踝足矫形器在轻度痉挛型脑瘫患儿中的临床应用

轻度痉挛型脑瘫患儿站立不稳 ,步行中出现畸形步态是影响患儿活动的主要原因。为了使轻度痉挛型脑瘫患儿克服双下肢痉挛畸形、足尖步及交叉步 ,经康复训练达到正确步态 ,我科采用德国生产的聚苯烯热塑材料制作的踝足矫形器 ,配戴后对患儿进行 3个月的家庭康复训练 ,结果患儿步态矫治效果显著。1　资料与方法1 .1　一般资料　 1矫形器组 :轻度痉挛型脑瘫患儿1 2例 ,男 8例 ,女 4例 ;年龄 2～ 5岁 ,平均 2 .4岁 ;双足跟不能着地 9例 ,右足 2例 ,左足 1例 ;能独立行走 <1 0 m l例 ,需扶助站立或行走 1 1例。 2对照组 :轻度痉挛性脑瘫患儿 1 6例…     

髋关节旋转矫正带配合踝足矫形器对脑瘫患儿步态的影响

2005年5月～2012年8月我院矫形科收治的痉挛型脑瘫患儿36例,均符合1998年全国脑性瘫痪座谈会诊断标准[1]。男21例,女15例;年龄（6．75±2．43）岁;入选条件：①患儿双下肢一年内无矫形手术史;②双下肢瘫痪,因肌张力降低或存在轻、中度痉挛造成步行时髋关节内旋,并伴有轻度足内翻下垂症状,无明显髋、膝关节屈曲挛缩。③患儿均有穿戴矫形器且〉2个月,     

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。     

为痉挛型脑瘫患儿设计的功能性踝足矫形器

痉挛型脑瘫患儿 10例 ,男 7例 ,女 3例 ;年龄 2 5～ 8岁 ,平均 5 5岁 ;双侧外翻平足畸形 4例 ,单侧外翻平足畸形 1例 ,双侧马蹄内翻畸形 3例 ,单侧马蹄足畸形 1例 ,单侧马蹄足及前足内收畸形 1例 ;患儿站立时足跟不能平放 ,额状面跟骨轴线偏离小腿轴线 ,站立平衡能力较差 ,行走时呈程度不同的剪刀步态。 10例患儿均使用功能性踝足矫形器进行站立和步行训练。该矫形器由后片式刚性聚丙烯塑料外壳和置于足底的柔性足托构成。柔性的功能性足托分后足、中足和前足 3个部位 ,分别包容和支撑人体足跟、足弓和足趾。足托的前足部分斜向上升起 ,与…     

脑瘫患儿踝足矫形器配戴前后对运动功能的量化评价

目的 :对痉挛型脑瘫患儿踝足矫形器配戴前后的运动功能进行量化评价。方法 :2 3例痉挛型脑瘫患儿配戴踝足矫形器后根据《小儿脑瘫运动评价量表》的第 4、5功能区自拟量化评价表 ,于 1周后进行运动功能评价。结果 :2 3例患儿均达到了控制下肢肌张力、纠正尖足、膝反张、足内外翻 ,保持正确站立姿势及改善步态的效果 ,与配戴踝足矫形器前比较差异有显著性 (P <0 .0 0 1)。结论 :踝足矫形器在提高脑瘫患儿的下肢运动功能方面起到积极的作用。     

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.     

