在脑瘫和特发性足尖行走人群中，使用踝足矫形器是否会影响行走过程中的动态运动控制指标？

Does use of ankle foot orthoses affect the dynamic motor control index during walking in cerebral palsy and idiopathic toe walking populations?

作者信息

Saraswat Prabhav, Carson Lisa T, Shull Emily R, Hyer Lauren C, Westberry David E

机构信息

Shriners Children's, Motion Analysis Center, Greenville, SC, USA.

出版信息

Gait Posture. 2023 May;102:100-105. doi: 10.1016/j.gaitpost.2023.03.007. Epub 2023 Mar 11.

DOI:10.1016/j.gaitpost.2023.03.007

PMID:36958157

Abstract

BACKGROUND

The dynamic motor control (walk-DMC) index during walking is a measure of the complexity of muscle activation pattern. Ankle Foot Orthoses (AFO) are frequently used to improve the gait of children with Cerebral Palsy (CP) and Idiopathic Toe Walking (ITW). The purpose of this study was to assess the change in walk-DMC index secondary to AFO use.

RESEARCH QUESTION

Does the change in walk-DMC reflect the change in walking kinematics with the use of AFO.

METHODS

Individuals with diagnosis of CP or ITW with gait analysis data available for barefoot and AFO condition were retrospectively identified. For each individual, the walk-DMC index, Gait Deviation Index (GDI) and Gait Variable Scores (GVS) of knee and ankle kinematics were computed for BF and AFO conditions. Paired t-tests were used to compare key variables between BF and AFO conditions. Multi-variate stepwise regression analysis was performed to identify variables that may predict the increase in walk-DMC between BF and AFO condition.

RESULTS

253 individuals were included in the study. For CP individuals (n = 208), statistically significant but quantitatively minimal improvement was observed in walk-DMC (1 ± 9), GDI (2 ± 9) and ankle GVS (2 ± 7). For ITW individuals (n = 45), larger improvements were observed in walk-DMC (11 ± 13), GDI (9 ± 11) and ankle GVS (6 ± 7). Diagnosis of ITW, use of Solid-AFO and Posterior Leaf Spring-AFO were the significant predictor of increase in walk-DMC with AFO. Higher ankle GVS at BF condition (larger deviation from TD) led to larger increase in walk-DMC. Higher knee GVS (larger deviation from TD) led to smaller increase in walk-DMC.

SIGNIFICANCE

Use of AFO can lead to improvement in walking kinematics that is reflected in increase in walk-DMC with AFO compared to BF for ITW individuals. The change in kinematics and walk-DMC with use of AFO was minimal for CP individuals.

摘要

背景

步行过程中的动态运动控制（walk-DMC）指数是衡量肌肉激活模式复杂性的指标。踝足矫形器（AFO）常用于改善脑瘫（CP）和特发性足尖行走（ITW）儿童的步态。本研究的目的是评估使用AFO后继发的walk-DMC指数变化。

研究问题

walk-DMC的变化是否反映了使用AFO时步行运动学的变化。

方法

回顾性确定有CP或ITW诊断且有裸足和AFO条件下步态分析数据的个体。对于每个个体，计算其在裸足（BF）和AFO条件下的walk-DMC指数、步态偏差指数（GDI）以及膝关节和踝关节运动学的步态变量评分（GVS）。采用配对t检验比较BF和AFO条件下的关键变量。进行多变量逐步回归分析以确定可能预测BF和AFO条件下walk-DMC增加的变量。

结果

253名个体纳入研究。对于CP个体（n = 208），在walk-DMC（1±9）、GDI（2±9）和踝关节GVS（2±7）方面观察到有统计学意义但在数量上极小的改善。对于ITW个体（n = 45），在walk-DMC（11±13）、GDI（9±11）和踝关节GVS（6±7）方面观察到更大的改善。ITW诊断、使用实心AFO和后叶弹簧AFO是使用AFO时walk-DMC增加的显著预测因素。BF条件下较高的踝关节GVS（与正常发育差异较大）导致walk-DMC增加幅度更大。较高的膝关节GVS（与正常发育差异较大）导致walk-DMC增加幅度较小。