Fatone Stefania, Gard Steven A, Malas Bryan S
Prosthetics Research Laboratory and Rehabilitation Engineering Research Program, Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA.
Arch Phys Med Rehabil. 2009 May;90(5):810-8. doi: 10.1016/j.apmr.2008.11.012.
To investigate the effect of ankle-foot orthosis (AFO) alignment and foot-plate length on sagittal plane knee kinematics and kinetics during gait in adults with poststroke hemiplegia.
Repeated measures, quasi-experimental study.
Motion analysis laboratory.
Volunteer sample of adults with poststroke hemiplegia (n=16) and able-bodied adults (n=12) of similar age.
Subjects with hemiplegia were measured walking with standardized footwear in 4 conditions: (1) no AFO (shoes only); (2) articulated AFO with 90 degrees plantar flexion stop and full-length foot-plate-conventionally aligned AFO (CAFO); (3) the same AFO realigned with the tibia vertical in the shoe-heel-height compensated AFO (HHCAFO); and (4) the same AFO (tibia vertical) with 3/4 length foot-plate-3/4 AFO. Gait of able-bodied control subjects was measured on a single occasion to provide a normal reference.
Sagittal plane ankle and knee kinematics and kinetics.
In adults with hemiplegia, walking speed was unaffected by the different conditions (P=.095). Compared with the no AFO condition, all AFOs decreased plantar flexion at initial contact and mid-swing (P<.001) and changed the peak knee moment in early stance from flexor to extensor (P<.000). Both AFOs with full-length foot-plates significantly increased the peak stance phase plantar flexor moment compared with no AFO and resulted in a peak knee extensor moment in early stance that was significantly greater than control subjects, whereas the AFO with three-quarter length foot-plate resulted in ankle dorsiflexion during stance and swing that was significantly less than control subjects.
These findings suggest that when an articulated AFO is to be used, a full-length foot-plate in conjunction with a plantar flexion stop may be considered to improve early stance knee moments for people with poststroke hemiplegia.
探讨踝足矫形器（AFO）对线及足板长度对脑卒中后偏瘫成年人步态矢状面膝关节运动学和动力学的影响。
重复测量的准实验研究。
运动分析实验室。
脑卒中后偏瘫成年人（n = 16）及年龄相仿的健全成年人（n = 12）志愿者样本。
偏瘫受试者在4种条件下穿着标准化鞋具行走时接受测量：（1）不使用AFO（仅穿鞋子）；（2）带有90度跖屈止动装置和全长足板的关节式AFO - 传统对线AFO（CAFO）；（3）与胫骨垂直重新对线于鞋内且足跟高度补偿的AFO（HHCAFO）；（4）与上述相同的AFO（胫骨垂直）搭配3/4长度足板 - 3/4 AFO。对健全对照受试者的步态进行单次测量以提供正常参考。
矢状面踝关节和膝关节运动学及动力学。
在偏瘫成年人中，步行速度不受不同条件影响（P = 0.095）。与不使用AFO的情况相比，所有AFO均降低了初始接触和摆动中期的跖屈（P < 0.001），并将早期站立时的膝关节峰值力矩从屈曲变为伸展（P < 0.000）。与不使用AFO相比，两种带有全长足板的AFO均显著增加了站立相峰值跖屈肌力矩，并导致早期站立时的膝关节伸展峰值力矩显著大于对照受试者，而带有3/4长度足板的AFO在站立期和摆动期导致的踝关节背屈显著小于对照受试者。
这些研究结果表明，当使用关节式AFO时，可考虑使用全长足板并结合跖屈止动装置，以改善脑卒中后偏瘫患者早期站立时的膝关节力矩。
