步行矫形器在截瘫患者步行能力恢复中的作用

目的通过观察4例完全性截瘫患者配戴步行矫形器(Walkabout)行走功能恢复情况,探讨Walkabout在截瘫患者恢复中的应用价值。方法选择4例典型T10～L1节段完全性脊髓损伤患者,经过转移平衡训练后,装配步行矫形器,再进行步行训练。结果病例1～4佩戴Walkabout及进行功能训练后分别达到:用双肘拐5min步行20m,用助步器233s行走20m,达到功能性步行;用助步器148s行走20m,达到功能性步行;用助步器步行20m,耗时250s;用双走拐步行20m,耗时176s。4例完全性损伤患者均达到功能性步行。结论步行矫形器能帮助T10以下完全性截瘫患者完成功能性步行。     

新型互动式截瘫行走器在截瘫患者中的应用

目的 探讨新型互动式截瘫行走器(walkabout orthosis，WO)对截瘫患者的作用。方法 针对截瘫患者个体差异，制作并装配WO，对患者进行康复治疗及步态训练。结果 患者经过康复治疗及训练后，其Barthel指数明显提高，患者站立及步行能力明显改善，能够达到治疗性步行及家庭性步行。结论 康复治疗可以有效地改善患者的独立生活能力，WO能明显提高截瘫患者的行走能力，是较好的行走器之一。     

Standing performance of persons with paraplegia

This study measures standing stability of four individuals with paraplegia using knee-ankle-foot orthoses (KAFOs) with a center-of-force monitoring platform as compared with similar data from 10 neurologically healthy subjects. Both groups were compared under conditions of quiet standing with eyes open and closed and with hands on and off parallel bars. Individuals with paraplegia were also tested under similar conditions with the ankles of their KAFOs mechanically unlocked and with bilateral functional neuromuscular stimulation of the quadriceps muscles. Sway path, mean amplitude, and mean frequency were measured for each subject. We found that postural stability in paraplegic individuals using KAFOs compared favorably with the control group under conditions of eyes open and closed with hands on parallel bars; however, visual information was much more important for paraplegic individuals during quiet stance. Unlocking the ankles of the KAFOs resulted in an increase in swap path and mean frequency. Functional muscular stimulation of the quadriceps muscles resulted in standing stability slightly less than with KAFOs. Although KAFOs may not be the ideal assistive device for various reasons, postural stability appears reasonable, and other proposed orthoses must be comparable in order to be considered as an alternative.     

Effects of a simple functional electric system and/or a hinged ankle-foot orthosis on walking in persons with incomplete spinal cord injury

OBJECTIVES: To compare the effect of functional electric stimulation (FES) with that of a hinged ankle-foot orthosis (AFO) for assisting foot clearance, gait speed, and endurance and to determine whether there is added benefit in using FES in conjunction with the hinged AFO in persons with incomplete spinal cord injury (SCI). DESIGN: Within-subject comparison of walking under 4 conditions: AFO, FES, AFO and FES, and no orthosis. A plastic hinged AFO was used for all AFO conditions. SETTING: Tertiary rehabilitation center. PARTICIPANTS: Nineteen subjects with incomplete SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The self-selected gait speed, 6-minute walk distance, and foot clearance values were compared between conditions. RESULTS: Gait speed increased with FES ( P <.05) and with the AFO ( P =.06). Six-minute walk distance also increased with the AFO ( P <.05). No difference was found between the 2 forms of orthoses in either gait speed or endurance. The greatest increase in gait speed and endurance from the no-orthosis condition occurred with the combined AFO and FES condition. Foot clearance improved with FES but not with AFO. Subjects whose gait speed increased with FES had weaker hip flexors, knee flexors, and ankle dorsiflexors than those who did not benefit from FES. CONCLUSIONS: Both FES and the hinged AFO promote walking and FES is only superior to the AFO in increasing foot-clearance values. The hinged AFO and FES together may offer advantages over either device alone.     

