Ramdharry Gita M, Pollard Alexander J, Marsden Jonathan F, Reilly Mary M
School of Rehabilitation Sciences, St George's University of London and Kingston University, Cranmer Terrace, London SW17 0RE, UK.
Physiother Res Int. 2012 Dec;17(4):191-9. doi: 10.1002/pri.531. Epub 2012 Jan 9.
Ankle foot orthoses (AFOs) are commonly prescribed for people with Charcot-Marie-Tooth (CMT) disease. Scant evidence exists to guide the type and timing of orthotic prescription. This study explores the latter issue by investigating the differences in presentation and gait function of people with CMT disease who wore AFOs for daily mobility (n = 11) and a group who did not (n = 21). The aim was to see if there was a difference in the characteristics in people who regularly wear AFOs.
Primary measures of gait function were a 10-m timed walk (comfortable and maximum speed) and a 6-minute walk test. Means of the variables were compared using independent t-tests. Secondary measures included disease severity, lower limb muscle strength, sensory impairment, walking effort, fatigue severity and perceived walking ability.
AFO wearers walked slower with higher effort. They also had greater disease severity, weaker leg muscles and perceived greater walking difficulty. Subjects not wearing AFOs showed significant relationships between gait variables and muscle strength, whereas AFO wearers showed significant relationships between gait variables and perceived walking ability, fatigue severity and effort.
People who regularly wore AFOs were more severely affected, had a slower maximum walking speed, higher energy cost of walking and worse perceived walking ability. Walking ability in this group was related to fatigue, perceived exertion during walking and perceived walking ability. Gait function of people not using AFOs was determined by lower limb muscle function. People prescribed AFOs, those who do not wear them and those not prescribed AFOs were similar in presentation, suggesting that people choose to wear orthoses when their condition becomes sufficiently severe.
踝足矫形器（AFO）常用于治疗夏科-马里-图思病（CMT）患者。但目前几乎没有证据可指导矫形器处方的类型和时机。本研究通过调查日常活动中佩戴AFO的CMT病患者（n = 11）与未佩戴者（n = 21）在表现和步态功能上的差异，探讨了后一个问题。目的是了解经常佩戴AFO的人群在特征上是否存在差异。
步态功能的主要测量指标为10米定时步行（舒适速度和最大速度）和6分钟步行试验。使用独立t检验比较变量的均值。次要测量指标包括疾病严重程度、下肢肌肉力量、感觉障碍、步行用力程度、疲劳严重程度和自我感知步行能力。
佩戴AFO的患者步行速度较慢且用力程度更高。他们的疾病严重程度也更高，腿部肌肉较弱，且自我感知步行困难更大。未佩戴AFO的受试者在步态变量与肌肉力量之间显示出显著关系，而佩戴AFO的患者在步态变量与自我感知步行能力、疲劳严重程度和用力程度之间显示出显著关系。
经常佩戴AFO的患者受影响更严重，最大步行速度较慢，步行能量消耗更高，自我感知步行能力更差。该组患者的步行能力与疲劳、步行时的自我感知用力程度和自我感知步行能力有关。未使用AFO的患者的步态功能由下肢肌肉功能决定。已开具AFO处方的患者、未佩戴AFO的患者和未开具AFO处方的患者在表现上相似，这表明当病情变得足够严重时，患者会选择佩戴矫形器。
