Stallard J, Major R E
Orthotic Research & Locomotor Assessment Unit (ORLAU), Robert Jones & Agnes Hunt Hospital NHS Trust, Oswestry, Shropshire, UK.
Prosthet Orthot Int. 1995 Aug;19(2):108-14. doi: 10.3109/03093649509080352.
This study examines the evidence which supports the importance of maintaining relative abduction for effective reciprocal walking in high level paraplegic patients. In comparisons of orthoses, where this can only be achieved mechanically, those with higher lateral rigidity consistently showed greater levels of walking efficiency. The influence on hybrid systems of functional electrical stimulation (FES) of the gluteal muscles, where the primary function is to maintain abduction, also showed reductions in overall energy cost, reductions in upper limb effort, or both. Examination of the effect of increasing lateral rigidity of a purely mechanical orthosis by 10% showed that significant energy cost reductions were achieved (30% reduction in Physiological Cost Index) for patients with thoracic lesions experienced in reciprocal walking. A review of FES research suggested that for the modern healthcare sector the cost effectiveness of purely mechanical systems make them an attractive means of routinely providing the functional and therapeutic benefits of walking for high level paraplegic patients. In the prevailing climate of strict budgetry control a case is made for concentrating more research resources on improving still further walking efficiency, and resolving the outstanding problems of functionality and cosmesis in such systems for reciprocal walking.
本研究考察了支持维持相对外展对高位截瘫患者有效交互步行重要性的证据。在只能通过机械方式实现这一点的矫形器比较中，具有较高侧向刚度的矫形器始终显示出更高的步行效率水平。对臀肌功能性电刺激（FES）的混合系统的影响，其主要功能是维持外展，也显示出总体能量消耗降低、上肢用力减少或两者皆有。对纯机械矫形器侧向刚度增加10%的效果进行检查表明，对于有交互步行经验的胸段损伤患者，可实现显著的能量消耗降低（生理成本指数降低30%）。对FES研究的综述表明，对于现代医疗保健部门而言，纯机械系统的成本效益使其成为为高位截瘫患者常规提供步行功能和治疗益处的一种有吸引力的手段。在当前严格预算控制的环境下，有理由将更多研究资源集中在进一步提高步行效率，以及解决此类交互步行系统中功能和美观方面的突出问题上。
