佩戴踝足矫形器对痉挛型脑性瘫痪儿童足底压力步态的作用

背景:由于设计及方法的差异,佩戴蹀足矫形器对脑性瘫痪(脑瘫)儿童步行时运动学、运动力学、能耗等各方面的影响尚未取得统一的结果.目的:观察佩戴踝足矫形器对痉挛型脑瘫患儿足底压力步态特征的影响.方法:采用足底压力式步态分析系统对21例具有独立步行能力的痉挛型脑瘫儿童进行步态分析.分别记录同一天内、同一时间段、同一种身体状态下不佩戴踝足矫形器及佩戴踝足矫形器步行时每例脑瘫患儿足底压力式步态分析数据,包括时间参数、运动学参数以及各参数的绝对对称性指标,并进行对比.记录双足的足底压力重心偏移轨迹作为步行能力的定性直观观察指标,对比佩戴支具前后的足底压力重心偏移轨迹图并做对照描述.结果与结论:与未佩戴踝足矫形器相比,佩戴踝足矫形器使痉挛型脑瘫患儿步态周期时间缩短,步频增加(P<0.01).佩戴踝足矫形器步行时脑瘫儿童单足支撑期、单侧支撑期、单足摆动期、步态周期时间的绝对对称性指标值均较未佩戴矫形器时显著减少(P<0.05).痉挛型脑瘫儿童步行时双足的足底压力重心偏移轨迹表现出无序的特性,不能形成左右对称的蝴蝶状轨迹图.佩戴踝足矫形器后,足底压力中心偏移轨迹比未佩戴时有序,尖足步态患儿佩戴踝足矫形器后患足的足底压力偏移轨迹起始点后移.结果提示痉挛型脑瘫儿童佩戴踝足矫形器后步态周期时间缩短,步频增加,步态对称性改善,总体步行能力得到提高.足底压力式步态分析系统能以客观精确的数据和直观的图表表达,是评定脑瘫儿童步行能力的一种新型测试手段.

Effects of ankle-foot orthosis on gait characteristic in children with spastic cerebral palsy

BACKGROUND: Due to differences in designs and methods,the results of effects of ankle foot orthosis(AFO)on kinematics,kinetics and energy consumption during walking in children with cerebral palsy remain controversial.OBJECTIVE: To explore the effects of AFO on gait characteristics in children with spastic cerebral palsy.METHODS: A total of 21 ambulatory children with cerebral palsy were selected.A plantar pressure gait analysis system was used to perform plantar pressure gait analysis tests of participants when walking with an AFO and without an AFO at the same time of one day,under the same physical condition.All plantar pressure data were recorded,including cadence,cycle time of gait,absolute symmetry index(ASI)of each gait phase,and visualized pressure diagram including dynamic plantar pressure diagram and Center of Gravity's transfer track diagram.Visualized pressure diagrams were described and analyzed.RESULTS AND CONCLUSION: Gait cycle time was shortened in the children walking with an AFO compared with walking without an AFO(P< 0.01).ASI of single-foot supporting phase,swing phase,double-foot supporting phase and gait cycle time of children walking with AFO was significantly reduced compared with children walking without AFO(P < 0.05).Center of Gravity's transfer track diagram of children with cerebral palsy was disordered and could not show as butterfly-shape graphics with good symmetry.After wearing an AFO,the diagram became more ordered.Results show that when wearing an AFO,the gait cycle time in gait was shortened,and the cadence was increased; the symmetry of gait was improved,and the general walking ability was increased.Plantar pressure gait analysis technology can be effectively applied to evaluate the balancing ability of children with spastic cerebral palsy in gait using accurate data and visualized diagrams.