Energy consumption in paraplegic ambulation using the reciprocating gait orthosis and electric stimulation of the thigh muscles

The energy consumption of six thoracic paraplegic persons ambulating in the reciprocating gait orthosis (RGO) with and without functional electric stimulation (FES) of their thigh muscles was determined as a function of walking speed. Plots of Kcal/kg-min and Kcal/kg-m vs walking speed in the RGO and RGO & FES were experimentally determined in this study and compared with the energy cost of walking in the long leg brace (LLB), the hip guidance orthosis (HGO), and an FES walking aid from data available in the literature. The RGO powered with electric stimulation of the thigh muscles required the lowest energy expenditure in Kcal/kg-m across the full range of walking speeds. The RGO, HGO, LLB, and FES walking orthoses ranked second, third, fourth, and fifth respectively. The lowest energy costs in Kcal/kg-min were associated with the RGO & FES, followed by the RGO, HGO, LLB, and FES for walking speeds below .28m/sec. At walking speeds higher than .28m/sec the HGO demonstrates lower energy cost followed by the RGO & FES, RGO, FES, and LLB. At the end of a 30-m walk, patients using the RGO & FES had a mean heart rate (HR) which was 12 beats/min less than the mean HR when using the RGO without FES, 31 beats/min less than the HR when using the LLB, and 42 beats/min less than the HR when using FES only. It was concluded that the FES-powered RGO combines the advantages of a passive mechanical orthosis with those of FES to provide substantial improvements in energy cost which may provide paraplegic persons with a mode of independent ambulation superior to the wheelchair.     

Evaluation of the performance of paraplegic subjects during walking with a new design of reciprocal gait orthosis

Background: Spinal cord injury (SCI) influences a person's ability to stand and walk. Various orthoses have been developed to solve these standing and walking problems, however, patients still experience high energy consumption during walking and high forces on the upper limbs. A new reciprocal gait orthosis (RGO) was designed to address these problems. The aim of this study was to evaluate the performance of the new orthosis design with paraplegic subjects. Method: Three paraplegic subjects with the lesion at level T12 and three able-bodied subjects were included in this study. Hip and pelvis range of motion and vertical ground reaction force were evaluated using the Qualysis motion analyzer system and a Kistler force plate. Energy consumption was measured with the Polar heart rate monitoring system. The differences between SCI individuals when walking with a Knee Ankle Foot Orthosis (KAFO) and the new RGO, and the differences between able-bodied and paraplegic subjects were evaluated by the use of paired sample and two sample t test, respectively. Result: The results showed that energy consumption and gait analysis outcomes with new RGO orthosis were better than the KAFO. However, there was a large difference between paraplegic and able-bodied subjects while walking with the new orthosis. Conclusion: The new RGO design performed better than a KAFO in terms of energy consumption, walking style and vertical ground reaction force. Therefore, it appears that RGO may be a useful orthosis for patients with paraplegia.

• Implications for Rehabilitation

• Walking and standing of the subjects with spinal cord injury (SCI) improve their physiological and physiological health.

• This study introduces a new type of orthosis design in order to improve the abilities of SCI subjects during walking and standing.

• It seems that the new design works better than available orthoses (KAFO).

     

Comparison of functional electrical stimulation to long leg braces for upright mobility for children with complete thoracic level spinal injuries.

