Chafetz Ross S, Mulcahey Mary Jane, Betz Randal R, Anderson Caroline, Vogel Lawrence C, Gaughan John P, Odel Mary Ann, Flanagan Ann, McDonald Craig M
Clinical Research, Shriners Hospitals for Children, 3551 N. Broad St., Philadelphia, PA 19140, USA.
J Spinal Cord Med. 2007;30 Suppl 1(Suppl 1):S178-83. doi: 10.1080/10790268.2007.11754598.
BACKGROUND/OBJECTIVE: The purpose of this study is to assess the impact of a thoracolumbosacral orthosis (TLSO) on children with spinal cord injuries (SCI) in terms of functional independence and time requirements for performance of functional activities and to ascertain the children's preference for TLSO use.
Fourteen subjects with thoracic SCI, ages 6 to 14 years, were studied. All subjects had previously been prescribed and were using a TLSO to prevent the progression of scoliosis. Functional activities included in the Functional Independence Measure and 6 additional wheelchair and transfer skills were scored by level of assistance required. The timed motor test (TMT) included 6 activities involving dressing, transfers, and wheelchair propulsion. Subjects completed the activities of the functional activities scale (FAS) and TMT while wearing a TLSO and without a TLSO. Subjects were asked their preference for wearing or not wearing the TLSO during each of the activities.
For the TMT, subjects were slower with a TLSO when donning a shirt or pants, with even and uneven transfers and hallway propulsion (P < 0.05). The majority of subjects preferred not wearing the TLSO during the TMT activities. Lower functional activity scores were recorded while wearing a TLSO for upper-extremity dressing (P < 0.05), lower-extremity dressing, bladder management, transferring to bed, and reaching for objects on the floor. Subjects preferred not wearing a TLSO for the following activities: lower-extremity dressing, bladder management, reaching for an object on the floor, and transfer from a supine to a sitting position.
Wearing a TLSO adversely affected independence level and time requirements for selected functional activities. Subjects preferred not wearing a TLSO while performing the activities. Activities that required hip flexion, such as donning pants or transitioning from a supine to a sitting position were restricted by the TLSO. Future studies with larger sample sizes should explore the relationships between functioning with a TLSO as related to a patient's age, level of injury, and TLSO design.
背景/目的：本研究旨在评估胸腰骶矫形器（TLSO）对脊髓损伤（SCI）儿童功能独立性的影响，以及进行功能活动所需的时间，并确定儿童对使用TLSO的偏好。
对14名年龄在6至14岁的胸段脊髓损伤受试者进行了研究。所有受试者此前均已被开具并正在使用TLSO以预防脊柱侧弯的进展。功能独立性测量中包含的功能活动以及另外6项轮椅和转移技能，根据所需的协助程度进行评分。定时运动测试（TMT）包括6项涉及穿衣、转移和轮椅推进的活动。受试者在佩戴TLSO和不佩戴TLSO的情况下完成功能活动量表（FAS）和TMT的活动。受试者被问及在每项活动中对佩戴或不佩戴TLSO的偏好。
对于TMT，受试者在穿着衬衫或裤子、进行平稳和不平稳转移以及在走廊推进时佩戴TLSO的速度较慢（P<0.05）。大多数受试者在TMT活动期间更喜欢不佩戴TLSO。在上肢穿衣（P<0.05）、下肢穿衣、膀胱管理、转移到床上以及伸手去拿地上的物品时佩戴TLSO时，功能活动得分较低。受试者在以下活动中更喜欢不佩戴TLSO：下肢穿衣、膀胱管理、伸手去拿地上的物品以及从仰卧位转移到坐位。
佩戴TLSO对选定功能活动的独立性水平和所需时间有不利影响。受试者在进行活动时更喜欢不佩戴TLSO。需要髋关节屈曲的活动，如穿裤子或从仰卧位转换到坐位，会受到TLSO的限制。未来更大样本量的研究应探索佩戴TLSO的功能与患者年龄、损伤水平和TLSO设计之间的关系。
