Lehmann J F, Condon S M, Price R, deLateur B J
Department of Rehabilitation Medicine, University of Washington, Seattle 98195.
Arch Phys Med Rehabil. 1987 Nov;68(11):763-71.
Hemiparetic gait is characterized by slow speed and poorly coordinated movements. Because the values of gait parameters vary with changes in speed, the slow speed that is typical of hemiparetic gait necessitates applying controls for the influence of speed when comparing hemiparetic and able-bodied persons. Gait kinetics and kinematics were measured in seven hemiparetic and seven able-bodied adults to compare their gait patterns at similar speeds and to assess the effectiveness of ankle-foot orthoses which were double-stopped in 5 degrees of dorsiflexion or 5 degrees of plantarflexion. Hemiparetic persons ambulating without the orthoses had a shorter step length, longer duration stance, and shorter duration swing than normal. They displayed greater than normal flexion of the affected hip during midstance, which, by putting the center of mass farther in front of the knee, may explain the increased knee extension moment due to vertical force. Affected hip adduction during single support was less in hemiparetic persons than in able-bodied persons, indicating a decreased lateral shift to the paretic side. During the swing phase, the affected limbs of hemiparetic persons were in less knee flexion and less dorsiflexion than normal, necessitating circumduction to achieve toe clearance. Ankle-foot orthoses increased walking speed to normalize heelstrike duration through use of an optimally adjusted plantarflexion stop. An improperly adjusted orthosis may produce an exaggerated knee flexion moment resulting in knee instability.
偏瘫步态的特点是速度缓慢且动作协调性差。由于步态参数的值会随速度变化，偏瘫步态典型的缓慢速度使得在比较偏瘫患者和健全人时需要控制速度的影响。对7名偏瘫成年人和7名健全成年人进行了步态动力学和运动学测量，以比较他们在相似速度下的步态模式，并评估在背屈5度或跖屈5度时双止动的踝足矫形器的有效性。未使用矫形器行走的偏瘫患者步长较短，站立期较长，摆动期较短。他们在站立中期患侧髋关节的屈曲大于正常情况，这通过将重心置于膝关节前方更远的位置，可能解释了垂直力导致的膝关节伸展力矩增加。偏瘫患者在单支撑期患侧髋关节内收比健全人少，表明向患侧的侧向移位减少。在摆动期，偏瘫患者患侧肢体的膝关节屈曲和背屈比正常情况少，需要划圈动作以实现足趾离地。踝足矫形器通过使用最佳调整的跖屈止动装置提高行走速度，使足跟触地持续时间正常化。调整不当的矫形器可能会产生过度的膝关节屈曲力矩，导致膝关节不稳定。
