治疗小儿脑性瘫痪的常用矫形器

本通过10年来的临床实践,对脑性瘫痪（脑瘫）患儿康复中应用矫形器及其它辅助器具的目的、常用种类、作用、流程、评定、应用注意事项等内容做了简介。临床实践表明矫形器及其它辅助器具的应用在脑瘫患儿康复中起到了应有的作用。     

下肢矫形器在脑瘫患儿中的应用

脑性瘫痪（简称脑瘫）是造成儿童运动功能障碍的主要疾病，患儿通常伴有继发性肌肉骨骼问题，从而造成步态异常。下肢矫形器在矫正脑瘫患儿异常步态、提高其日常生活能力方面具有重要作用，可预防、矫正畸形，增加关节稳定性，抑制肌肉痉挛及不随意运动，从而促进正常运动发育并改善整体活动能力。脑瘫患儿常用的矫形器主要包括上肢矫形器、下肢矫形器、颈托与围腰等，本文主要介绍各种类型下肢矫形器及其在脑瘫患儿中的应用。     

治疗小儿脑性瘫痪的常用矫形器

本文通过10年来的临床实践,对脑性瘫痪(脑瘫)患儿康复中应用矫形器及其它辅助器具的目的、常用种类、作用、流程、评定、应用注意事项等内容做了简介。临床实践表明矫形器及其它辅助器具的应用在脑瘫患儿康复中起到了应有的作用。     

踝足矫形器对脑瘫患儿步行周期的影响

脑性瘫痪（cerebral palsy，CP）简称脑瘫，是指出生前到生后1个月内发生的、由非进行性脑损伤所致的以中枢性运动障碍及姿势异常为特征的综合征。目前尚无有效的根治方法，只有采取综合康复治疗措施，才能促进其运动、智力、心理等方面的发育和改善，姿势异常是脑瘫运动障碍的主要表现之一。脑瘫患儿采用矫形器治疗，主要是抑制异常姿势反射，促进正常姿势运动，刺激浅表的感受器和固有感受器，从而促进患儿内在因素的提高。同时，通过踝足矫形器（ankle foot orthoses，AFO）限制踝关节的跖屈或者背屈角度，利用人体力学原理，纠正患儿站立姿势（如轻度的膝过伸）和促进行走。我院于1994年开始将踝足矫形器用于脑瘫患儿的跟腱挛缩治疗及姿势纠正，取得了较好的疗效。     

可调式“A”字架矫形器对痉挛型脑性瘫痪患儿步态的影响

目的:研究可调式"A"字架矫形器对脑瘫患儿下肢肌肉挛缩及步态的影响。方法:对32例5—8岁双下肢痉挛型脑瘫患儿随机分为两组,每组16例,在进行常规康复治疗的基础上,试验组夜间佩戴可调式"A"字架矫形器,对照组夜间佩戴踝足矫形器(AFO)。可调式"A"字架矫形器是在双侧膝踝足矫形器(KAFO)的内侧胫骨平台水平处连接一个可调节长度的横杆,通过调节"A"字架矫形器中间的横杆来调整患儿股内收角的角度,每次均调至最大髋外展角度。在治疗前和治疗6个月后测量双侧被动髋外展角度,并进行简易步态分析。结果:佩戴可调式"A"字架矫形器脑瘫患儿双侧髋被动髋外展角度之和由63.23°±4.21°增加至113.16°±5.47°(P0.05),佩戴AFO组脑瘫患儿双侧被动髋外展角度之和由62.84°±5.37°增加至87.25°±4.83°(P0.05)。佩戴可调式"A"字架矫形器脑瘫患儿步幅由21.38±6.53cm增加至35.56±9.54cm(P0.05),步速由12.67±2.52cm/s增加至19.79±5.59cm/s(P0.05),步长偏差由6.38±3.61cm减少至3.44±2.56cm(P0.05),均较佩戴AFO的脑瘫患儿改善显著。结论:可调式"A"字架矫形器能有效改善痉挛型脑瘫患儿异常步态,其效果优于AFO。     