Decreased energy cost and improved gait pattern using a new orthosis in persons with long-term stroke

OBJECTIVE: To measure energy cost and gait analysis in persons with stroke with and without a newly developed orthosis. DESIGN: Immediate and long-term (3wk) intervention (before-after trial). SETTING: University medical center. PARTICIPANTS: Volunteer sample of 27 persons with long-term (range, 0.6-19y) hemiparetic stroke. INTERVENTION: Three-week familiarization to the new walking aid. MAIN OUTCOME MEASURES: Energy cost (per distance walked), preferred walking speed (PWS), and step length. Energy cost was examined in all subjects while walking on a treadmill at 3 different velocities (PWS, PWS+30%, PWS-30%) during 3 different situations (without orthosis, with orthosis, after 3-wk orthosis familiarization). Spatiotemporal aspects of the gait pattern were examined using a 6-m instrumented walkway system. RESULTS: Using the orthosis immediately decreased energy cost in persons with stroke during walking at the PWS (P<.001) and significantly increased walking speed (P<.005) and step length (P<.001). After 3 weeks of familiarization to the orthosis, energy cost at the PWS and at PWS+30% showed further improvement in energy cost (P<.05). CONCLUSIONS: The newly developed orthosis immediately decreases energy cost and improves walking speed and step length in persons with long-term stroke. After only 3 weeks of orthosis familiarization, energy cost shows additional improvement.     

Ambulation study of a woman with paraplegia using a reciprocating gait orthosis with functional electrical stimulation in Taiwan: A case report

Purpose. Many patients who suffer from spinal cord injuries with paraplegia cannot recover to walk independently. They need to use a special walking orthoses to support their body to walk properly. Traditionally, long leg braces (LLB) were fitted to patients for walking. Unfortunately, the results were not satisfactory as this device supplies adequate support with less than optimum mobility. This study used the latest reciprocating gait orthosis (RGO) combined with functional electrical stimulation (FES). This combination provides a greater support range while applying assistant mechanical walking structures. The FES co-ordination helps restore natural walking abilities that the paralysed patient has lost.

Method. This study developed a walking orthosis with FES, using FES to stimulate specific muscles (quadriceps, hamstring) in the paralysed patients' lower limbs. The proposed method can achieve the benefits of physical therapeutics while paralysed patients can achieve the purpose of walking. The FES is designed with control buttons on the walking orthosis. A patient can control the left or right leg in walking and speed control via the control buttons.

Results. Several practical tests were conducted on the new walking orthosis. A 25-year-old female paralysed patient (L1 complete spinal cord injury) used traditional LLB, RGO and RGO with FES to proceed with walking rehabilitation and clinical assessment. Heart rate difference (HRdifference), mean blood pressure (MBPdifference), walking speed, length of steps, number of steps and oxygen consumption comparisons were made before and after walking. The results show that RGO and RGO with FES were both better than LLB. However, the differences between RGO and RGO with FES in HRdifference, MBPdifference, and walking speed were not significant. This is because the patient's right leg reaction to the electrical stimulation was relatively low.

Discussion and conclusions. In general, RGO can help the patient achieve quicker and more independent walking. The combination of RGO and FES can increase the effectiveness of RGO for more mobile aid. These two walking orthoses are better than traditional LLB. Both methods provide patients who suffer from paraplegia with better choices.     

步行矫形器在截瘫患者康复中的应用

目的：改善截瘫患者的转移能力，促进早日回归社会。方法：先后有4例T10-L1节段脊髓损伤患者，经过转移平衡训练后，配戴步行矫形器（Walkabout），再进行步行训练。结果：4例完全性损伤患者均达到功能性步行。结论：步行矫形器能帮助T10以下完全性截瘫患者完成功能性步行，值得临床推广应用。     

使用助行器械和矫形器步行训练的最新进展

本文介绍了助行器和矫形器在步行训练上最新进展,包括实现功能性电刺激的下肢矫形器、实现截瘫步行的下肢矫形器、重度偏瘫步行重建的下肢矫形器、治疗下肢痉挛的下肢矫形器,可以爬楼梯的轮椅等,供大家在临床康复工作中借鉴和应用.     

Work values: A comparison of non-disabled persons with persons with paraplegia

A number of studies focus on factors that might explain the low level of employment of persons with paraplegia without questioning the social representations connected to work. Being employed is considered a priori as beneficial, constituting an important objective for rehabilitation. However sociologists have recently pointed out that work, as a means of self fulfilment, is a 'constructed' rather than a 'natural' category.

