Arazpour M, Samadian M, Ebrahimzadeh K, Ahmadi Bani M, Hutchins S W
Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Spinal Cord. 2016 Jun;54(6):412-22. doi: 10.1038/sc.2015.238. Epub 2016 Feb 9.
Orthoses for various joints sections are considered to greatly influence the gait function and energy expenditure in spinal cord-injured (SCI) patients. The aim of this review was to determine the influence of orthoses characteristics and options on the improvement of walking in patients with SCI.
A search was performed using the Population Intervention Comparison Outcome (PICO) method, based on selected keywords; studies were identified electronically in the Science Direct, Google Scholar, Scopus, Web of Knowledge and PubMed databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to report the results. Assessment of the quality of all articles was performed based on the Physiotherapy Evidence Database (PEDro scale).
Twelve studies evaluated the effects of different hip joint options on walking parameters and energy expenditure. Five studies investigated the role of knee joint options on gait parameters and compensatory trunk motion. Only five studies analyzed modified ankle joints on gait parameters in SCI patients. Nine studies analyzed gait parameters in SCI patients as powered orthoses and exoskeleton. These studies had a low level of evidence according to the PEDro score (2/10).
The various joint types of orthoses appear to be critical in the improvement of walking in patients with SCI. In particular, 'user friendly' orthoses that support the related structure such as the hip joint with a reciprocating mechanism, activated knee joint and movable ankle joint with dorsiflexion assist enable SCI patients to optimize their walking pattern when wearing an orthoses system.
各种关节部位的矫形器被认为对脊髓损伤（SCI）患者的步态功能和能量消耗有很大影响。本综述的目的是确定矫形器的特性和选择对改善SCI患者步行能力的影响。
采用人群干预对照结局（PICO）方法，根据选定的关键词进行检索；通过电子方式在科学Direct、谷歌学术、Scopus、知识网络和PubMed数据库中识别研究。采用系统评价和Meta分析的首选报告项目（PRISMA）方法报告结果。基于物理治疗证据数据库（PEDro量表）对所有文章的质量进行评估。
12项研究评估了不同髋关节选择对步行参数和能量消耗的影响。5项研究调查了膝关节选择对步态参数和代偿性躯干运动的作用。只有5项研究分析了改良踝关节对SCI患者步态参数的影响。9项研究分析了SCI患者作为动力矫形器和外骨骼的步态参数。根据PEDro评分，这些研究的证据水平较低（2/10）。
各种关节类型的矫形器似乎对改善SCI患者的步行能力至关重要。特别是，“用户友好型”矫形器通过往复机构支撑相关结构，如髋关节，激活膝关节和带有背屈辅助的可移动踝关节，使SCI患者在佩戴矫形器系统时能够优化其步行模式。
