臺灣博碩士論文加值系統

摘要:
固定式踝足部矯具用於偏癱病患已有三十年的歷史,鉸接式蹠曲限制踝足部矯具被認為在處理偏癱病患行走時的背曲軟癱具有良好的效果。然而中風病患穿著鉸接式蹠曲限制踝足部矯具在降低痙攣的機轉及效果並不是十分清楚。
本研究收集十四位中風病患,在下列三種情況行走六公尺以便記錄關節角度變化與肌電圖: (1)只穿著球鞋, (2)雙腳著球鞋並在患側穿著零度背曲(踝關節正中位置)之鉸接式蹠曲限制踝足部矯具, (3)雙腳著球鞋並在患側穿著五度背曲之鉸接式蹠曲限制踝足部矯具。 根據 Crenna (1992) 以及 Lamontagne (2001) 的研究,對於痙攣的量化(痙攣指數)使用肌電反應對肌肉伸長速度作回歸分析,肌肉伸長速度的資料由步態分析系統(Vicon 250,Oxford,UK)取得,而肌電資料由表面電極取得(Gould Instrument System Inc,USA)
結果顯示 (1)健側及患側間的痙攣指數具有顯著差異(p<0.001), (2)患側穿著五度背曲之鉸接式蹠曲限制踝足部矯具相對於不穿著的情況下,其痙攣指數有明顯上升(p<0.01),但是病患穿著零度背曲之鉸接式蹠曲限制踝足部矯具在痙攣指數上並無顯著差異(p>0.05), (3) 零度及五度背曲之鉸接式蹠曲限制踝足部矯具對於載重反應時期(loading response)的時間有明顯改善(p<0.001),但是五度背曲之鉸接式蹠曲限制踝足部矯具對於擺盪前期時期(Pre-swing)的時間有顯著的減少。本研究的結論是正中位置(neutral position)之鉸接式蹠曲限制踝足部矯具相對於五度背曲之鉸接式蹠曲限制踝足部矯具在改善中風並患步態更具改善效果。

Abstract
Conventional rigid ankle-foot orthosis (AFO) has been used in hemiplegic subjects to improve gait function for almost thirty years. However, hinged plantarflexion-stop ankle-foot orthoses (PSAFO) are suggested to be effective for patients with hemiparesis and weak ankle dorsiflexion to stabilize the ankle in the sagittle and coronal plane during ambulation. However, the changes of ankle spasticity in stroke patients during ambulation with PSAFO is not very clear.
Totally 14 CVA patients participated in this study. They would walk about 6 meters in three conditions: (1) wearing only sports shoes. (2) wearing sports shoes with zero-degree PSAFO (with neutral ankle) on the paretic side. (3) wearing sports shoes with five-degree dorsiflexion PSAFO on the paretic side. We measured the spasticity index proposed by Crenna (1992) and Lamontagne (2001) with muscle length-EMG activity relationship to quantify the spasticity during walking. The gait cycles were recorded by the motion analysis system (Vicon 250, Oxford, UK). The EMG activities were recorded by surface electrodes (Gould Instrument Systems Inc., USA).
Results of present studies were: (1) the spasticity index between sound sides and paretic sides were significantly different at all conditions with and without PSAFO (p<0.001). (2) The spasticity index of the paretic side with five-degree AFO was significantly greater than that without AFO (p<0.01), and the spasticity index of zero-degree AFO was not significantly different from that without PSAFO (p>0.05). (3) PSAFO in zero and five-degree dorsiflexion could improve the loading response, but the pre-swing phase with five-degree PSAFO was significantly reduced. The major conclusion is that zero-degree AFO is a good prescription for stroke patients to enhance the walking ability.

Contents

Chapter 1. Introduction I
1.1 Project Motivation I
1.2 Literature Review 2
1.2.1 Gait Pattern in CVA 2
1.2.2 Studies of AFO and Other Othoses in CVA 5
1.2.3 Biomechanics of AFO 9
1.2.4 Measurements of spasticity 10
1.3 Hypotheses and Objectives 13

Chapter 2. Materials and Methods 14
2.1 Subjects 14
2.2 Study Design 16
2.3 Experimental Protocols 16
2.4 AFO Fabrication procedures 16
2.4.1 Molding Procedures 16
2.4.2 Cast Modification 19
2.4.3 Fabrication 20
2.4.4 Fitting 23
2.5 Equipments 24
2.6 Experimental procedures 24
2.7 Spasticity Measurements 28
2.8 Data Analysis 30

Chapter 3. Results 31
3.1 Demographic data 31
3.2 Lengthening velocity and EMG responses during stance phase 31
3.2.1 Lengthening velocity and EMG responses during stance phase without PSAFO 32
3.2.2 Lengthening velocity and EMG responses during stance phase with Zero- degree PSAFO 35
3.2.3 Lengthening velocity and EMG responses during stance phase with Five- degree PSAFO 37
3.3 Comparison of spasticity index during stance phase with and without PSAFO 39
3.4 EMG firing pattern during stance phase with and without PSAFO 41
3.5 Comparison of kinematic data during stance phase 45

Chapter 4. Discussion 48
4.1 Abnormal gait pattern in hemiplegic patients 48
4.2 Effect of PSAFO on spasticity 48
4.3 Effect of PSAFO on EMG firing pattern 49
4.4 Effect of PSAFO on gait cycle 50
4.5 Mechanism of PSAFO on Spasticity 51
4.6 Proposed clinical application 54
4.7 Limitation of study 54
4.8 Future works 55

Chapter 5. Conclusion 56

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