝具，較節省能量消耗的交替性步態。
並列摘要
Most paraplegic patients used their wheelchairs as a transportation tool, but largely confined by environment that didn't adapt for them. In this study, we introduced the new walking system to the paraplegia and the rehabilitation team workers in Taiwan. We obtained the clinical experience how to manufacture, modify and fitting the orthoses during training sessions. Isocentric Reciprocal Gait Orthosis (IRGO) is a hip-knee-ankle-foot orthosis (HKAFO) which controls hip extension while assisting reciprocal hip flexion. It comprises laterally placed hip joints that connect bilateral knee-ankle-foot orthoses (KAFOs) to a thoracolumbar corset. Walkabout Orthosis (WO) consists of two KAFOs joined by a single axis hip joint called the Walkabout Unit. The hip joint is positioned between the medial uprights of the KAFOs, under the perineum, and is designed for easy removal from the KAFOs. We performed clinical tests of the new IRGO and WO in a paraplegic patient with T12 motor complete lesion. The results were as follows. (1) Walking speed on a level surface: IRGO=0.39 m/sec, WO=0.14 m/sec, and KAFOs=0.14 m/sec. (2) Step length: IRGO=58.82 cm/step, WO= 24.82 cm/step, and KAFOs=18.63 cm/step. (3) Cadence: IRGO=39.96 steps/min, WO=33.17 steps/mm, and KAFOs=45.61 steps/mm. (4) PCI: IRGO=1.36 beats/m, WO=3.28 beats/m, and KAFOs=4.47 beats/m. In the functional assessment tasks, the results included the following. (1) He could independently perform donning and doffing the orthosis, changing positions from sitting to standing and from standing to sitting, and walking on a level surface with all three type orthoses. (2) Walking up and down the ramps: IRGO=stand-by assistance, WO and KAFOs=minimal assistance. (3) Getting up and down the stairs: IRGO, WO, and KAFOs were stand-by assistance. (4) Up and down the curb of 3.0 cm height IRGO was stand-by assistance; WO and KAFOs were moderate assistance. In summary, the IRGO performed a quicker and more independent gait, while the WO achieved a more stable standing and easy don-doff by himself than conventional KAFOs. Furthermore both of them walked with less energy consumption than conventional KAFOs.