Nash Barbara, Roller Joellen M, Parker Michael G
St. Alexius Medical Center, Bismarck, North Dakota, USA.
J Neurol Phys Ther. 2008 Mar;32(1):39-47. doi: 10.1097/NPT.0b013e3181659556.
Most literature about the efficacy of tone-reducing orthotics pertains to adults and children with central nervous system (CNS) pathology. There is relatively little mention of using this type of orthotic with adults after spinal cord injury (SCI). Therefore, the purpose of this study was to investigate whether tone-reducing orthotics have an effect on gait including electromyographic (EMG) activity, velocity, step length, time in double-limb support, and SCI-Functional Ambulation Inventory (SCI-FAI) scores for an individual with incomplete SCI and spasticity.
We used a single case design. The subject was a 25-year-old white male who was 16 months post-injury with a diagnosis of T6 left/T9 right sensory, L3 motor American Spinal Injury Association C incomplete SCI. Five different walking conditions were tested during each of two separate sessions: barefoot, shoes, foot plates, one ankle-foot orthosis (AFO) with a joint, and one with a tone-reducing AFO, and tone-reducing AFOs bilaterally. Surface EMG was used to record electrical activity of four muscle groups bilaterally. Step length, gait velocity, and time in double limb support were calculated for all five walking conditions. Gait parameters were further analyzed with video analysis using the SCI-FAI.
Mean EMG was relatively constant in all muscle groups under all walking conditions with the exception of the gastrocnemius. In this muscle group, EMG activity with the use of tone-reducing orthotics was better modulated than the other conditions. Gait velocity and step length both increased with tone-reducing orthotics, whereas double limb support time decreased, thus improving the corresponding SCI-FAI score accordingly.
The subject showed improvement in the control of his lower extremities while wearing bilateral tone-reducing AFOs as evidenced by an increased step length and gait velocity and a decrease in the amount of time spent in double limb support. Electromyographic data were less conclusive, although activity in the left gastrocnemius muscle group was more erratic under alternative walking conditions when compared to the tone-reducing AFOs.
大多数关于降低肌张力矫形器疗效的文献都涉及患有中枢神经系统（CNS）病变的成人和儿童。对于脊髓损伤（SCI）后的成人使用这类矫形器的提及相对较少。因此，本研究的目的是调查降低肌张力矫形器对不完全性SCI和痉挛患者的步态是否有影响，包括肌电图（EMG）活动、速度、步长、双下肢支撑时间以及脊髓损伤功能性步行量表（SCI-FAI）评分。
我们采用单病例设计。受试者是一名25岁的白人男性，受伤后16个月，诊断为美国脊髓损伤协会C级不完全性SCI，T6左侧/T9右侧感觉损伤，L3运动损伤。在两个单独的时段中，每个时段都测试了五种不同的步行条件：赤脚、穿鞋、使用脚板、佩戴一个有关节的踝足矫形器（AFO）、佩戴一个降低肌张力的AFO以及双侧佩戴降低肌张力的AFO。使用表面肌电图记录双侧四个肌肉群的电活动。计算所有五种步行条件下的步长、步态速度和双下肢支撑时间。使用SCI-FAI通过视频分析进一步分析步态参数。
除腓肠肌外，所有步行条件下所有肌肉群的平均肌电图相对稳定。在该肌肉群中，使用降低肌张力矫形器时的肌电图活动比其他条件下的调节更好。使用降低肌张力矫形器时，步态速度和步长均增加，而双下肢支撑时间减少，从而相应地提高了SCI-FAI评分。
受试者在佩戴双侧降低肌张力的AFO时，下肢控制能力有所改善，表现为步长和步态速度增加，双下肢支撑时间减少。肌电图数据的结论性较差，尽管与降低肌张力的AFO相比，在其他步行条件下左侧腓肠肌组的活动更不稳定。