OBJECTIVE: To prospectively compare functional electrical stimulation (FES) to long leg braces (LLB) as a means of upright mobility for children with motor-complete thoracic level spinal cord injuries (SCIs). DESIGN: Intrasubject group comparison of two interventions. SETTING: Nonprofit pediatric orthopedic rehabilitation facility specializing in SCI. PATIENTS OR OTHER PARTICIPANTS: Convenience sample of five children between 9 and 18 years old with motor-complete thoracic level SCI. The hip and knee extensors were excitable by electrical stimulation. INTERVENTIONS: The FES system consisted of percutaneous intramuscular electrodes implanted to the hip and knee extensors and a push-button activated stimulator worn about the waist. Standing was accomplished by simultaneous stimulation of all implanted muscles. For foot and ankle stability, either ankle-foot orthoses (AFO) or supramalleolar orthoses were used. The LLB system consisted of a custom knee-ankle foot orthosis (KAFO) for four subjects and a custom reciprocating gait orthosis (RGO) for one subject who required bracing at the hip. For both interventions, either a front-wheeled walker or Lofstrand crutches were used as assistive devices. Each subject was trained in the use of both FES and LLB in seven standardized upright mobility activities: stand and reach, high transfer, toilet transfer, floor to stand, 6-meter walk, stair ascent, and stair descent. MAIN OUTCOME MEASURES: For each mobility activity, five repeated measures of level of independence, using the 7-point Functional Independence Measure (FIM) scale, and time to completion were recorded for each intervention. Subjects were also asked which intervention they preferred. RESULTS: For 94% of comparisons, subjects required equal (70%) or less (24%) assistance using FES as compared with LLB. Six of the seven mobility activities required less time to complete using FES, two activities at significant levels. The FES system was preferred in 62% of the cases, LLB were desired 27% of the time, and there was no preference in 11% of the cases. CONCLUSIONS: The FES system generally provided equal or greater independence in seven mobility activities as compared with LLB, provided faster sit-to-stand times, and was preferred over LLB in a majority of cases. Follow-up evaluations of both modes of upright mobility are needed to compare long-term performance and satisfaction.     

Physiologic costs of computer-controlled walking in persons with paraplegia using a reciprocating-gait orthosis

Blood pressure, heart rate, oxygen uptake, cardiac output, and the surface electromyogram from key muscle groups in the upper body were measured in four subjects with paraplegia during ambulation using only a reciprocating-gait orthosis (RGO) and using an RGO with movement assisted by functional electrical stimulation (FES) of the hamstring and gluteus maximus muscles. These data were compared to data collected on four able-bodied control subjects during ambulation at matched speeds. Whether walking with FES and RGOs or walking with RGOs alone, subjects had an optimum gait speed at which efficiency was highest. For paralyzed subjects using FES, the optimum walking speed was approximately 1.5 mph (2.4km/hr); without FES, the optimum speed averaged about 0.75mph (1.2km/hr). Blood pressure, heart rate, oxygen uptake, and cardiac output were measured during ambulation with FES and were found to be higher than those of controls, but they were significantly lower than those in the paralyzed subjects in RGOs with no FES. Electromyogram studies showed that the activity in upper body muscles was much higher when walking in RGOs without FES than in RGOs with FES.     

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.     

Feasibility study for a controllable orthotic knee joint

Purpose.?The purpose of this study was to demonstrate the feasibility of producing an orthotic knee joint that could lock and unlock during ambulation for eventual use in a reciprocating gait orthosis (RGO) for severely disabled patients.

Method.?Three prototype orthotic knee joints incorporating braking mechanisms were designed and manufactured to demonstrate their ability to withstand a maximum calculated sagittal plane bending moment of 73 Nm. Each was then subjected to bench trials to test their performance against the required specification.

Results.?Although all three joints achieved the requirement to sustain the specified externally applied bending moments, the hydraulic disc brake system proved significantly superior and was selected for more comprehensive testing.

Conclusions.?The results confirmed the feasibility of utilising a hydraulic braking mechanism within an orthotic knee joint to withstand the knee flexing moments during walking in a lower limb orthosis. This gave the development group confidence to progress to the prototype design phase with the specific aim of eventually incorporating such a joint in an RGO designed for severely disabled patients such as those with complete paraplegia up to level T4 and those with severe neurological dysfunction.     

Efficacy of corrective spinal orthoses on gait and energy consumption in scoliosis subjects: a literature review

Background: Adolescent idiopathic scoliosis (AIS) is a progressive growth disease that affects spinal anatomy, mobility, and left-right trunk symmetry. As a consequence, AIS can modify human gait. Spinal orthoses are a commonly used conservative method for the treatment of AIS.

Objective: This review evaluated the AIS spinal orthosis literature that involved gait and energy consumption evaluations.

Study design: Literature review.

Method: According to the population intervention comparison outcome measure methods and based on selected keywords, 10 studies met the inclusion criteria.

