Brehm Merel-Anne, Harlaar Jaap, Schwartz Michael
Department of Rehabilitation Medicine, VU University Medical Center, De Boelenlaan 1117, Amsterdam, The Netherlands.
J Rehabil Med. 2008 Jul;40(7):529-34. doi: 10.2340/16501977-0209.
To determine the effect of ankle-foot orthoses on walking efficiency and gait in a heterogeneous group of children with cerebral palsy, using barefoot walking as the control condition.
A retrospective study.
Barefoot and ankle-foot orthosis data for 172 children with spastic cerebral palsy (mean age 9 years; hemiplegia: 21, diplegia: 97, and quadriplegia: 54) were compared. These data consisted of non-dimensional speed, net non- dimensional energy cost of walking (NN-cost), and NN-cost as a percentage of speed-matched controls (NN-cost(pct)). For 80 of these children the Gillette Gait Index and data for 3D gait kinematics and kinetics were also analyzed.
Speed was 9% faster (p<0.001), NN-cost was 6% lower (p=0.007), and NN-cost(pct) was 9% lower (p=0.022) when walking with an ankle-foot orthosis. The Gillette Gait Index remained unchanged (p=0.607). Secondary subgroup analysis for involvement pattern showed a significant improvement in NN-cost(pct) only for quadriplegics (20%, p=0.004), whereas it remained unchanged for patients with hemiplegia and diplegia. Changes in the minimum knee flexion angle in stance phase and in terminal swing were found to be significantly related to the change in NN-cost(pct) (p=0.013 and p=0.022, respectively).
The use of an ankle-foot orthosis resulted in a significant decrease in the energy cost of walking of quadriplegic children with cerebral palsy, compared with barefoot walking, whereas it remained unchanged in hemiplegic and diplegic children with cerebral palsy. Energy cost reduction was related to both a faster and more efficient walking pattern. The improvements in efficiency were reflected in changes of stance and swing phase knee motion, i.e. those children whose knee flexion angle improved toward the typical normal range demonstrated a decrease in energy cost of walking, and vice versa.
以赤足行走作为对照条件，确定踝足矫形器对一组异质性脑瘫儿童步行效率和步态的影响。
一项回顾性研究。
比较了172例痉挛型脑瘫儿童（平均年龄9岁；偏瘫：21例，双瘫：97例，四肢瘫：54例）的赤足和踝足矫形器数据。这些数据包括无量纲速度、步行的净无量纲能量消耗（NN-消耗）以及NN-消耗占速度匹配对照组的百分比（NN-消耗（百分比））。对其中80名儿童还分析了吉列步态指数以及三维步态运动学和动力学数据。
佩戴踝足矫形器行走时，速度快9%（p<0.001），NN-消耗低6%（p=0.007），NN-消耗（百分比）低9%（p=0.022）。吉列步态指数保持不变（p=0.607）。按受累模式进行的亚组分析显示，仅四肢瘫患者的NN-消耗（百分比）有显著改善（20%，p=0.004），而偏瘫和双瘫患者的该指标保持不变。发现站立期和终末摆动期最小屈膝角度的变化与NN-消耗（百分比）的变化显著相关（分别为p=0.013和p=0.022）。
与赤足行走相比，使用踝足矫形器可使脑瘫四肢瘫儿童的步行能量消耗显著降低，而脑瘫偏瘫和双瘫儿童的步行能量消耗则保持不变。能量消耗的降低与更快、更高效的步行模式有关。效率的提高反映在站立期和摆动期膝关节运动的变化上，即那些屈膝角度向典型正常范围改善的儿童，其步行能量消耗降低，反之亦然。
