Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.
J Neuroeng Rehabil. 2021 Jun 8;18(1):97. doi: 10.1186/s12984-021-00890-8.
In people with calf muscle weakness, the stiffness of dorsal leaf spring ankle-foot orthoses (DLS-AFO) needs to be individualized to maximize its effect on walking. Orthotic suppliers may recommend a certain stiffness based on body weight and activity level. However, it is unknown whether these recommendations are sufficient to yield the optimal stiffness for the individual. Therefore, we assessed whether the stiffness following the supplier's recommendation of the Carbon Ankle7 (CA7) dorsal leaf matched the experimentally optimized AFO stiffness.
Thirty-four persons with calf muscle weakness were included and provided a new DLS-AFO of which the stiffness could be varied by changing the CA7® (Ottobock, Duderstadt, Germany) dorsal leaf. For five different stiffness levels, including the supplier recommended stiffness, gait biomechanics, walking energy cost and speed were assessed. Based on these measures, the individual experimentally optimal AFO stiffness was selected.
In only 8 of 34 (23%) participants, the supplier recommended stiffness matched the experimentally optimized AFO stiffness, the latter being on average 1.2 ± 1.3 Nm/degree more flexible. The DLS-AFO with an experimentally optimized stiffness resulted in a significantly lower walking energy cost (- 0.21 ± 0.26 J/kg/m, p < 0.001) and a higher speed (+ 0.02 m/s, p = 0.003). Additionally, a larger ankle range of motion (+ 1.3 ± 0.3 degrees, p < 0.001) and higher ankle power (+ 0.16 ± 0.04 W/kg, p < 0.001) were found with the experimentally optimized stiffness compared to the supplier recommended stiffness.
In people with calf muscle weakness, current supplier's recommendations for the CA7 stiffness level result in the provision of DLS-AFOs that are too stiff and only achieve 80% of the reduction in energy cost achieved with an individual optimized stiffness. It is recommended to experimentally optimize the CA7 stiffness in people with calf muscle weakness in order to maximize treatment outcomes. Trial registration Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170 .
在小腿肌无力的人群中，背侧叶片式踝足矫形器（DLS-AFO）的硬度需要个性化定制，以最大限度地发挥其对行走的影响。矫形器供应商可能会根据体重和活动水平推荐一定的硬度。然而，尚不清楚这些建议是否足以产生个体的最佳硬度。因此，我们评估了供应商对 Carbon Ankle7（CA7）背侧叶片的建议硬度是否与实验优化的 AFO 硬度相匹配。
纳入 34 名小腿肌无力的患者，并提供了一种新型的 DLS-AFO，其硬度可以通过改变 CA7®（Ottobock，Duderstadt，德国）背侧叶片来改变。对于五个不同的硬度级别，包括供应商推荐的硬度，评估了步态生物力学、行走能量消耗和速度。基于这些指标，选择了个体实验优化的 AFO 硬度。
在 34 名参与者中，只有 8 名（23%）参与者的供应商推荐硬度与实验优化的 AFO 硬度相匹配，后者的平均硬度低 1.2±1.3 Nm/度。具有实验优化硬度的 DLS-AFO 可显著降低行走能量消耗（-0.21±0.26 J/kg/m，p<0.001）和提高速度（+0.02 m/s，p=0.003）。此外，与供应商推荐的硬度相比，实验优化的硬度可使踝关节运动范围增加（+1.3±0.3 度，p<0.001）和踝关节功率增加（+0.16±0.04 W/kg，p<0.001）。
在小腿肌无力的人群中，当前供应商对 CA7 硬度级别的建议导致提供的 DLS-AFO 过于僵硬，仅能达到与个体优化的硬度相同的能量消耗降低 80%。建议在小腿肌无力患者中对 CA7 硬度进行实验优化，以最大限度地提高治疗效果。
荷兰临床试验注册中心 5170. 注册日期：2015 年 5 月 7 日。http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170。
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