Results: People with AIS who wore a spinal orthosis, compared with able-bodied participants, walked slower with decreased hip and pelvic movements, decreased hip mediolateral forces, ground reaction force asymmetry, and excessive energy cost. Pelvis and hip frontal plane motion decreased when wearing an orthosis. Hip and pelvis movement symmetry improved when using an orthosis. Ankle and foot kinematics did not change with orthotic intervention. People with AIS continued to have excessive energy expenditure with an orthosis.

Conclusion: Spinal orthoses may be considered for improving the walking style, although energy cost does not decline following the orthotic intervention.

• Implications for Rehabilitations

• Problems related to scoliosis include reduced quality of life, disability, pain, postural alterations, sensory perturbations, standing instability and gait modifications.

• Wearing corrective spinal orthoses in AIS subjects produce a reduction in walking speed and cadence, increase in stride length and reduction of gait load asymmetry compared to without brace condition.

• Spinal orthoses do not decline excessive energy expenditure to walk versus without it.

     

The effect of an isocentric reciprocating gait orthosis incorporating an active knee mechanism on the gait of a spinal cord injury patient: A single case study

Objective: The aim of this study was to identify the effect of induced knee flexion during gait on the kinematics and temporal-spatial parameters during walking by a patient with spinal cord injury (SCI) through the application of an isocentric reciprocating gait orthosis (IRGO) with a powered knee mechanism.

Methods: Two orthoses were considered and evaluated for an ISCI subject with a T8 level of injury. An IRGO was initially manufactured by incorporating drop lock knee joints and was fabricated with custom molded AFOs to block ankle motion. This orthosis was also adapted with electrically-activated knee joints to provide active knee extension and flexion when disengaged.

Results: Walking speed, stride length and cadence were increased 37.5%, 11% and 26%, respectively with the new orthosis as compared to using the IRGO. The vertical and horizontal compensatory motions reduced compared to mechanical IRGO. At end of stance phase, knee joint flexion was 37.5° for the AKIRGO compared to 7° of movement when walking with the IRGO. The overall pattern of walking produced was comparable to that of normal human walking.

Conclusion: Knee flexion during swing phase resulted in an improved gait performance and also reduction in compensatory motions when compared to a mechanical IRGO.

Implications for Rehabilitation

• Powered orthosis could be used by spinal cord injury subjects.

• A major advantage of this new orthotic mechanism was regeneration of knee movement closer to that of normal human walking.

• The IRGO with a powered knee joint mechanism improved the speed of walking, step length, cadence and vertical displacement in a spinal cord injury patient which also produced near-normal knee joint angle patterns during gait.

     

The efficiency of mechanical orthoses in affecting parameters associated with daily living in spinal cord injury patients: a literature review

Objective: The most simple and common approach in providing standing and walking by subjects with spinal cord injury (SCI) is the use of mechanical orthoses. These include traditional orthoses, medial linkage orthoses (MLOs) and reciprocating gait orthoses (RGOs). Independence, energy expenditure, gait parameters, system reliability and cosmesis are important factors in orthotic design. The aim of this review was to compare the evidence of existing mechanical orthoses to that of other types regarding these factors. Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) method was used by an experience researcher based on selected keywords and their composition and an electronic search was performed in well-known databases. Results: Twenty articles were selected for final evaluation. Many were case studies, and also had limited and heterogeneous sample sizes with different instruments used for evaluation. The results of the analysis demonstrated that independence and cosmesis are improved when using MLOs, but gait parameters, energy expenditure and stability are all improved when using RGOs. Conclusion: Those mechanical orthoses which have reciprocal motion and congruency between the anatomical and orthotic joints have been shown to provide positive effects on patient lifestyles. However, further improvement is needed to more effectively meet the needs of SCI patients.

• Implications for Rehabilitation

• The most simple and traditional approach to enable standing and walking by people with SCI is use of purely mechanical orthoses.

• The most important factors that increase rejection rates of orthoses in paraplegia patients are excessive energy expenditure and increased applied force on upper limb joints.

• Improvement of the structure of mechanical orthoses is needed to improve independence, energy expenditure, and gait parameters, and is an important approach to improve ambulatory function in subjects with paraplegia.

