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。     

脑性瘫痪患儿踝足矫形器的应用

目的踝足矫形器是小儿脑性瘫痪治疗中最常见的一种矫形器，探讨不同种类踝足矫形器的特点及有效性。方法应用计算机检索PubMed 1992—07／2004—05期间相关文章．检索词为“orlhoses，cerebral palsy”，并限定文章语言种类为English，同时计算机检索《中国临床康复》1990-01／2004-05期间相关文章，并限定语言种类为中文，检索词“矫形器，脑性瘫痪”。结果英文文献共检得19篇，除6篇为重复研究，选取13篇纳入；中文文献共检出2篇，全部纳入。结论不同设计的踝足矫形器对脑性瘫痪患儿的治疗作用各有侧重，最好据实际情况为患儿佩戴最适合的矫形器。踝足矫形器是脑性瘫痪治疗中一项重要的有效的治疗手段。     

脑性瘫痪患儿踝足矫形器的应用

目的踝足矫形器是小儿脑性瘫痪治疗中最常见的一种矫形器,探讨不同种类踝足矫形器的特点及有效性。方法应用计算机检索PubMed1992-07/2004-05期间相关文章,检索词为“orthoses,cerebralpalsy”,并限定文章语言种类为English,同时计算机检索《中国临床康复》1990-01/2004-05期间相关文章,并限定语言种类为中文,检索词“矫形器,脑性瘫痪”。结果英文文献共检得19篇,除6篇为重复研究,选取13篇纳入;中文文献共检出2篇,全部纳入。结论不同设计的踝足矫形器对脑性瘫痪患儿的治疗作用各有侧重,最好据实际情况为患儿佩戴最适合的矫形器。踝足矫形器是脑性瘫痪治疗中一项重要的有效的治疗手段。     

减重步行训练对脑性瘫痪患儿步行功能的效果

目的探讨减重步行训练对脑瘫患儿下肢功能的影响。方法 40例脑瘫患儿分为对照组和观察组各20例。对照组接受以Bobath法为主的基础康复和生物反馈,观察组在对照组基础上增加减重步行训练。共治疗2个月。治疗前后均采用粗大运动功能量表(GMFM)中的D区和E区进行评估。结果两组患儿治疗后,D区和E区评分均较治疗前提高(P<0.05),观察组较对照组提高更多(P<0.05)。结论增加减重步行训练可以进一步促进脑瘫患儿步行能力的提高。     

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。     

踝足矫形器对脑性瘫痪患儿步态功能的改善作用

脑性瘫痪丰要影响患儿的行走功能,出现异常低效的步态模式,矫形器足用于改变神经肌肉和骨骼系统的机能特性或结构的体外使用装置,在矫形器治疗中使用最多的是踝足矫形器.踝足矫形器能够在踝足矢状面、碰状面、水平面3个平面提供合理的运动控制,保持关节的力线排列,促进功能,改善步态,是脑瘫患儿改善步态较为理想的矫形器.踝足矫形器在使用时也存在一些问题,比如关节活动范围受限,导致肌肉功能受限,因为加重了局部皮肤受压,容易引起感染等.正因为有这些不足,多年来临床医生与科研工作者一直在寻求各种各样的改良方式,如在现有标准踝足矫形器作用的基础上.附加某些治疗或保护性功能,以期获得更好的临床效果.为患者设计与装配最为合适的、个性化的踝足矫形器,是矫形器制作和设计的发展发向.     

踝足矫形鞋对痉挛型脑性瘫痪患儿尖足的矫治:1年随访

目的观察踝足矫形鞋对痉挛型脑性瘫痪双足尖畸形患儿的矫治作用。方法选取2001-01/2003-01河南省南阳市中心医院儿童脑性瘫痪康复门诊双足尖足畸形患儿18例,年龄9个月～4岁。根据患儿尖足畸形情况定模制作踝足矫形鞋,培训家长掌握使用的具体方法及使用中的注意事项。穿戴踝足矫形鞋的同时进行站、走姿势矫正训练。参照足部矫形器佩戴前后尖足评定标准进行疗效评分。结果随访1年。18例36足配戴前尖足评分为(1.37±0.46)分,配戴1年后评分为(2.52±0.46)分,评分明显提高(t=3.2,P<0.05)。治疗后足背屈角平均减少(6.12±0.9)°,差异有显著意义(t=2.9,P<0.05)。结论矫形鞋用于生长发育阶段的痉挛型脑性瘫痪患儿尖足,可起到预防和矫正畸形的双重效果。     