佩戴硬踝足矫形器脑瘫患儿的康复训练及护理

总结60例佩戴硬踝足矫形器脑瘫患儿的康复训练及护理经验.在治疗师和医生的指导下,对配戴硬踝足矫形器的痉挛型脑瘫患儿进行综合的康复训练和护理,根据患儿异常姿态和运动障碍选择适宜的运动、物理和中医康复训练方法,对患儿进行综合系统的康复训练.根据患儿和家属的心理状态,行积极的心理护理,使其配合康复训练,指导家长正确佩戴硬踝足矫形器的方法和步骤.并定期检查和做运动评估,为更换适宜的矫形器提供依据.本组患儿经过综合康复训练和护理后挛缩状态有明显改善,有效和显效患儿共47例.     

为脑瘫患儿设计的动态踝足矫形器

近年来 ,随着人们对矫形器生物力学功能认识的逐步深入 ,矫形器在痉挛型脑瘫患儿康复中的应用也越来越多。笔者应用生物力学原理设计的动态踝足矫形器 ,采用了功能性足托和动态踝 ,在脑瘫患儿的康复治疗中取得了较好的成效。1动态踝足矫形器的设计与构造动态踝足矫形器采用后片式踝足矫形器的结构形式 ,用抗疲劳强度和刚性具佳的聚丙烯塑料制成 ,而且足和小腿两部分连成一体 ,形成一定的初始踝角度 ,而且踝部能够围绕初始踝角度在一定范围内进行背屈 /跖屈活动 ,以达到控制和稳定踝关节的目的。本矫形器在足部特别设计了一个功能性足托 ,具…     

踝足矫形器对小腿三头肌痉挛的脑瘫患儿康复治疗作用

目的：探讨踝足矫形器在脑瘫康复治疗中对大运动功能的影响。方法：伴有小腿三头肌痉挛的脑瘫患儿71例,分为矫正组50例和对照组21例,均采用以Vojta法,Bobath法为主的综合康复治疗,其中矫正组患儿下肢肌张力有所下降,踝关节活动度好转,足背屈（被或主动）近90°时取模制作踝足矫形器（AFO）,并在无训练时坚持每天配戴。治疗前后2组均采用粗大运动功能量表（GMFM）进行大运动功能评分。结果：治疗3个月后,2组大运动功能与治疗前比较均明显提高（P〈0.001）,矫正组得分高于对照组（P〈0.05）。结论：神经生理学疗法辅以踝足矫形器更有利于脑瘫患儿大运动功能的康复。     

脑性瘫痪病儿硬踝足矫形器的制作及应用

目的 研究硬踝足矫形器对脑性瘫痪（脑瘫）病儿运动功能的影响。方法 用高温聚乙烯板料为20例患儿制作并使用硬踝足矫形器,观察其对关节运动及痉挛的影响。结果 硬踝足矫形器能够在三个平面提供合理的运动控制,能较好地控制踝跖屈、内外翻及抑制痉挛。结论 硬踝足矫形器是脑瘫患儿改善步态较为理想的矫形器。     

脑性瘫痪病儿硬踝足矫形器的制作及应用

目的研究硬踝足矫形器对脑性瘫痪(脑瘫)病儿运动功能的影响。方法用高温聚乙烯板料为20例患儿制作并使用硬踝足矫形器,观察其对关节运动及痉挛的影响。结果硬踝足矫形器能够在三个平面提供合理的运动控制,能较好地控制踝跖屈、内外翻及抑制痉挛。结论硬踝足矫形器是脑瘫患儿改善步态较为理想的矫形器。     

医师、技师、家长共同参与脑性瘫痪儿童使用下肢矫形器具的疗效分析及评估

目的探讨医师、技师、家长共同参与脑性瘫痪儿童下肢矫形器具在康复治疗中的应用及评估方法。方法将110例使用下肢矫形器具的CP儿童分为两组,观察组由医师,技师及培训后的家长共同干预,对照组仅由矫形器技师干预。结果观察组有效率明显高于对照组(x2=30.2,P＜0.005)。结论为了确保CP儿童下肢矫形器具的有效使用,应从医师,技师及家长3个环节进行疗效评估。     

