Motion Analysis Center, Shriners Hospitals for Children, Portland, OR 97239, USA.
School of Physical Therapy and Athletic Training, Pacific University, Hillsboro, Oregon, USA.
Phys Ther. 2021 Mar 3;101(3). doi: 10.1093/ptj/pzab003.
This study demonstrated the use of computerized motion analysis to assist in evidence-based clinical decision-making.
A 15-year-old girl who had right hemiparesis after a stroke was referred for 3-dimensional computerized motion analysis to determine the effect of 3 devices intended to control her dropfoot and to assist in developing a treatment plan. Four conditions were tested and compared: barefoot, lateral support ankle brace, functional electrical stimulation (FES) device, and dropfoot cuff.
Kinematics showed the right ankle had significant dropfoot during swing phase (32.7 degrees of plantarflexion at terminal swing) in barefoot. The lateral support ankle brace, FES device, and dropfoot cuff reduced terminal swing plantarflexion to 27.2 degrees, 17.6 degrees, and 15.3 degrees, respectively, though ankle kinematics remained abnormal because of inadequate dorsiflexion. Improvements in gait variable score with FES (-8.2 degrees) or dropfoot cuff (-8.7 degrees) were significantly more than that with the lateral support brace (-2.2 degrees), and the difference in gait variable score between FES and dropfoot cuff was insignificant. Compared with the barefoot condition, the lateral support brace condition did not show a clinically significant difference in gait profile score; however, the gait profile scores of both FES and dropfoot cuff conditions showed clinically significant improvement (-1.7 degrees and -2.1 degrees, respectively).
Objective data delineated subtle changes among 3 devices and led to the recommendation to discontinue the lateral support ankle brace, continue using her night ankle-foot orthosis and FES device, with the dropfoot cuff as a backup when she feels leg fatigue or skin irritation, and consider serial casting or surgical calf lengthening.
Computerized motion analysis provides quantitative evaluation of subtle differences in the effect of braces with different designs, which are hard for the human eye to discern. The objective data inform and validate treatment decision-making. The recommendations were made as a result of evidence-based practice.
本研究展示了计算机运动分析在基于证据的临床决策中的应用。
一名 15 岁女孩中风后出现右侧偏瘫，为了确定 3 种旨在控制其马蹄内翻足的装置的效果并协助制定治疗计划，对其进行了 3 维计算机运动分析。测试并比较了 4 种情况：赤脚、外侧支撑踝足矫形器、功能性电刺激（FES）装置和马蹄内翻足套。
运动学显示，在赤脚状态下，右侧踝关节在摆动末期出现明显的马蹄内翻（终末摆动时跖屈 32.7°）。外侧支撑踝足矫形器、FES 装置和马蹄内翻足套分别将终末摆动跖屈减少到 27.2°、17.6°和 15.3°，但由于背屈不足，踝关节运动仍呈异常。FES（-8.2°）或马蹄内翻足套（-8.7°）改善步态变量评分明显高于外侧支撑支具（-2.2°），FES 和马蹄内翻足套之间的步态变量评分差异无统计学意义。与赤脚状态相比，外侧支撑支具状态在步态轮廓评分上没有显示出临床显著差异；然而，FES 和马蹄内翻足套两种状态的步态轮廓评分都显示出了临床显著的改善（分别为-1.7°和-2.1°）。
客观数据描述了 3 种装置之间的细微变化，并建议停用外侧支撑踝足矫形器，继续使用夜间踝足矫形器和 FES 装置，当她感到腿部疲劳或皮肤刺激时，使用马蹄内翻足套作为备用，并考虑连续塑形或手术小腿延长。
计算机运动分析提供了定量评估不同设计支具效果的细微差异的方法，而这些差异是肉眼难以察觉的。客观数据为治疗决策提供了信息和验证。这些建议是基于循证实践做出的。