半掌踝足矫形器与足跟镂空踝足矫形器对脑卒中患者步态影响的比较

目的 观察半掌踝足矫形器和足跟镂空踝足矫形器对脑卒中患者步态的影响。方法 选取符合标准的脑卒中患者25例,采用步态分析系统分别对25例脑卒中后步行功能障碍患者裸足、佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的步行状态进行分析,记录三种状态下患者的步速、步频、健侧摆动相、患侧摆动相、跌倒风险和3 m起立计时行走时间,并进行统计学分析。 结果 受试者佩戴足跟镂空踝足矫形器时的步频为（86.718±17.947）Hz,较裸足和佩戴半掌踝足矫形器时均显著加快,差异均有统计学意义（P<0.05）。受试者佩戴足跟镂空踝足矫形器时的步态不对称系数为（0.086±0.070）,与裸足时比较,差异有统计学意义（P<0.05）。受试者佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的3 m起立计时行走时间较裸足时均显著缩短,差异均有统计学意义(P<0.05)。受试者佩戴半掌踝足矫形器和佩戴足跟镂空踝足矫形器时的跌倒风险均显著低于裸足时,差异均有统计学意义(P<0.05);且受试者佩戴足跟镂空踝足矫形器时的跌倒风险亦显著低于佩戴半掌踝足矫形器时,差异有统计学意义（P<0.05）。 结论 佩戴半掌踝足矫形器和足跟镂空踝足矫形器均可有效纠正脑卒中患者的步态,降低其跌倒风险,且佩戴足跟镂空踝足矫形器的优势更加明显。     

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。     

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…     

踝足矫形器对偏瘫患者步行速度的影响

目的：了解踝足矫形器（ａｎｋｌｅ－ｆｏｏｔ ｏｒｔｈｏｓｉｓ,ＡＦＯ）对偏瘫患者步行速度的影响。方法：３０例偏瘫患者在步态分析实验分别穿鞋和赤足行走两次,用摄像机录下患者的步行过程,用运动动态分析软件进行数据分析。结果：不穿ＡＦＯ者穿鞋和赤足的步行速度无显著性差异（Ｐ〉０．０５）;不穿ＡＦＯ者穿鞋与穿ＡＦＯ者穿鞋加ＡＦＯ时步行速度无显著性差异（Ｐ〉０．０５）;不穿ＡＦＯ者与穿ＡＦＯ者赤足时步行速度     

The effect of fixed ankle foot orthoses in children with cerebral palsy

Purpose.?To identify the characteristics of children with cerebral palsy who benefited from tuning of their fixed ankle foot orthoses (AFOs) to create a screening tool.

Method.?A retrospective review was conducted using video records of 21 independently walking children with cerebral palsy who were referred to a Gait Laboratory for AFO tuning. All showed a ground reaction vector (GRV) in front of the knee (extending) when barefoot. The stance phase was digitised to obtain kinematic and kinetic parameters. Effectiveness of AFO tuning was judged by optimisation of the GRV at the knee and statistical and scatter plot analysis sought to discriminate between those who tuned and those who did not.

Results.?Analysis showed clear distinction between the two groups based on knee kinematics. Those who tuned showed flexion of no more than 20° in the first third of stance combined with movement towards extension in the second third of stance to a minimum of 10° flexion or less.

Conclusions.?This study has created a screening tool to identify children likely to benefit from AFO tuning based on kinematic data and which could be used in the community.     

The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy

Purpose.?To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines.

Method.?Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0° with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period.

Results.?AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking.

Conclusion.?The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy.     

The effect of hinged ankle-foot orthosis on gait and energy expenditure in spastic hemiplegic cerebral palsy

Purpose. To assess the effectiveness of a hinged ankle-foot orthoses on gait impairments and energy expenditure in children with hemiplegic cerebral palsy (CP) whom orthoses were indicated to control equines.

Method. Eleven children (seven males, four females) who had a diagnosis of hemiplegic cerebral palsy were included in the study. Each child underwent gait analysis and energy consumption studies with and without ankle-foot orthosis (AFO). The AFOs were all custom-made for the individual child and had plantarflexion stop at 0° with no dorsoflexion stop. The Vicon 512 Motion analysis system was used for gait analysis. Walking energy expenditure measurements were done with breath by breath method using an open-circuit indirect calorimeter (Vmax 29c, Sensormedics, USA). All tests were carried out on the same day with enough resting period.

Results. AFO application, as compared with the barefoot condition improved walking speed, stride length and single support time. Double support time was decreased significantly with AFOs and no change in cadance. Ankle dorsiflexion at initial contact, midstance and midswing showed significiant increase. Knee flexion at initial contact was decreased and no significant change in maximum knee extension at stance and maximum knee flexion at swing was obtained. The oxygen consumption was significantly reduced during AFO walking.