COMBINATION TAPING TECHNIQUE VERSUS ANKLE FOOT ORTHOSIS ON IMPROVING GAIT PARAMETERS IN SPASTIC CEREBRAL PALSY: A CONTROLLED RANDOMIZED STUDY

BackgroundOne of the important goals in the treatment of spastic cerebral palsy is to maintain efficient and effective walking in order to be independent in activities and participate in society.ObjectiveTo compare the efficacy of foot combination taping of kinesio tape and athletic tape vs ankle foot orthosis in correcting spatiotemporal gait parameters in children with spastic diplegia.MethodsThirty-six children with spastic diplegia were randomly assigned into 3 groups; control, combination taping, and ankle foot orthosis groups. Children in the control group, in addition to those in both experimental groups, continued with conventional physical therapy, 1 h, 3 times per week for 4 weeks. Spatiotemporal gait parameters were assessed with the GAITRite system before and after the application of interventions.ResultsThere were significant increases in walking velocity, step length, stride length, right single support duration, and left single support duration of the ankle foot orthosis and combination taping groups compared with pre-intervention values. Moreover, the post-intervention values of the double support duration of the ankle foot orthosis and combination taping groups were significantly lower than pre-intervention values. There were no significant differences between the post-intervention values of the ankle foot orthosis and combination taping groups for all parameters.ConclusionThe results demonstrated that combination taping is an effective alternative technique to ankle foot orthosis to improve spatiotemporal parameters in children with spastic diplegic in combination with conventional physiotherapy.LAY ABSTRACTChildren with cerebral palsy have abnormal patterns of walking secondary to spasticity, which can negatively affect their functional abilities and quality of life. Several therapeutic interventions are used, with the aim of improving gait quality in those children so that they become independent in functional activities and can participate in society. This study compared the effectiveness of ankle bracing with the application of a combination taping on gait parameters. The results showed that both interventions are equally effective. Combination taping might be considered a promising alterative to ankle joint bracing, as it is a more functional and less aggressive technique.Key words: combination taping, ankle foot orthosis, gait parameters, cerebral palsy

Cerebral palsy (CP) is a lifelong motor impairment caused by an early brain injury. Depending on the dominant neurological signs of children with CP, the condition is classified as spastic, ataxic, athetoid, or flaccid (1). More than 70% of children with CP are spastic (2). Gait in children with spastic CP is frequently associated with abnormal gait kinematics, linked to increased walking energy cost, which may lead to activity limitations (3).Plantar flexion in the ankle at the beginning of standing and in all phases of walking is one1 of the most common dynamic musculoskeletal deformities in children with spastic CP, which could be accompanied by additional abnormal joint positions of the lower extremities (4). The ability to maintain proper joint alignment of the lower extremity, and monitor the position of the foot while standing and walking, are critical prerequisites for gait in children with CP (5).Lower extremity orthosis, such as ankle foot orthosis (AFO) is widely recommended in children with spastic CP to prevent the progression of the deformity and to improve the child’s gait efficiency (6). The solid AFO maximizes control by restricting both plantarflexion and dorsiflexion movements in the stance and swing phases. Its rigid structure prevents ankle rocker function and reduces excessive plantarflexion during the stance phase, thus facilitating clearance of the toes during the swing phase (7). The benefits of wearing an AFO on gait parameters in children with spastic CP have already been documented in the literature (8).Athletic and Kinesio tapes are the 2 most common types of tape used in clinical settings. Both can be used on patients with orthopaedic or neurological dysfunctions. Athletic tape is a rigid/inelastic tape that restricts movement, while Kinesio tape is a form of flexible/elastic tape. Researchers have used them for similar purposes, such as spasticity control, muscle function facilitation, and joint stabilization (9). Furthermore, studies suggest that rigid tape is more effective than elastic tape at controlling joint mobility (10).The use of Kinesio taping in paediatric rehabilitation has become increasingly popular in recent years. Recent systematic reviews reported moderate evidence that Kinesiology taping is a valuable complement to physiotherapy treatment in better-performing children with CP (11, 12). Combination taping is a technique first introduced by Kenzo et al. (13), in which Kinesio tape is combined with rigid athletic tape to maximize the treatment benefits. This approach remains briefly addressed in the literature with no prior studies has examined the effects of combination tapings of Kinesio tape and athletic tape in the CP paediatric population. Hence, this study was conducted to compare the effectiveness of foot combined taping vs AFO in correcting spatiotemporal gait parameters in spastic CP children with equinus deformity.     