     

不同步行矫形器在下胸段脊髓损伤中的应用探讨

探讨三种不同步行矫形器在下胸段脊髓损伤中的应用及对患者步行能力的影响。方法:T10-12完全性脊髓损伤患者16例,在装配步行矫形器前进行强化康复训练与治疗(包括肌力、心肺功能、转移、ADL、膀胱功能等),其中5例装配KAFO(KAFO组),5例装配Walkabout(Walkabout组),6例装配RGO(RGO组),矫形器装配后配合步态步行训练;分别于矫形器装配前和装配训练8周后应用ASIA运动评分、MBI及限时的步行功能检查(包括6min步行评测和10m步行时间评测)作为指标进行观察。结果:3组患者ASIA运动评分矫形器装配前后及组间比较差异无显著性意义(P>0.05),ADL(MBI)评分装配前后比较差异有显著性意义(P<0.01)、组间比较差异无显著性意义(P>0.05);装配训练8周后步行能力评分比较,Walkabout组与KAFO组差异具有显著性意义(P<0.01),RGO组与Walkabout组和KAFO组比较差异均具有显著性意义(P<0.01)。结论:步行矫形器与功能训练相结合对改善下胸段脊髓损伤患者的步行能力疗效显著,Walkabout和KAFO可恢复患者治疗性步行能力,而RGO则在恢复患者功能性步行能力方面效果理想。     

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。     

Effect of robotic locomotor training in an individual with Parkinson's disease: a case report

Purpose.?The purpose was to test the effect of robot-assisted gait therapy with the Lokomat system in one representative individual with Parkinson's disease (PD).

Methods.?The patient was a 67-year-old female with more than an 8-year history of PD. The manifestations of the disease included depressive mood with lack of motivation, moderate bradykinesia, rigidity and resting tremor, both involving more the right side of the body, slow and shuffling gait with episodes of freezing and risk of falling. The patient underwent six sessions of robot-assisted gait training. The practice included treadmill walking at variable speed for 25–40?min with a partial body weight support and assistance from the Lokomat orthosis.

Results.?After the therapy, the patient increased the gait speed, stride length and foot clearance during over ground walking. She reduced the time required to complete a 180° turn and the latency of gait initiation. Improvements were observed in some items of the Unified Parkinson's Disease Rating Scale including motivation, bradykinesia, rigidity, freezing, leg agility, gait and posture.

Conclusions.?Although the results supported the feasibility of using robot-assisted gait therapy in the rehabilitation an individual with PD, further studies are needed to assess a potential advantage of the Lokomat system over conventional locomotor training for this population.     

The impact of walking speed on the effects of functional electrical stimulation for foot drop in people with multiple sclerosis

Purpose: Functional electrical stimulation (FES) is effective in assisting people with multiple sclerosis (pwMS) with gait. Previous studies have investigated the effects of FES in pwMS with slow self-selected walking speeds (SSWS). This study reports on the effect of the Odstock Dropped Foot Stimulator (ODFS) on the speed and oxygen (O₂) cost of gait in pwMS walking at a range of SSWS. Methods: Twenty pwMS (mean age 50.4?±?7.3 years) currently using FES walked at their SSWS for 5?min with and without FES. O₂ cost of gait was measured using a gas analysis system, and gait speed was calculated. Data were analysed for all participants, and comparisons were made between those with a SSWS < and >0.8?m/s (walking speed required for community ambulation). Results: Significant improvements in the speed and O₂ cost of gait were seen using FES in the group with SSWS <0.8?m/s (n?=?11, p?=?0.005). When participants’ SSWS >0.8?m/s, no difference in gait speed was noted, and a significant increase in O₂ cost of gait using FES (n?=?9, p?=?0.004) was noted. Conclusion: FES has a different effect on the speed and O₂ cost of gait dependent on the SSWS of pwMS. This requires further investigation.

• Implications for Rehabilitation

• Functional electrical stimulation (FES) used for foot drop is effective in improving the speed and oxygen cost of walking in pwMS walking at SSWS <0.8?m/s.

• FES does not seem to have a beneficial effect on the speed and oxygen cost of walking in pwMS walking at SSWS >0.8?m/s.

