Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA.
School of Kinesiology, University of Michigan, Ann Arbor, MI 48109, USA.
Gait Posture. 2019 Mar;69:101-111. doi: 10.1016/j.gaitpost.2019.01.020. Epub 2019 Jan 15.
Ankle-foot orthoses (AFOs) are commonly prescribed to provide ankle support during walking. Current prescription standards provide general guidelines for choosing between AFO types, but are limited in terms of guiding specific design parameter choices. These design parameters affect the ankle stiffness of the AFO.
The aim of this review was to investigate the impact of AFO stiffness on walking mechanics.
A literature search was conducted using three databases: Pubmed, Engineering Village, and Web of Science.
After applying the exclusion criteria, 25 of 287 potential articles were included. The included papers tested a range of stiffnesses (0.02-8.17 Nm/deg), a variety of populations (e.g. healthy, post-stroke, cerebral palsy) and various gait outcome measures. Ankle kinematics were the most frequently reported measures and the most consistently affected by stiffness variations. Greater stiffnesses generally resulted in reduced peak ankle plantarflexion, dorsiflexion, and total range of motion, as well as increased dorsiflexion at initial contact. At the knee, a few studies reported increased flexion at initial contact, and decreased peak extension and increased peak flexion during stance when stiffness was increased. Stiffness did not affect hip kinetics and there was low evidence for its effects on hip or pelvis kinematics, ankle and knee kinetics, muscle activity, metabolic cost, ground reaction forces and spatiotemporal parameters. There were no generalizable trends for the impact of stiffness on user preference.
AFO stiffness is a key factor influencing ankle movement. Clear reporting standards for AFO design parameters, as well as additional high quality research is needed with larger sample sizes and different clinical populations to ascertain the true effect of stiffness on gait.
踝足矫形器（AFO）常用于在行走时提供踝关节支撑。目前的处方标准为 AFO 类型的选择提供了一般指南，但在指导特定设计参数选择方面存在局限性。这些设计参数会影响 AFO 的踝关节刚度。
本综述的目的是研究 AFO 刚度对步行力学的影响。
使用三个数据库（Pubmed、Engineering Village 和 Web of Science）进行文献检索。
在应用排除标准后，从 287 篇潜在文章中筛选出 25 篇。纳入的文献测试了一系列刚度（0.02-8.17 Nm/deg），涵盖了各种人群（如健康人、中风后患者、脑瘫患者）和各种步态结果测量指标。踝关节运动学是最常报告的测量指标，也是受刚度变化影响最一致的指标。较大的刚度通常会导致峰值踝关节跖屈、背屈和总活动范围减小，以及初始接触时背屈增加。在膝关节方面，少数研究报告称初始接触时膝关节屈曲增加，站立时峰值伸展减少，峰值屈曲增加。刚度不影响髋关节动力学，刚度对髋关节或骨盆运动学、踝关节和膝关节动力学、肌肉活动、代谢成本、地面反作用力和时空参数的影响证据不足。刚度对用户偏好的影响没有普遍的趋势。
AFO 刚度是影响踝关节运动的关键因素。需要明确 AFO 设计参数的报告标准，并进行更多高质量的研究，纳入更大的样本量和不同的临床人群，以确定刚度对步态的真实影响。