踝足矫形鞋对痉挛型脑性瘫痪患儿尖足的矫治:1年随防

目的观察踝足矫形鞋对痉挛型脑性瘫痪双足尖畸形患儿的矫治作用.方法选取2001-01/2003-01河南省南阳市中心医院儿童脑性瘫痪康复门诊双足尖足畸形患儿18例,年龄9个月～4岁.根据患儿尖足畸形情况定模制作踝足矫形鞋,培训家长掌握使用的具体方法及使用中的注意事项.穿戴踝足矫形鞋的同时进行站、走姿势矫正训练.参照足部矫形器佩戴前后尖足评定标准进行疗效评分.结果随访1年.18例36足配戴前尖足评分为(1.37±0.46)分,配戴1年后评分为(2.52±0.46)分,评分明显提高(t=3.2,P＜0.05).治疗后足背屈角平均减少(6.12±0.9)°,差异有显著意义(t=2.9,P＜0.05).结论矫形鞋用于生长发育阶段的痉挛型脑性瘫痪患儿尖足,可起到预防和矫正畸形的双重效果.     

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…     

新型动力式踝足矫形器在脑性瘫痪患儿中的应用

目的研究动力式踝足矫形器对痉挛性脑性瘫痪患者步态和稳定性的影响。方法10例曾配戴标准式踝足矫形器患者使用动力式踝足矫形器,用目测法观察动力式踝足矫形器对患者行走时步态周期的影响。结果动力式踝足矫形器可在矢状面允许踝足有背屈和跖屈活动,患儿的步态更接近正常。结论使用动力式踝足矫形器能更好地改善步态,增加稳定性。     

Ankle-foot orthoses: effect on gait in children with cerebral palsy

PURPOSE: In this study our aim was to evaluate the effectiveness of Ankle-Foot Orthoses (AFOs) on gait function in patients with spastic cerebral palsy for whom orthoses were indicated to control dynamic equines deformity. METHOD: Twenty-four spastic cerebral palsied patients with dynamic equines deformity were included in the study. Videotape recordings were performed to each patient on the same day with barefoot and AFOs. Temporal distance factors including velocity, cadence, stride length, stride width and Clinical Gait Assessment Score (CGAS) were compared across two conditions. RESULTS: The use of AFOs during gait, produced a statistically significant increase in velocity (p=0.011) and stride length (p<0.001), no significant difference in cadence (p=0.501), and stride width (p=0.796), and a significant decrease in CGAS (p<0.001), compared to barefoot condition. CONCLUSIONS: Cerebral palsied children with dynamic equines deformities can benefit from AFOs for ambulation.     

Ankle-foot orthoses: effect on gait in children with cerebral palsy

Purpose: In this study our aim was to evaluate the effectiveness of Ankle-Foot Orthoses (AFOs) on gait function in patients with spastic cerebral palsy for whom orthoses were indicated to control dynamic equines deformity. Method: Twenty-four spastic cerebral palsied patients with dynamic equines deformity were included in the study. Videotape recordings were performed to each patient on the same day with barefoot and AFOs. Temporal distance factors including velocity, cadence, stride length, stride width and Clinical Gait Assessment Score (CGAS) were compared across two conditions. Results: The use of AFOs during gait, produced a statistically significant increase in velocity (p=0.011) and stride length (p<0.001), no significant difference in cadence (p=0,501), and stride width (p=0.796), and a significant decrease in CGAS (p<0.001), compared to barefoot condition. Conclusions: Cerebral palsied children with dynamic equines deformities can benefit from AFOs for ambulation.     

