Maltais D, Bar-Or O, Galea V, Pierrynowski M
Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Med Sci Sports Exerc. 2001 Feb;33(2):320-5. doi: 10.1097/00005768-200102000-00023.
The aim of this study was to assess the effects of hinged ankle foot orthoses (AFO) on the metabolic and cardiopulmonary cost of walking and gross motor skills of children with cerebral palsy (CP).
Ten habitual users of hinged AFO with spastic diplegic CP (9.01 yr +/- 2.10) participated in the study. Expired gas and heart rate (HR) were measured during sitting and with AFO on and off during steady state treadmill walking at three speeds: 3 km.h(-1), comfortable walking speed (CWS), and 90% of their fastest walking speed (FWS). Comfortable and fastest ground walking speed and Gross Motor Function Measure scores were also assessed with AFO on and off and analyzed with ANOVA. Because not all children could walk at all speeds on the treadmill, an ANOVA was performed on data for children who walked at 3 km.h(-1) and CWS (N = 8 for HR; N = 9 for pulmonary ventilation and metabolic variables) and a t-test on data at 90% of FWS (N = 9 for HR; N = 8 for pulmonary ventilation and metabolic variables).
When children wore their AFO net oxygen uptake (L.min(-1), absolute--sitting values) was significantly (P < 0.05) reduced by 8.9% at 3 km.h(-1) and by 5.9% at 90% of FWS. Net pulmonary ventilation (L.min(-1)) was significantly (P < 0.05) lower with AFO on by 10.3% but only at 3 km.h(-1). AFO did not affect net HR (beats.min(-1)) nor the respiratory exchange ratio at any speed, nor any physiologic variable at CWS, nor gross motor skills.
Use of hinged AFO reduces the oxygen and ventilatory cost of walking in children with spastic diplegic CP.
本研究旨在评估铰链式踝足矫形器（AFO）对痉挛型双侧瘫脑瘫（CP）患儿步行时的代谢及心肺负荷以及粗大运动技能的影响。
10名习惯性使用铰链式AFO的痉挛型双侧瘫CP患儿（9.01岁±2.10）参与了本研究。在患儿坐位时以及在跑步机上以三种速度进行稳态步行期间，分别测量其佩戴和不佩戴AFO时的呼出气体及心率（HR），这三种速度分别为：3 km·h⁻¹、舒适步行速度（CWS）以及其最快步行速度（FWS）的90%。还评估了患儿佩戴和不佩戴AFO时的舒适和最快地面步行速度以及粗大运动功能测量得分，并采用方差分析进行分析。由于并非所有患儿都能在跑步机上以所有速度行走，因此对以3 km·h⁻¹和CWS行走的患儿的数据进行方差分析（HR数据N = 8；肺通气和代谢变量数据N = 9），对以FWS的90%行走的数据进行t检验（HR数据N = 9；肺通气和代谢变量数据N = 8）。
当患儿佩戴AFO时，在3 km·h⁻¹速度下，净摄氧量（L·min⁻¹，绝对值 - 坐位值）显著降低（P < 0.05），降低了8.9%；在FWS的90%速度下，降低了5.9%。净肺通气量（L·min⁻¹）仅在3 km·h⁻¹速度下显著降低（P < 0.05），佩戴AFO时降低了10.3%。AFO在任何速度下均不影响净心率（次·min⁻¹）和呼吸交换率，在CWS时也不影响任何生理变量及粗大运动技能。
使用铰链式AFO可降低痉挛型双侧瘫CP患儿步行时的氧气及通气负荷。
