Stallard J, Major R E, Farmer S E
Orthotic Research and Locomotor Assessment Unit (ORLAU), Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, UK.
Prosthet Orthot Int. 1996 Aug;20(2):122-8. doi: 10.3109/03093649609164429.
Whereas walking for paraplegic patients is now a routine clinical option, ambulation for heavily handicapped cerebral palsy patients is less well established. There are good reasons for supposing that therapeutic benefits similar to that achieved with paraplegic patients are possible for this group. However, the biomechanical problems which must be overcome are different and in many ways more difficult to address. The most important factors are identified as appropriate truncal support, control of abduction/adduction, rotation and flexion range at the hip, and of knee flexion. A means of applying these controls is described as being a combination of a walking frame and orthosis. The special walking frame provides adjustable support at thoracic, abdominal and sacral levels and incorporates castor steering and upper limb support. Controls on lower limb movements are applied through a special orthosis which has a readily available variation of specification to accommodate the wide range of conditions met in cerebral palsy. Practical application of a prototype system has shown that it can enable patients to walk unaided. However, in most cases it was used indoors only. Evaluation of the experience in applying the system has enabled the fundamental principles to permit more practical applications to be defined.
虽然步行对于截瘫患者来说现在已是一种常规的临床选择，但对于重度残疾的脑瘫患者而言，行走功能的确立程度较低。有充分理由认为，该群体有可能获得与截瘫患者类似的治疗效果。然而，必须克服的生物力学问题有所不同，而且在很多方面更难解决。最重要的因素包括适当的躯干支撑、控制髋关节的外展/内收、旋转和屈曲范围，以及膝关节的屈曲。一种应用这些控制的方法被描述为步行架和矫形器的组合。这种特殊的步行架在胸部、腹部和骶部提供可调节支撑，并集成了脚轮转向和上肢支撑。下肢运动控制通过一种特殊的矫形器实现，该矫形器有多种规格可供选择，以适应脑瘫患者遇到的各种情况。一个原型系统的实际应用表明，它可以使患者独立行走。然而，在大多数情况下，它仅在室内使用。对应用该系统的经验进行评估，使得能够确定基本原则，以实现更实际的应用。