Physical strain of comfortable walking in children with mild cerebral palsy

Purpose.?To evaluate the physical strain of comfortable walking in children with mild cerebral palsy ((CP)) in comparison to typically developing ((TD)) children. Physical strain was defined as the oxygen uptake during walking ((VO_2walk)) expressed as a percentage of their maximal aerobic capacity ((VO_2peak)).

Method.?Eighteen children ((aged 8–16 years)) participated, including eight ambulant children ((four girls, four boys)) with mild spastic CP ((three hemiplegia, five diplegia, GMFCS I: n == 7 and II: n == 1)) and 10 TD children. VO_2walk was measured during 5?min of walking on an indoor track at comfortable walking speed. VO_2peak was measured in a shuttle run test.

Results.?VO_2walk was significantly higher in CP ((19.7 ((2.8)) ml//kg//min)) compared to TD ((16.8 ((3.6)) ml//kg//min, p == 0.033)), while walking speed did not differ significantly between groups. VO_2peak was significantly lower in CP ((37.2 ((2.2)) ml//kg//min)) compared to TD ((45.0 ((5.3)) ml//kg//min, p == 0.001)). Consequently, the physical strain during walking was significantly higher in CP ((52 ((7.7)) %%)) compared to TD ((36 ((8.4)) %%, p == 0.001)).

Conclusions.?The higher physical strain during comfortable walking of children with mild CP compared to TD children may be related to reported problems with fatigue in this population, and suggest a need for physical aerobic training programmes.     

Sagittal X-ray parameters in walking or ambulating children with cerebral palsy

Adolescents with cerebral palsy (CP) who walk or ambulate often have an abnormal clinical and radiological spinal profile during pubertal growth compared with adolescents of the same age without neuromotor impairments. Therefore, in the following study, we aimed to conduct a radiological assessment of static data on the lumbar-pelvic-femoral complex in ambulatory children with CP to compare these data with those of an asymptomatic population. The CP population was comprised of 119 children and the asymptomatic population was comprised of 652 children. The large format (30 × 90 cm) sagittal X-rays were taken while subjects were in a comfortable position in which knees and hips were in maximal extension. Analyses were performed using Optispine^® software to measure the parameters of an X-ray of the profile of the spine, pelvis and femurs. Comparing, the two populations, we found no difference in the shape parameter (pelvic incidence) but we did find significant differences in the positional parameters (pelvic tilt and sacral slope) of the pelvis. We found a difference in the curvature and orientation of lumbar lordosis as well as in the number of vertebrae involved in the kyphosis and its orientation. There was also a significant difference in the C7 plumb line. We can say that the CP population is not structurally different from the control population, but that parameters become disturbed during growth. These disturbances should be identified and monitored so that changes can be detected early and progression can be prevented.     

康复机器人辅助步行训练对脑瘫患儿步行能力的影响

摘要 目的：探讨康复机器人辅助步行训练对脑瘫患儿步行能力的影响。 方法：将32例患儿随机分为机器人组和对照组,每组16例,均进行8周康复训练。所有患儿均采用常规康复治疗,机器人组在此基础上给予康复机器人辅助步行训练。分别在训练前和训练后采用粗大运动功能测试量表(GMFM)中D区和E区评分进行评定。 结果：两组患儿各项指标在治疗前无显著性差异(P>0.05)。经过治疗后,对照组与机器人组患儿的GMFM D区评分分别为59.33±20.69,77.24±17.35;E区评分分别为：41.58±9.81,49.81±21.06,两组评分较治疗前都明显提高(P<0.01),且机器人组的评分优于对照组（P<0.05）。 结论：康复机器人辅助步行训练可显著提高脑瘫患儿的步行能力。     

脑卒中偏瘫患者最大步行速度决定因子的研究

目的：根据脑卒中偏瘫患者最大步行速度的决定因子探讨脑卒中不同阶段的治疗方案。方法：测定１８例脑卒中偏瘫患者从独步开始到治疗８周后的最大步行速度和相关生物力学因子,用逐次重回归分析求出最大步行速度的决定因子。结果：独步开始最大步行速度的决定因子是健侧的大腱四头肌肌力,治疗８周后最大步行速度的决定因子是左右重心移植距离。结论：脑卒中偏瘫的不同阶段,最大步行速度的决定因子不同。