Nsenga Leunkeu Angeline, Lelard Thierry, Shephard Roy J, Doutrellot Pierre-Louis, Ahmaidi Said
Laboratoire de Recherche EA: 3300 "Adaptations Physiologiques á l'Exercice et Réadaptation á l'Effort", Faculté des Sciences du Sport, Université de Picardie Jules Verne, Amiens, France.
Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
NeuroRehabilitation. 2014;35(4):657-63. doi: 10.3233/NRE-141163.
Information on altered foot pressures during ambulation would clarify how far limb deformities modify walking patterns in cerebral palsy (CP), and whether such data can inform prognosis and guide rehabilitation.
To compare patterns of plantar pressures during walking between children with CP and their able-bodied (AB) peers.
Twenty-five children/adolescents (10 with hemiplegia, 5 with diplegia, and 10 AB, respective ages 13.0 ± 1.9, 13.0 ± 0.6 and 14.0 ± 0.7 years) walked a 12 m line at a self-selected speed. Spatio-temporal parameters and peak in-shoe plantar pressures were recorded for both feet, using the Parotec analysis system.
Walking speeds (m·-1) differed significantly between groups (0.65 ± 0.13, hemiplegia, 0.93 ± 0.22 diplegia and 1.26 ± 0.05 AB), with shorter stride lengths in CP. Contact time, double support time and step duration were also shorter in hemiplegia. Plantar pressures differed substantially and consistently between AB and CP, with increased medial heel pressures in hemiplegia, and reduced hallux and lateral heel pressures but increased lateral, medial mid-foot and first metatarsal pressures in diplegia.
Substantial alterations in spatio-temporal parameters (greater in hemiplegia than in diplegia) and plantar pressure distribution reflect attempts to compensate for poor stability of posture in CP. Further study of these adaptive changes holds clinical promise in providing data relevant to the design of orthotics, determinations of prognosis and the planning of neurorehabilitation.
有关行走过程中足部压力改变的信息将阐明肢体畸形在多大程度上改变脑瘫（CP）患者的行走模式，以及此类数据是否能为预后提供参考并指导康复治疗。
比较脑瘫患儿与健全同龄人行走时的足底压力模式。
25名儿童/青少年（10名偏瘫患者、5名双瘫患者和10名健全者，年龄分别为13.0±1.9岁、13.0±0.6岁和14.0±0.7岁）以自我选择的速度沿12米直线行走。使用Parotec分析系统记录双脚的时空参数和鞋内足底压力峰值。
各组之间的行走速度（米·秒⁻¹）差异显著（偏瘫组为0.65±0.13，双瘫组为0.93±0.22，健全组为1.26±0.05），脑瘫患者的步幅较短。偏瘫患者的接触时间、双支撑时间和步长也较短。健全者与脑瘫患者之间的足底压力存在显著且持续的差异，偏瘫患者的内侧足跟压力增加，双瘫患者的拇趾和外侧足跟压力降低，但外侧、内侧中足和第一跖骨压力增加。
时空参数（偏瘫患者比双瘫患者变化更大）和足底压力分布的显著改变反映了脑瘫患者为补偿姿势稳定性差而做出的努力。对这些适应性变化的进一步研究有望为矫形器设计、预后判定和神经康复规划提供相关数据，具有临床应用前景。