The comparisons of the representations of work given by two groups: persons with paraplegia (n = 350), and non-disabled persons (n = 327) show that persons with paraplegia are more likely than non-disabled persons to consider work as a source of personal fulfilment and social recognition and less likely to positively value the fact of not-working. In addition, a demonstrated satisfaction with not working, among persons of working age, is clearly more significant among non-disabled persons than among persons with paraplegia. Among these, some of them who have generally made up their mind about not working declare that they feel satisfied being unoccupied. This satisfaction is explained, in part, by expressed representations of work. The authors suggest a reflection on the place of work in rehabilitation programmes.     

Exercise moderation of foot function during walking with a re-usable semirigid ankle orthosis

A study was conducted to investigate the effects of a re-usable semirigid ankle orthosis on the support phase of the walking stride in both pre- and post-exercise conditions. Ten young, adult males were required to complete ten trials in each of four orthosis/no orthosis and pre-/post-exercise conditions. Data were collected via a force platform and a high speed camera. The analysis consisted of the evaluation of selected ground reaction force parameters and kinematic parameters describing rearfoot motion. The exercise regimen consisted of 70 maximal eccentric actions of the ankle everters, with 15 s between each action. The results revealed significant differences between the orthosis/no orthosis conditions for the variables describing the mediolateral action of the ankle during walking. Only the rearfoot touchdown angle was affected by the exercise regimen. The data indicated that the semirigid orthosis moderated ankle joint mechanics, although the measured values were within normal bounds.     

Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis.

OBJECTIVE: To measure walking speed and energy cost in patients with prior stroke with and without a carbon composite ankle foot orthosis. DESIGN: Within-group comparisons of 2 walking conditions. PARTICIPANTS: Convenience sample of 10 hemiparetic patients with a stroke at least 6 months earlier (average age 52 years) habituated to a carbon composite ankle foot orthosis. METHODS: Subjects walked on a treadmill at self-selected speed both with and without ankle foot orthosis for 5 minutes on each occasion. Energy expenditure was measured by breath-by-breath analysis and electrocardiography. Main outcome measures were walking speed, oxygen consumption, heart rate and energy cost per metre. RESULTS: Walking speed: without ankle foot orthosis 0.27 (SEM +/- 0.03) m/s, with 0.34 (+/- 0.06) m/s, difference 20%. Oxygen consumption: without ankle foot orthosis 8.6 (+/- 0.4) ml/kg/min, with 8.8 (+/- 0.5) ml/kg/min. Energy cost: without ankle foot orthosis 0.58 (+/- 0.07) ml/kg/m, with 0.51 (+/- 0.06) ml/kg/m, difference 12%. CONCLUSION: Use of a carbon composite ankle foot orthosis in patients with stroke may increase speed and decrease energy cost during walking.     

踝足矫形器对脑性瘫痪患儿步行障碍的治疗作用

目的:探求矫形器在康复工程上矫治作用,分析踝足矫形器对脑性瘫痪患儿康复治疗的可行性和有效性。方法:以2002-10/2004-06在福建省假肢中心治疗的下肢畸形的61例脑性瘫痪患儿为观察对象。所有患儿配戴矫形器治疗,应用了踝足矫形器95具,膝踝足矫形器8具、膝矫形器6具、足矫形器14具,除睡觉、洗澡外,要求全天候穿戴。患儿配戴矫形器后,每天参加康复训练和日常生活活动训练。治疗前和治疗18个月应用《使用矫形器前后Holden功能分类结果比较》(0级为无功能;Ⅰ级为需要大量持续性的帮助;Ⅱ级为小量帮助;Ⅲ级为需要监护或语言指导;Ⅳ级为平地独立行走;Ⅴ为完全独立行走)评估患儿步行功能,根据治疗前后级别变化分析踝足矫形器的矫治效果(改善1个级别为有效,改善2个级别以上为显效)。结果:61例患儿均进入结果分析。所有患儿治疗后达到控制下肢肌张力,控制膝反张、膝屈曲,纠正畸形步态,保持正确站立姿势及行走步态的效果,显效率为74%(45/61),总有效率为100%(61/61)。结论:矫形器在脑瘫矫治中能让患儿保持正确的肢位,维持或增大下肢各关节的活动范围,增强局部的稳定性,抑制肌张力、足原始反射、痉挛,预防肢体挛缩变形,同时提高步行质量和步行速度,使坐、立位的转换以及上下楼变得更为容易。矫形器治疗是综合康复治疗中一个有效的方法,一项重要的治疗手段。     

