踝足矫形器对脑卒中偏瘫患者下肢功能恢复的影响

目的:研究踝足矫形器疗法对脑卒中偏瘫患者下肢功能恢复的影响。方法:脑卒中偏瘫患者(2年内)分为常规康复组30例和矫形器康复组31例。常规康复组采用常规运动疗法治疗,矫形器康复采用常规运动疗法并加用踝足矫形器。在治疗前后分别用Fugl-Meger下肢评分,评衡评分及10米最大步行速度来评定。结果:2组在康复治疗前评测的各主要指标间无明显差别(P0.05);康复治疗后评测的下脚FMA、平衡FMA与10米最大步行速度2组间有显著性差异(P0.01)。结论:踝足矫形器疗法可以促进脑卒中偏瘫患者下肢功能康复。     

Stability analysis of paraplegic standing while wearing an orthosis

Paraplegics can maintain a standing posture, called the “C-posture”, while wearing an orthosis. The significant feature of the C-posture is that the body’s center of mass is located behind the hip joint. In this study, we investigate the C-posture mechanism and assess the relationship between posture and stability, the aim being to restore standing function. We first measured the standing postures of paraplegic subjects wearing an orthosis. The subjects maintained the standing posture for 30 s. Next, assuming the C-posture to be an equilibrium attractor in the musculoskeletal system, we used a dynamic model of the musculoskeletal system to analyze the relationship between posture and stability, and also to assess the influence of ankle stiffness. We calculated the standing posture on the basis of a return map. The calculated standing postures show some features of the C-posture. The stability analysis revealed that, despite a limitation in the range of stable postures, the C-posture is more stable than the postures of normal people. The results suggest that although the C-posture is an appropriate posture for paraplegic standing, sufficient ankle stiffness and an appropriate alignment of ankle angle are necessary and preventing hip flexion movements is desirable.An erratum to this article can be found at     

应用往复式截瘫步行器重建完全性截瘫病人的步行功能

目的 应用自行研制的往复式截瘫步行器(RGO)帮助截瘫患者重建站立和行走功能，促进截瘫患者全面康复。方法 为19例T4～L1脊髓完全性损伤患者安装往复式截瘫步行器，并对其进行肌肉力量、关节活动度、平衡、站立等综合康复训练。结果 19例患者中，16例应用往复式截瘫步行器可作功能性家庭内步行，3例可作治疗性步行。通过电话或信件随访，5例患者对截瘫步行器逐步熟悉和适应，达到功能性社区内步行，11例患者可作功能性家庭内步行，2例患者应用步行器作治疗性步行，1例患者放弃应用步行器。结论 T4-L1完全性脊髓损伤患者可以应用往复式截瘫步行器以重建站立及步行功能、防治并发症、提高生存质量。损伤平面高低决定患者能否应用截瘫步行器步行，治疗师对病人进行的综合康复训练是影响使用效果的重要因素。对T6以上的截瘫患者应慎重，安装前应考虑患者的年龄、体型、上肢力量、脊柱稳定性、躯干的控制能力及腰背肌、腹肌肌力等条件，心理因素也不能忽视。     

A commentary from the pioneers on the innovation of the relative motion concept: History,biologic considerations,and anatomic rationale

The relative motion concept is simply recognition of the normal functional anatomic relationships that allow powerful extrinsic muscles, the extensor digitorum communis (EDC) and flexor digitorum profundus (FDP), to vary forces on individual finger joints and function in response to the relative position of adjacent metacarpophalangeal joints (MCPJs) in the hand, one to another. First identified as a cause of complications after surgery, a better understanding now allows us to harness these forces by way of differential metacarpophalangeal joint (MCPJ) positioning using an orthosis. This can reduce undesirable tension and allow immediate controlled active motion while permitting functional use of the hand. Tissue gliding with active motion prevents restrictive scarring, maintains joint mobility and avoids unnecessary limitations and stiffness on normal neighboring structures. The historical development of this concept is shared with explanation of the anatomic and biologic rationale for this approach. Acute and chronic hand conditions that may benefit from better understanding of relative motion are numerous and growing.