Botulin toxin A in the treatment of dynamic equinovarus foot in cerebral palsied children

Background. Contracture of the triceps in the calf occurs in most CP children especially those with diplegia and spastic hemiplegia. The purpose of our research was to evaluate the effective of TB-A in the treatment of these contractures and the associated disturbances of the dynamic position of the foot in CP children.
Material and methods. Thirty five CP children (19 with diplegia and 16 with hemiplegia) received botulinum toxin A (TBX-A-Dysport) for the dynamic contracture of the triceps surae muscle and secondary equinovarus foot deformity. These children ranged in age from 2-11 years (mean 4.6). Previous conservative treatment had failed to alleviate these conditions. Goniometric measurements of the passive range of motion and the evaluation of dynamie equinovarus foot were performed prior to injection of BTX-A to 54 gastrocnemius muscles, and again at 2, 6, and 12 weeks post injection.
Results. The results showed high effectiveness for TBX-A, e.g. marked reduction in equinovarity in 47 and 49 ankle joints (68%- 78%) at 2 and 6 weeks respectively, and in 19 joints (35%) at 12 weeks post-treatment, and moderate reduction in 12 (22%), 8 (15%) and 14 (26%) joints respectively. These improvements were statistically significant. In some children the positive effect was present up to 16 and 20 weeks post injection. No change was found on follow-up in 5 ankle joints (9%) at 2 weeks and in 7 (13%) at 6 and 12 weeks. Reversion to baseline scores was observed in 14 ankle joints (26%). The TB-A therapy was cllosely integrated with physiotherapy and the use of AFO orthosis when necessary.
Conclusions. Botulin toxin therapy is effective in the treatment contractures of the triceps of the calf and equinovarus foot in children with cerebral palsy.     

Contrôle de l’équilibre et port unilatéral d’une orthèse rigide de cheville. Partie II : effets sur des sujets sains évalués debout en bipédie

In order to compare the effects induced by the unilateral wearing of a rigid orthosis (Thuasne, Ligacast Immo^®) in comparison to a reference model consisting of an elastic stocking, balance control strategies of 14 healthy subjects have been evaluated in two-legged standing. To this aim, 10 trials lasting 32 s have been recorded through a device made of two separate force platform allowing the separate measurement of the reaction forces intervening under each foot. Balance strategies have been assessed from the centre of pressure trajectories issued from the left (CP_G) and right feet (CP_D) and, through a calculation, from the resultant CP (CP_Res). These various trajectories, projected along mediolateral (ML) and anteroposterior (AP) axes, have been then analysed in the frequency domain. If no difference has been observed for the CP_Res trajectories, the separate analysis of each support has furnished statistically significant results for the CP trajectories measured under the foot wearing the orthosis since the amplitudes decrease along both ML and AP axes. Contrary to what was observed in the previous study conducted in one-legged standing, with effects occurring only along the AP axis, these results appear thus in better accordance with the objectives of an orthosis since diminishing the involvement of the lateral ligaments. This kind of protocol appears thus more relevant for characterising in situ the effects of an orthosis made of two rigid shells.     