• Further research is needed to understand the possible mechanisms involved so that FES for foot drop can be efficiently prescribed.

     

The effects of a new designed forearm orthosis in treatment of lateral epicondylitis

Purpose: This paper reports on the design and testing of a new designed forearm orthosis and explores its efficacious in comparison to the standard counterforce orthosis in patients with lateral epicondylitis. Method: Twenty-four patients were enrolled in this assessor-blinded clinical trial and randomly assigned to two parallel treatment groups. The measures of pain and function, the pain threshold and grip strength were compared using patient rated tennis elbow evaluation (PRTEE) form, algometer and dynamometer respectively at baseline and 4 weeks after treatment. Paired and independent t-test statistical methods recruited for within and between groups comparisons respectively. Results: The both orthoses, counterforce and new-designed, significantly relieved pain, and improved function, pain threshold and grip strength of all patients after 4 weeks application. The new-designed orthosis seemed to be more effective than the counterforce orthosis in pain relief, but there was not any significant difference in efficacious of two types of orthoses regarding function. Conclusions: The new-designed orthosis can significantly relieve pain, improve function, increase pain threshold and grip strength after application. This orthosis seemed to be more effective than counterforce orthosis in relieving pain and increasing the pain threshold probably due to the limitation of forearm supination.

Implications for Rehabilitation

• Several orthoses have been prescribed in the literature to decrease pain and inflammation of the lateral epicondylitis.

• The new-designed forearm orthosis is composed of wrist and below elbow counterforce straps that are connected by a non flexible middle part.

• The new-designed orthosis was better than counterforce orthosis in relieving pain and increasing pain threshold.

     

The influence of a rocker sole adaptation on gait parameters in spinal cord injury patients ambulating with the advanced reciprocating gait orthosis – a pilot study

Objective: When walking with an advanced reciprocating gait orthosis (ARGO), ankle and knee joint motion is restricted which causes an un-cosmetic gait compared to normal walking. The purpose of this study was to develop and evaluate a rocker modification for use with the ARGO in order to improve hip joint kinematics, walking speed, step length and cadence. Method: Spinal cord injury patients (n?=?4) with thoracic-level injury participated in this study, and walked with a standard ARGO and one which was also adapted with a rocker sole in a randomized order. Results: Mean walking speed and step length were both significantly increased by volunteer SCI subjects when ambulating using the ARGO adapted with a rocker sole compared to the standard ARGO. Cadence was not significantly affected, but swing time was significantly reduced and mean hip flexion and extension were both significantly increased when walking with the adapted ARGO. Conclusion: The rocker sole modification produced an increase in walking speed and step length, and improved sagittal plane hip joint kinematics when ambulating using an ARGO. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard unmodified version.

• Implications for Rehabilitation

• The ARGO adapted with a rocker sole could be used by spinal cord injury patients.

• A major advantage of the walking with the ARGO adapted with a rocker sole was increased of walking speed and step length, and improvement of the sagittal plane hip joint kinematics.

• The findings of this study would appear to provide useful data for rehabilitation teams who utilize orthoses to walk and rehabilitate SCI subjects. Using this type of shoe modification has the potential to improve gait parameters in SCI patients compared to the standard un-modified version.

     

Design of the Wearable Power-Assist Locomotor (WPAL) for paraplegic gait reconstruction

Purpose: To develop and clinically evaluate a novel assistive walking system, the Wearable Power-Assist Locomotor (WPAL). Methods: To evaluate the performance of WPAL, a clinical trial is conducted with four paraplegic patients. After fitting the WPAL, patients learned to use the WPAL. The length and duration of independent walking was measured and compared to conventional orthosis (Primewalk). Results: After training, all patients were able to stand, sit, and walk independently with the WPAL. Compared to a conventional orthosis (Primewalk), the duration and distance of independent ambulation increased. The physiological cost index (PCI), perceived exertion and EMG of upper extremities decreased. Conclusions: WPAL might greatly enhance the possibility of restoration gait to paraplegic patients.

Implications for Rehabilitation

• WPAL is developed to provide independent and comfortable walking for spinal cord injury patients.

• WPAL is less demanding physically than conventional orthosis (Primewalk).