矫形器结合功能训练改善患者步行能力

目的探讨矫形器结合功能训练对患者步行能力的影响。方法对 3 6例步行困难患者 (腰膨大脊髓损伤 11例、脑血管意外及脑外伤 2 5例 )于不同康复训练阶段配合踝足矫形器 (AFO)进行强化训练 6周 ,分别在患者入院时、AFO训练前和AFO训练 6周后进行ASIA、FMA运动评分评定和限时的步行功能检查 (包括 6min步行评定和 10米步行时间评定 )。结果AFO训练 6周后 ,患者的步行功能评分与AFO训练前的差异具有非常显著性意义 (P <0 .0 1) ;脊髓损伤患者的ASIA运动评分与入院时的差异无显著性意义 (P >0 .0 5 ) ;脑损伤患者的运动评分与入院时的差异具有非常显著性意义 (P <0 .0 1) ,脑损伤患者的运动评分与AFO训练前的差异有显著性意义 (P <0 .0 5 )。结论AFO结合功能训练可显著改善腰膨大脊髓损伤及部分脑损伤患者的步行能力。     

Multisite comparison of wheelchair propulsion kinetics in persons with paraplegia

A multisite collaborative study is being conducted on the association between propulsion biomechanics and upper-limb injuries. This substudy compared subject characteristics and pushrim kinetics across three sites and identified early on in the main study any differences that could affect interpretation of the findings or data pooling. A total of 42 manual wheelchair users with paraplegia (14 from each site) performed 0.9 m/s and 1.8 m/s steady state propulsion trials and an acceleration-brake-coastdown trial on a wheelchair dynamometer while propulsion forces and moment about the hub were measured with a SmartWheel. Significant differences between two sites were found in peak and average resultant force (p < 0.05), peak and average moment at the slower steady state speed (p < 0.005), and peak and average torque at the faster steady state speed (p = 0.06). Subjects at the site with significantly lower forces and torques had a slower deceleration rate during coastdown compared with the subjects at the other two sites (p < 0.001). These results imply that rolling resistance is lower at one of the sites and likely due to differences in dynamometer properties. A mechanical method was used to site-normalize the data and enable data pooling for future analyses.     

The influence of ankle-foot orthosis stiffness on walking performance in individuals with lower-limb impairments

Background

Passive-dynamic ankle-foot orthoses utilize stiffness to improve gait performance through elastic energy storage and return. However, the influence of ankle-foot orthosis stiffness on gait performance has not been systematically investigated, largely due to the difficulty of manufacturing devices with precisely controlled stiffness levels. Additive manufacturing techniques such as selective laser sintering have been used to successfully manufacture ankle-foot orthoses with controlled stiffness levels. The purpose of this study was to use passive-dynamic ankle-foot orthoses manufactured with selective laser sintering to identify the influence of orthosis stiffness on walking performance in patients with lower-limb neuromuscular and musculoskeletal impairments.

Methods

Thirteen subjects with unilateral impairments were enrolled in this study. For each subject, one passive-dynamic ankle-foot orthosis with stiffness equivalent to the subject's clinically prescribed carbon fiber orthosis, one 20% more compliant and one 20% more stiff, were manufactured using selective laser sintering. Three-dimensional kinematic and kinetic data and electromyographic data were collected from each subject while they walked overground with each orthosis at their self-selected velocity and a controlled velocity.

Findings

As the orthosis stiffness decreased, ankle range of motion and medial gastrocnemius activity increased while the knee became more extended throughout stance. Minimal changes in other kinematic, kinetic and electromyographic quantities were observed.

Interpretation

Subjects effectively compensated for changes in ankle-foot orthosis stiffness with altered gastrocnemius activity, and the stiffness levels analyzed in this study had a minimal effect on overall walking performance.     

介绍一种小儿头皮针固定法

小儿静脉输液是常用的一种治疗方法。由于小儿不易配合，常因固定不当而致穿刺失败。临床上多采用穿刺成功后再倒手或用另一只手撕取胶布，针头容易脱出，造成穿刺失败。我科对穿刺固定方法进行了改进，经临床应用，效果满意。[第一段]