理解针对脑卒中后个体的被动动态踝足矫形器弯曲刚度进行定量处方的效果。
Understanding the effects of quantitatively prescribing passive-dynamic ankle-foot orthosis bending stiffness for individuals after stroke.
机构信息
University of Delaware, Newark, DE.
出版信息
Prosthet Orthot Int. 2021 Aug 1;45(4):313-321. doi: 10.1097/PXR.0000000000000012.
BACKGROUND
Passive-dynamic ankle-foot orthosis (PD-AFO) bending stiffness, which assists plantar flexor function, can be prescribed to improve poststroke gait. However, outcomes with PD-AFOs are variable likely because of improper personalization. We implemented a prescription model that objectively personalizes PD-AFO bending stiffness based on each individual's level of plantar flexor weakness (quantitatively prescribed PD-AFO).
OBJECTIVES
To evaluate whether a quantitatively prescribed PD-AFO improves peak paretic plantar flexion moment compared with the original AFO for individuals after stroke and to examine the immediate effects of wearing a quantitatively prescribed PD-AFO.
STUDY DESIGN
This is a repeated-measures study.
METHODS
PD-AFO bending stiffness was personalized for 10 individuals after stroke through the previously developed prescription model. Participants underwent an instrumented gait analysis while wearing their original AFO and the quantitatively prescribed PD-AFO.
RESULTS
Participants' peak paretic plantar flexion moment significantly increased while wearing the quantitatively prescribed PD-AFO compared with the original AFO. In addition, participants showed different levels of improvements in a series of other key biomechanical and walking performance parameters with PD-AFO use. Some participants showed improvements in all parameters, whereas others showed moderate to no improvements.
CONCLUSIONS
Quantitatively prescribed PD-AFO bending stiffness resulted in inconsistent improvements in biomechanical and walking performance parameters, which warrants further investigation. Future work should investigate whether more consistent benefits are seen with faster walking speeds and longer-term PD-AFO use. In addition, future work should conduct larger-scale studies that aim to understand and optimize orthosis-patient matching for all AFO designs/characteristics.
背景
被动式动态踝足矫形器（PD-AFO）的弯曲刚度有助于跖屈肌功能，可用于改善脑卒中后的步态。然而，PD-AFO 的效果因人而异，这可能是因为矫形器的个性化定制不当。我们实施了一种基于个人跖屈肌无力程度的客观 PD-AFO 弯曲刚度个性化定制方案（定量 PD-AFO）。
目的
评估与原始 AFO 相比，定量 PD-AFO 是否可以改善脑卒中后个体的患足最大跖屈力矩，并研究定量 PD-AFO 即刻佩戴的效果。
研究设计
这是一项重复测量研究。
方法
通过先前开发的处方模型，对 10 名脑卒中患者的 PD-AFO 弯曲刚度进行个性化定制。参与者在佩戴原始 AFO 和定量 PD-AFO 时进行了仪器化步态分析。
结果
与原始 AFO 相比，参与者在佩戴定量 PD-AFO 时患足最大跖屈力矩显著增加。此外，参与者在一系列其他关键生物力学和步行表现参数方面也表现出不同程度的改善。一些参与者在所有参数上都有改善，而另一些则只有适度或没有改善。
结论
定量 PD-AFO 弯曲刚度导致生物力学和步行表现参数的改善不一致，这需要进一步研究。未来的工作应该研究在更快的步行速度和更长期的 PD-AFO 使用情况下是否能看到更一致的益处。此外，未来的工作应该进行更大规模的研究，旨在了解和优化所有 AFO 设计/特点的矫形器-患者匹配。
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