Ibuki Aileen, Bach Timothy, Rogers Douglas, Bernhardt Julie
National Centre for Prosthetics and Orthotics, Division of Allied Health, La Trobe University, Bundoora, 3086, Victoria, Australia.
Prosthet Orthot Int. 2010 Jun;34(2):154-65. doi: 10.3109/03093641003649405.
Tone-reducing ankle-foot orthoses (TRAFOs) are said to improve the control and functioning of spastic lower limbs by their biomechanic and neurophysiologic effects. Unfortunately, there is limited evidence in literature to support the theory that TRAFOs can effectively decrease spasticity in the foot and ankle neurophysiologically. The primary purpose of this investigation was to determine the neurophysiologic effect of TRAFOs on soleus muscle reflex excitability in subjects with spasticity following stroke while standing. A repeated-measures intervention study was conducted on 15 adult subjects with stroke who were recruited from the community. Custom-made articulated ankle-foot orthoses (AFOs) and TRAFOs with orthokinetic compression garments (OCGs) were fabricated for each subject. Five conditions were tested: (1) Shoes only, (2) AFO, (3) TRAFO, (4) TRAFO with OCG, (5) shoes only, to determine if the TRAFOs were most effective in decreasing spasticity as assessed by the ratio of maximum Hoffmann reflex amplitude to maximum muscle response amplitude (Hmax:Mmax ratio) of the soleus. The results found that there were no significant treatment effects for the interventions (F = 0.992, df = 2.167, p = 0.388), however, when analysed subject-by-subject, four subjects displayed significant increases in their Hmax:Mmax ratios to at least one treatment condition. Overall, the results demonstrated that the tone-reducing devices had no significant neurophysiologic effect on soleus reflex excitability in subjects with spasticity, however individual responses showed that the TRAFOs increased spasticity in some individuals.
据说降低肌张力的踝足矫形器（TRAFOs）通过其生物力学和神经生理学作用来改善痉挛性下肢的控制和功能。不幸的是，文献中支持TRAFOs能在神经生理学上有效降低足踝部痉挛的证据有限。本研究的主要目的是确定TRAFOs对中风后痉挛患者站立时比目鱼肌反射兴奋性的神经生理作用。对从社区招募的15名成年中风患者进行了一项重复测量干预研究。为每个受试者制作了定制的关节式踝足矫形器（AFOs）和带有运动控制压缩衣（OCGs）的TRAFOs。测试了五种情况：（1）仅穿鞋子，（2）AFO，（3）TRAFO，（4）带OCG的TRAFO，（5）仅穿鞋子，以确定TRAFOs在通过比目鱼肌最大霍夫曼反射幅度与最大肌肉反应幅度之比（Hmax:Mmax比值）评估降低痉挛方面是否最有效。结果发现，干预措施没有显著的治疗效果（F = 0.992，自由度 = 2.167，p = 0.388），然而，逐个受试者分析时，有四名受试者在至少一种治疗情况下其Hmax:Mmax比值显著增加。总体而言，结果表明，降低肌张力的装置对痉挛患者的比目鱼肌反射兴奋性没有显著的神经生理作用，然而个体反应显示TRAFOs在一些个体中增加了痉挛程度。