上田正法治疗脑性瘫痪儿童的疗效初步评价

目的通过对上田正法的应用,探讨及评价治疗脑性瘫痪(CP)儿童的新方法。方法对22例8个月～10.8岁的CP儿作治疗前,后的运动功能变化进行动态观察及量化评价,并以同期年龄相对应的15例CP儿应用Vojta等法治疗作对照(包括单用上田正法11例,单用Vojta等法4例,自身对照11例,即先用Vojta法后用上田正法）。结果上田正法治疗后运动功能发育评价较治疗前增加10分,Vojta等法治疗后增加8分/月(P>0.05）。对重度,极重度CP儿两种方法分别增加11分/月,7分/月(P<0.05）。结论上田正法亦是治疗小儿CP的有效方法,且优于Vojta等法,尤其是对以前Vojta等法较棘手的重度CP儿也有较好的疗效。     

痉挛型脑瘫儿童佩戴不同类型踝足矫形器后下肢生物力学的变化

目的：比较痉挛型脑瘫患儿在佩戴传统硬直式踝足矫形器（RAFO）与新型动力型踝足矫形器（DAFO）后所产生的下肢生物力学变化及差异,为临床选用更合适的踝足矫形器（AFO）进行治疗提供理论依据。方法：采用Vicon三维步态分析系统及Kislter测力台分别测评16例痉挛型脑瘫患儿在裸足、佩戴RAFO及DAFO 3种条件下的下肢关节运动学,动力学以及时间空间参数。结果：与裸足比较,佩戴RAFO后步长增加0.05 m,DAFO增加0.07 m;首次着地RAFO增加9°,DAFO增加11.3°;支撑相中RAFO增加10°,DAFO增加11°,且2种方法踝关节背屈角度均明显增大,跖屈角度明显减小;跖屈力矩RAFO增加0.33 Nm/kg,DAFO增加0.37 Nm/kg（均P〈0.05）。DAFO的踝关节活动范围较RAFO增加7°（P〈0.05）。结论：2种不同的踝足矫形器均能够有效提高痉挛型脑瘫患儿的步行能力及行走过程中的踝关节背伸功能。DAFO在矫正踝关节活动及马蹄足畸形方面效果好于RAFO,并可减轻RAFO所导致的踝关节功能受限。     

Use of a static adjustable ankle-foot orthosis following tibial nerve block to reduce plantar-flexion contracture in an individual with brain injury

BACKGROUND AND PURPOSE: Ankle plantar-flexion contractures are a common complication of brain injuries and can lead to secondary limitations in mobility. CASE DESCRIPTION: The patient was a 44-year-old woman with left hemiplegia following a right frontal arteriovenous malformation resection. She had a left ankle plantar-flexion contracture of -31 degrees from neutral. After a tibial nerve block, an adjustable ankle-foot orthosis was applied 23 hours a day for 27 days. Adjustments of the orthosis were made as the contracture was reduced. The patient received physical therapy during the 27-day period for functional mobility activities and stretching the plantar flexors outside of the orthosis. OUTCOMES: The patient's dorsiflexion passive range of motion increased from -31 degrees to +10 degrees. DISCUSSION: The application of an adjustable ankle-foot orthosis following a tibial nerve block, as an addition to a physical therapy regimen of stretching and mobility training, may reduce plantar-flexion contractures in patients with brain injury.     

Contrôle de l’équilibre et port unilatéral d’une orthèse rigide de cheville. Partie I : effets sur des sujets sains évalués debout en unipédie

In order to assess the effects induced by wearing a rigid ankle orthosis, 14 healthy adults, without traumatic previous injuries at this level, were tested in a one-legged postural task. The subjects stood upright on a force platform and were required to remain still, eyes open. Ten trials lasting 32 s were recorded in a random order in two conditions: with a rigid orthosis model worn at the ankle level of the supporting leg (Thuasne, Ligastrap Immo^®) and with an elastic stocking. Balance strategies have been quantified by studying the centre of pressure (CP) trajectories, that is, the successive positions of the resultant reaction forces, and processed through a frequency analysis. The results indicate that slight decreases occur for the CP displacements intervening along the medio-lateral axis whereas statistically significant trends were found for those intervening along the anteroposterior one. This finding a priori suggests that wearing a rigid orthosis affects one-legged standing in healthy individuals but mainly along an axis not usually weakened by sprained ankles.