From the Department of Rehabilitation, Nanjing Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China (XZ, HL, SD); and Department of Rehabilitation Center, Children's Hospital of Chongqing Medical University, Chongqing, China (NX).
Am J Phys Med Rehabil. 2013 Oct;92(10):905-11. doi: 10.1097/PHM.0b013e318296e3e8.
The aim of this study was to compare the effectiveness of treatment with hinged ankle-foot orthoses (AFOs) during the day vs. during both the day and the night in young ambulant children with spastic diplegia.
In this prospective randomized controlled trial, 112 ambulatory children (70 boys and 42 girls; mean age, 2 yrs 6.93 mos; range, 1 yr 1 mo to 4 yrs 0 mo) with spastic diplegia participated. Forty-eight were classified at level I of the Gross Motor Function Classification System; the remaining 64 were at level II. Using stratified randomization, all children were assigned to either the day AFO-wearing group (n = 56, wearing AFOs all day) or the day-night AFO-wearing group (n = 56, wearing AFOs all day and all night). The two groups underwent conventional rehabilitative treatments five times a week for 8 wks. The primary outcomes measured were passive ankle dorsiflexion angle and sections D and E of the 66-item Gross Motor Function Measure; the root mean square of surface electromyography in the ventral and dorsal lower limb muscles was compared in a subgroup (ten from each group).
Seven children did not complete the full intervention: three in the day AFO-wearing group and four in the day-night AFO-wearing group. Significant baseline-postintervention improvements were found for passive ankle dorsiflexion angle and the 66-item Gross Motor Function Measure in both groups (P < 0.05). On the basis of the score changes, there was no significant difference between these two groups with respect to passive ankle dorsiflexion angle; however, the improvements in the 66-item Gross Motor Function Measure were significantly better in the day AFO-wearing group (P < 0.01). A significant root mean square decrease in gastrocnemius (P < 0.05) was present after the intervention in the day AFO-wearing group, whereas the muscles affected in the day-night AFO-wearing group were the gastrocnemius (P < 0.05) and the tibialis anterior (P < 0.001).
The results demonstrate that the daytime use of AFOs was more effective in improving Gross Motor Function Measure scores than the day-night use. In addition, the prolonged wearing of AFOs may influence muscle activity, which should be monitored in the clinic.
本研究旨在比较铰链踝足矫形器（AFO）白天治疗与全天治疗（白天加夜间）对痉挛性双瘫年轻步行儿童的疗效。
在这项前瞻性随机对照试验中，112 名痉挛性双瘫的可步行儿童（70 名男孩和 42 名女孩；平均年龄 2 岁 6.93 个月；范围 1 岁 1 个月至 4 岁 0 个月）参与了研究。48 名儿童被分类为运动功能分类系统 I 级；其余 64 名儿童为 II 级。使用分层随机化，所有儿童均被分配至白天 AFO 穿戴组（n=56，全天穿戴 AFO）或白天-夜间 AFO 穿戴组（n=56，全天和夜间穿戴 AFO）。两组均接受每周 5 次的常规康复治疗，共 8 周。主要观察指标为被动踝关节背屈角度和 66 项粗大运动功能测量的 D 节和 E 节；在一个亚组（每组 10 名）比较了下肢腹侧和背侧肌肉的表面肌电图均方根。
7 名儿童未完成完整干预：白天 AFO 穿戴组 3 名，白天-夜间 AFO 穿戴组 4 名。两组的被动踝关节背屈角度和 66 项粗大运动功能测量在干预后均有显著的基线后改善（P<0.05）。基于评分变化，两组在被动踝关节背屈角度方面没有显著差异；然而，白天 AFO 穿戴组的 66 项粗大运动功能测量的改善明显更好（P<0.01）。白天 AFO 穿戴组在干预后腓肠肌的均方根显著下降（P<0.05），而白天-夜间 AFO 穿戴组受影响的肌肉是腓肠肌（P<0.05）和胫骨前肌（P<0.001）。
结果表明，白天使用 AFO 对提高粗大运动功能测量评分比全天使用更有效。此外，长时间佩戴 AFO 可能会影响肌肉活动，应在临床中进行监测。
