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首页> 外文期刊>Journal of prosthetics and orthotics: JPO >The Effect of Long-Term Ankle-Foot Orthosis Use on Gait in the Poststroke Population
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The Effect of Long-Term Ankle-Foot Orthosis Use on Gait in the Poststroke Population

机译：长期使用踝足矫形器对中风后人群步态的影响

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The goal of this study was to determine the clinical relevance of ankle-foot orthosis (AFO) use on walking ability and other gait parameters in the poststroke population. The study design was a crossover one with randomization. Four stroke patients wearing a thermoplastic AFO for at least the past 6 months and who had completed individualized rehabilitation programs were included. Walking ability of each subject was measured on a 10-m paper walkway and via the timed "Up and Go" (TUG) test. Patients were measured for their walking ability both wearing and not wearing their AFO. Step and stride lengths were calculated from the paper walkway. The mean difference in favor of the AFO for walking speed was 21.58 cm/s, and for the TUG 3.42 seconds. The mean difference for step and stride lengths in favor of the AFO was 3.63 and 5.93, respectively. Seventy-five percent of subjects reported feeling less exertion while wearing the AFO. The effect of AFO use on walking ability is statistically significant, but when compared with the predefined values for clinical relevance, only walking speed and step and stride lengths are clinically relevant. The effect on subjectively reported rates of perceived exertion suggests that other factors play a role in the motivation to use an AFO. The ability to walk is perhaps one of the most functionally significant goals of any rehabilitation process after stroke. The ability to independently ambulate ultimately determines the degree to which an individual will be able to return to the community. Often individuals with stroke are prescribed an ankle-foot orthosis (AFO) to assist in functional ambulation because of the loss of muscle strength, spasticity, impaired sensorimotor control, or the loss of cognitive function.1 The AFO functions primarily in stance to correct deformity and control motion and in swing phase to compensate for muscle weakness-in the case of the individual with stroke to promote dorsiflexion to provide toe clearance in swing. The AFO can also be sued to indirectly affect knee position in stance. However, the long-term effects on gait and daily use leave conflicting evidence in the literature. Hemiplegic gait is described as slow and asymmetric. The greatest deficit in gait patterning is perhaps the plantarflexed position the foot assumes through the swing phase of the gait cycle.1 Hemiparetic patients usually have less dorsiflexion during midswing and terminal swing because of a loss of motor control, spasticity of the gastrocnemius-soleus group, and ankle contracture,2 altering the position of the foot for initial contact and blocks toe clearance during swing. The positioning of the foot also blocks tibial advancement because of the presence of an extensor synergy pattern that produces hyperextension at the knee. The combination of these gait deficits ultimately leads to a decrease in walking ability. Use of an AFO allows control of plantarflexion at the ankle and allows for a more normal heel strike to occur at initial contact, thus beginning the stance period of gait in a more normal manner. Lehmann3 found that hemiplegic gait speed ranged from 13 to 92 cm/s as compared with 82 to 132 cm/s for comparably aged "normal" individuals, or that hemiplegic gait is on average half the speed of "normal" gait. Hemiplegic patients also showed an increase in asymmetry-walking with a shortened stance phase and a longer swing phase on the affected side.4 Roth et al.5 also found that gait velocity correlated with balance, limb strength, cadence, and ambulatory independence. Literature reveals few randomized control trials concerning AFO use and walking ability in stroke patients.6 Beckerman et al. reported no clinically relevant benefits of an AFO on walking ability; however, there are several studies7'8 that suggest improvements in walking speed and stride length. It is well published that AFOs are the most versatile and most frequently used lower extremity orthosis to overcome stroke-related
机译：这项研究的目的是确定踝足矫形器（AFO）使用对卒中后人群步行能力和其他步态参数的临床相关性。研究设计是一个随机的交叉设计。包括至少在过去的六个月中穿着热塑性AFO且已完成个性化康复计划的四名中风患者。在10米长的纸质人行道上并通过定时的“上而下”（TUG）测试来测量每个受试者的步行能力。测量患者在佩戴和不佩戴AFO时的步行能力。根据走纸通道计算步长和步幅。有利于AFO的步行速度的平均差异为21.58 cm / s，而TUG的平均差异为3.42秒。有利于AFO的步长和步幅的平均差分别为3.63和5.93。百分之七十五的受试者表示，在佩戴AFO时感觉疲倦。 AFO使用对步行能力的影响具有统计学意义，但与临床相关性的预定义值进行比较时，只有步行速度以及步幅和步幅长度与临床相关。对主观报告的感知劳累速率的影响表明，其他因素在使用AFO的动机中也起作用。步行能力可能是中风后任何康复过程中最重要的功能目标之一。独立移动的能力最终决定了个人能够重返社区的程度。由于肌肉力量的丧失，痉挛，感觉运动控制受损或认知功能丧失，经常给患有中风的人开具踝足矫形器（AFO）来辅助功能性走动。1AFO的主要作用是矫正畸形并在摆动阶段控制运动，以补偿肌肉无力-对于有中风的人，以促进背屈以在摆动中提供脚趾间隙。 AFO也可以被起诉以间接影响膝盖的姿势。但是，对步态和日常使用的长期影响在文献中有矛盾的证据。偏瘫步态被描述为缓慢且不对称。步态模式的最大缺陷可能是脚在步态周期的摆动阶段中所处的足底弯曲位置。1偏瘫患者通常由于运动控制丧失，腓肠肌-比目鱼组痉挛而在摆动中和末梢摆动时背屈较小。和脚踝挛缩2，改变脚的位置进行初始接触，并在挥杆时阻止脚趾间隙。由于存在在膝盖处产生过度伸展的伸肌协同作用模式，脚的定位也阻止了胫骨的前进。这些步态缺陷的组合最终导致步行能力下降。使用AFO可以控制脚踝的足底屈曲，并允许在初次接触时发生更正常的脚跟撞击，从而以更正常的方式开始步态的站立期。 Lehmann3发现，偏瘫步态的速度在13到92 cm / s之间，而年龄相对较大的“正常”个体为82到132 cm / s，或者偏瘫步态的平均速度是“正常”步态的一半。偏瘫患者还表现出不对称行走的增加，患侧的站立期缩短，摆动期更长。4Roth等人[5]还发现步态速度与平衡，肢体力量，节奏和门诊独立性相关。文献报道很少有关于卒中患者使用AFO和行走能力的随机对照试验。6Beckerman等。报道AFO对步行能力没有临床意义的益处;然而，有几项研究[7-8]提示步行速度和步幅的改善。众所周知，AFO是功能最全，使用最广泛的下肢矫形器，可以克服中风相关的疾病

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