Rethlefsen S, Kay R, Dennis S, Forstein M, Tolo V
Children's Hospital Los Angeles, Motion Analysis Laboratory, California 90027, USA.
J Pediatr Orthop. 1999 Jul-Aug;19(4):470-4. doi: 10.1097/00004694-199907000-00009.
Twenty-one subjects with spastic diplegic cerebral palsy were studied to quantify the effects of fixed and articulated ankle-foot orthoses (AFOs) on gait and delineate criteria for their use. Children underwent gait analysis under three conditions, fixed AFOs (FAFOs), articulated AFOs (AAFOs), and shoes alone. Greater dorsiflexion occurred at initial contact with both FAFOs and AAFOs than shoes alone. Dorsiflexion at terminal stance was greatest in AAFOs. Plantarflexor power generation at preswing was preserved in AAFOs. No differences were found in knee position during stance. Knee-extensor strength was positively related to knee extension during stance. No relationships were found between dorsiflexion range of motion, calf spasticity and strength, and peak dorsiflexion during stance. AAFOs are appropriate for subjects with varying degrees of calf spasticity, as long as adequate passive range of motion is available. These findings can be applied primarily to children who do not have a preexisting tendency to crouch.
对21名痉挛性双侧瘫脑瘫患者进行了研究，以量化固定和活动式踝足矫形器（AFO）对步态的影响，并确定其使用标准。患儿在三种情况下接受步态分析，即佩戴固定踝足矫形器（FAFO）、活动式踝足矫形器（AAFO）以及仅穿鞋子。与仅穿鞋子相比，在初始接触时，佩戴FAFO和AAFO均出现了更大程度的背屈。在终末支撑期，AAFO的背屈最大。在摆动前期，AAFO保留了跖屈肌的发力。站立期间的膝关节位置未发现差异。膝关节伸展力量与站立期间的膝关节伸展呈正相关。在背屈活动范围、小腿痉挛和力量以及站立期间的背屈峰值之间未发现相关性。只要有足够的被动活动范围，AAFO适用于不同程度小腿痉挛的患者。这些发现主要适用于没有预先存在蹲伏倾向的儿童。
