Nikamp Corien D M, van der Palen Job, Hermens Hermie J, Rietman Johan S, Buurke Jaap H
Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands; Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
Medisch Spectrum Twente, Medical School Twente, P.O. Box 50 000, 7500 KA, Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
Gait Posture. 2018 Jun;63:260-267. doi: 10.1016/j.gaitpost.2018.05.012. Epub 2018 May 16.
Compensatory pelvis, hip- and knee movements are reported after stroke to overcome insufficient foot-clearance. Ankle-foot orthoses (AFOs) are often used to improve foot-clearance, but the optimal timing of AFO-provision post-stroke is unknown. Early AFO-provision to prevent foot-drop might decrease the development of compensatory movements, but it is unknown whether timing of AFO-provision affects post-stroke kinematics.
An explorative randomized controlled trial was performed, including unilateral hemiparetic patients maximal six weeks post-stroke with indication for AFO-use. Subjects were randomly assigned to AFO-provision early (at inclusion) or delayed (eight weeks later). 3D gait-analysis with and without AFO was performed in randomized order. Measurements were performed in study-week 1, 9, 17 and 26.
Twenty-six subjects (15 early, 11 delayed) were analyzed. After 26 weeks, no differences in kinematics were found between both groups for any of the joint angles, both for the without and with AFO-condition. Changes in kinematics during the 26-weeks follow-up period did not differ between both groups for any of the joint angles during walking without AFO. Significant differences in changes in walking speed during the 26-weeks follow-up were found (p = 0.034), corresponding to the first eight weeks after AFO-provision.
Results indicate that early or delayed AFO-use post-stroke does not influence pelvis, hip and knee movements after 26 weeks, despite that AFO-use properly corrected drop-foot. AFOs should be provided to improve drop-foot post-stroke, but not with the intention to influence development of compensatory patterns around pelvis and hip.
据报道，中风后会出现代偿性骨盆、髋部和膝部运动，以克服足部间隙不足的问题。踝足矫形器（AFO）常用于改善足部间隙，但中风后佩戴AFO的最佳时机尚不清楚。早期佩戴AFO以预防足下垂可能会减少代偿性运动的发展，但尚不清楚佩戴AFO的时机是否会影响中风后的运动学。
1）比较在两个不同时间点（早期与延迟）佩戴AFO对亚急性中风患者的额状骨盆和髋部以及矢状髋部和膝部运动学的影响。在26周后评估效果；2）研究两组在26周随访期间运动学或步行速度的可能变化是否存在差异。
进行了一项探索性随机对照试验，纳入中风后最多六周且有使用AFO指征的单侧偏瘫患者。受试者被随机分配为早期（纳入时）或延迟（八周后）佩戴AFO。按随机顺序进行有AFO和无AFO时的三维步态分析。在研究的第1、9、17和26周进行测量。
分析了26名受试者（15名早期佩戴，11名延迟佩戴）。26周后，在无AFO和有AFO的情况下，两组之间的任何关节角度在运动学上均未发现差异。在无AFO行走期间，两组之间的任何关节角度在26周随访期间的运动学变化均无差异。发现在26周随访期间步行速度变化存在显著差异（p = 0.034），这与佩戴AFO后的前八周相对应。
结果表明，中风后早期或延迟使用AFO在26周后不会影响骨盆、髋部和膝部运动，尽管使用AFO可有效纠正足下垂。应提供AFO以改善中风后的足下垂，但并非旨在影响骨盆和髋部周围代偿模式的发展。