• Even patients who cannot walk independently with conventional orthosis might be able to do so with WPAL.

     

重心移动式截瘫步行矫形器对脊髓损伤患者日常生活活动能力及生存质量的影响

目的：了解装配重心移动式截瘫步行矫形器（AGO）后脊髓损伤患者日常生活活动能力（ADL）及生存质量（QOL）情况,证实AGO的应用价值。方法：完全性胸腰段脊髓损伤患者58例,按住院先后顺序及装配矫形器类型分为AGO组（27例）、交替迈步式步行矫形器（RGO）组（15例）、膝踝足矫形器（KAFO）组（6例）和对照组（10例）。各组均进行8周常规训练,包括肌力训练、平衡训练、转移训练、轮椅使用训练、ADL训练等,并在常规康复治疗的基础上使用步行矫形器并进行针对性步行训练6—8周。分别于入院时、装配矫形器前、装配矫形器后8周进行ADL评定和QOL评定。结果：组内比较,各组经常规康复治疗后ADL能力及QOL（生理及心理方面）均有所改善,治疗前后对比具有显著性意义（P<0.01）。组间比较, AGO组、RGO组在改善ADL能力和QOL-生理及心理方面优于KAFO组（P<0.05）和对照组（P<0.01）,AGO组与RGO组相比无显著性意义（P>0.05）,但在QOL-人际关系和周围环境方面,各组治疗前后均无明显改变。结论：AGO与进口截瘫步行矫形器一样在改善ADL和QOL方面有着良好的效果,但其价格便宜,可以广泛应用。     

踝足矫形器改善偏瘫患者步行能力的荟萃分析

背景：已有研究表明,踝足矫形器能增加来自足部及腿骨皮肤感受器的输入信息反馈,改善踝关节位置觉,促进大脑功能重组。 目的：系统评价踝足矫形器对偏瘫患者步行能力的康复效果。 方法：应用计算机检索中国生物医学文献数据库、中国知网、万方数据库和维普数据库中,关于踝足矫形器改善偏瘫患者步行能力的随机对照试验,检索时间从建库至2013年6月。对符合标准的随机对照试验进行Meta合并分析。 结果与结论：共纳入9个随机对照研究,456例患者。Meta分析结果显示,与常规康复治疗及药物治疗相比,踝足矫形器连续治疗对改善偏瘫患者下肢运动功能、提高生活能力及10 m 最大步行速度方面具有一定的优势。因纳入文献数量有限,对其余指标如步速、左右步幅差及平衡功能等仅作了描述性分析,提示踝足矫形器是通过改善异常步态、步行速度、步频、步态周期、空间不对称、踝关节肌痉挛和平衡等,达到改善步行功能的目标。在时间不对称、双支撑相延长和跨步长等指标上无明显改变,不能确认踝足矫形器在这些指标变化中的作用。现有资料显示,踝足矫形器可在一定程度上促进偏瘫患者下肢运动功能的恢复及日常生活活动能力的提高,但仍需更多高质量、大样本、多中心的随机对照试验证实。     

The effect of new dynamic splint in pinch strength in De Quervain syndrome: a comparative study

Objective For patients with De Quervain syndrome using thumb spica orthosis is restricting, so many patient are dissatisfied with using static model. The aim of this study is to compare the effect of modified dynamic and conventional static orthoses on pinch power and functional abilities of hand in De Quervain syndrome. Method In this quasi-experimental study, palmar and lateral pinch strength of the thumb, pain and functional abilities of hand, patient’s satisfaction of orthoses, were evaluated after using modified dynamic and conventional static orthosis in two groups. Results Both orthoses improved palmar and lateral pinch strength of the thumb, pain level and functional abilities. In comparison of mentioned variables, there was no significant difference between two groups regarding to pain recovery and abilities improvement (p?>?0.05). However, the satisfaction level of the patients who had used dynamic orthosis was higher (p?Conclusion It seems, adding a joint to the static thumb spica leads to patient’s relief and consequently to their satisfaction.

• Implications for Rehabilitation

• The dynamic thumb spica, is easier to use and patients satisfaction is higher than static thumb spica.

• Therefore, it can be used for conservative treatment of De Quervain syndrome.