Roehrig Susan, Yates David A
Physical Therapy Programs, Arkansas State University, State University, AR 72467, USA.
J Geriatr Phys Ther. 2008;31(1):38-46. doi: 10.1519/00139143-200831010-00007.
This case report describes the effects of a new ankle foot orthosis with bi-channel adjustable ankle locks combined with physical therapy intervention on gait parameters in a subject with longstanding hemiplegia.
A 69-year old male, 4.5 years post cerebrovascular accident with residual right hemiplegia, demonstrated impaired lower extremity muscle performance and motor control, with difficulty performing graded knee extension and achieving active knee flexion except in synergy, and slow gait (0.34 m/sec) with decreased left step time (0.57 sec) and length (26.3 cm) compared to the right (1.26 sec and 35.5 cm, respectively), decreased foot clearance during swing and knee hyperextension during stance.
Collaboration between the PT and orthotist with attention to the subject's knee control and history of lower extremity edema determined orthotic prescription. The subjects then received 24 outpatient physical therapy visits over 11 weeks.
The new orthosis and PT intervention resulted in improved foot clearance, usual and fast velocity, with increased cadence, and better step length differential and step time differential at usual speed. Following physical therapy, muscle performance of quadriceps and hamstring improved, with no knee hyperextension during stance. The subject demonstrated increased confidence in gait and a positive attitude toward his right lower extremity.
An appropriate orthosis combined with PT intervention can decrease energy expenditure in walking and increase confidence and attitude in a subject with longstanding hemiplegia.
本病例报告描述了一种新型双通道可调式踝关节锁的踝足矫形器结合物理治疗干预对一名长期偏瘫患者步态参数的影响。
一名69岁男性，脑血管意外后4.5年，遗留右侧偏瘫，下肢肌肉功能和运动控制受损，除协同运动外，进行分级膝关节伸展和主动膝关节屈曲困难，步态缓慢（0.34米/秒），与右侧相比，左侧步时（0.57秒）和步长（26.3厘米）缩短（右侧分别为1.26秒和35.5厘米），摆动期足离地间隙减小，站立期膝关节过伸。
物理治疗师与矫形师合作，根据患者的膝关节控制情况和下肢水肿病史确定矫形器处方。然后，患者在11周内接受了24次门诊物理治疗。
新型矫形器和物理治疗干预使足离地间隙、正常和快速速度得到改善，步频增加，正常速度下的步长差异和步时差异更好。物理治疗后，股四头肌和腘绳肌的肌肉功能得到改善，站立期无膝关节过伸。患者对步态的信心增强，对其右下肢持积极态度。
合适的矫形器结合物理治疗干预可减少长期偏瘫患者行走时的能量消耗，增强其信心并改善其态度。