Conclusion. The hinged AFO is useful in controlling dynamic equinus deformity and reducing the energy expenditure of gait in children with hemiplegic spastic cerebral palsy.     

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。     

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。     

运动平板训练对学龄期脑瘫患儿平衡功能与步态的影响

摘要 目的：探讨运动平板训练对痉挛型双瘫学龄期脑瘫患儿的平衡功能与步态的影响。 方法：将30例痉挛型双瘫学龄期脑瘫患儿采用电脑随机方法分为实验组和对照组。实验组和对照组各15例均接受隔天1次,每周3次的常规康复训练,实验组在常规训练基础上同时进行隔天1次,每周3次的运动平板训练,持续12周。分别于治疗前与治疗后对两组患者采用Berg平衡量表评定和步态分析。 结果：干预12周后,实验组Berg评分和步态时空参数（跨步长、步宽、步速）与对照组存在显著差异（P＜0.05）。 结论：运动平板训练对提高痉挛型双瘫学龄期脑瘫患儿的平衡功能与改善步态的效果显著。     

Risk factors contributing to crouch gait in children with spastic cerebral palsy

Background: Crouch gait is often observed in children with spastic cerebral palsy (CP). This pathological walking pattern can cause abnormally high stress to the knee anatomical structures, leading to various knee problems. Consequently, the ambulatory function of many of these children may eventually regress to depending on assistive walking aids or wheelchairs.

Objectives: The purpose and the focus of this review paper are to understand how risk factors contribute to crouch gait in children with spastic CP.

Major Findings: The risk factors include weakness, tightness, and/or spasticity of muscles, loss of plantarflexion/knee-extension (PF/KE) couple due to inaccurate surgical lengthening of the soleus, lever-arm dysfunctions (LADs) due to femoral and tibial torsion deformities, and foot instability. The analyses suggest that these risk factors contribute to crouch gait by directly or indirectly reducing the extensor control of the lower limbs during the stance phase of gait.

Conclusions: The risk factors identified in this review may not necessarily lead to crouch gait if proactive measures to prevent these risk factors are rendered, especially with the use of instrumented gait analysis (IGA).     

体外冲击波用于改善痉挛型脑性瘫痪患儿蹲伏步态的临床研究

目的:应用体外冲击波治疗痉挛型脑瘫患儿蹲伏步态的疗效分析。方法:30例痉挛性双瘫患儿随机分为治疗组和对照组(每组15例),治疗组加用冲击波治疗,治疗前和治疗后3个月对2组患儿的膝、踝关节的最大角度和关节活动度、肌张力、步长、步速和粗大运动功能评分(GMFM)进行评定。结果:治疗3个月后,两组患儿踝关节的关节活动度、膝关节和踝关节屈曲最大角度和最小角度都明显改善(P0.05);腘绳肌群和小腿三头肌群的肌张力明显下降(P0.05),但治疗组改善更明显;两组患儿GMFM评分、步速、步长均有改善(P0.05),但治疗组效果更明显。结论:体外冲击波可以降低脑瘫患儿腘绳肌、小腿三头肌肌张力,能够改善患儿的蹲伏步态。     

髋关节矫形器在儿童痉挛型脑性瘫痪康复中的作用

目的探讨髋关节矫形器 (HO)在儿童痉挛型脑性瘫痪康复中的作用。方法 5例痉挛型双瘫的脑瘫患儿在原有康复治疗的基础上 ,穿戴HO纠正剪刀样步态。采用基于数字视频和数字图像处理的二维步态分析系统 ,对患儿步行时额状面的双膝(K)与双髂前上棘 (I)之间的距离比 (K/I)进行测评。随访 1年。结果穿戴矫形器后 ,K/I较穿戴前有显著性差异 (P <0 0 5 )。结论髋关节矫形器能限制髋关节内收、改善异常剪刀样步行模式、增强步行稳定性。