Bregman Daan J J, De Groot Vincent, Van Diggele Peter, Meulman Hubert, Houdijk Han, Harlaar Jaap
MOVE Institute for Human Movement Research, Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Prosthet Orthot Int. 2010 Sep;34(3):293-304. doi: 10.3109/03093646.2010.495969.
The aim of this study was to assess the functional effects and mechanical contribution of Ankle Foot Orthoses (AFO) prescribed to overcome drop-foot gait. We hypothesized that poor functional effects of the AFO relate to insufficient mechanical contribution of the AFO during the swing phase, or unwanted constraining of the ankle during the stance phase. In seven patients with Stroke or Multiple Sclerosis, we determined changes in energy cost of walking resulting from wearing an AFO, as a measure of the functional effects. In addition, an instrumented gait analysis was performed, and the mechanical AFO properties were measured, to calculate the mechanical contribution of the AFO. The AFO was sufficiently stiff to effectively support the foot in swing, without hampering the ankle during stance. For the whole group, there was a significant improvement in walking speed and energy cost (12%). However, the AFO had no functional benefit in terms of a reduced energy cost of walking for three patients, who coherently demonstrated no pathological plantar flexion during swing without their AFO. We conclude that functional benefit from the AFO was only found when the mechanical AFO characteristics met the need to support the patients' mechanical deficiencies.
本研究的目的是评估为克服足下垂步态而开具的踝足矫形器（AFO）的功能效果和机械作用。我们假设AFO功能效果不佳与摆动期AFO机械作用不足或站立期对踝关节的不必要限制有关。在7名患有中风或多发性硬化症的患者中，我们确定了佩戴AFO导致的步行能量消耗变化，以此作为功能效果的衡量指标。此外，进行了仪器化步态分析，并测量了AFO的机械性能，以计算AFO的机械作用。AFO足够坚硬，能够在摆动期有效支撑足部，且在站立期不妨碍踝关节。对于整个组而言，步行速度和能量消耗有显著改善（12%）。然而，对于三名患者，AFO在降低步行能量消耗方面没有功能益处，他们在不佩戴AFO时摆动期连贯地未表现出病理性跖屈。我们得出结论，只有当AFO的机械特性满足支持患者机械缺陷的需求时，才能发现AFO的功能益处。
