踝足矫形器对老年脑卒中偏瘫病人平衡和步态的影响

Effects of varying ankle-foot orthosis on balance and gait in elderly hemiplegic patients with stroke

目的探讨裸足状态(bare foot)、穿戴软式塑料踝足矫形器(sAFO)和硬式塑料踝足矫形器(hAFO)对老年脑卒中偏瘫病人静态和动态平衡、步态功能的影响。方法共选取老年脑卒中偏瘫病人52例,男38例,女14例,分别在睁眼和闭眼2种方式下,采用Pro-Kin平衡评估训练仪评估bare foot、sAFO和hAFO 3种条件下的静态站立平衡功能,记录每种条件下双足最适距离站立以及主要测量参数,包括前后摆动幅度标准差、左右摆动幅度标准差、前后平均运动速度、左右平均运动速度、运动椭圆面积和运动长度。采用Tinetti平衡与步态量表(Tinetti Performance-Oriented Mobility Assessment,Tinetti POMA)评估老年脑卒中偏瘫病人在3种条件下的动态平衡和步态功能。结果静态站立时,bare foot、sAFO、hAFO双足间最适距离分别为(15.46±4.65)cm、(17.87±5.5)cm、(18.43±5.45)cm。使用sAFO站立时,在睁眼状态下,左右平均运动速度、运动椭圆面积、运动长度显著小于bare foot站立条件(P<0.05);在闭眼状态下,左右摆动幅度标准差、左右平均运动速度、运动椭圆面积、运动长度显著小于bare foot站立条件(P<0.05)。使用hAFO站立时,在睁眼状态下,前后摆动幅度标准差、左右摆动幅度标准差、左右平均运动速度、运动椭圆面积、运动长度显著小于bare foot站立条件(P<0.05);在闭眼状态下,前后摆动幅度标准差、左右摆动幅度标准差、左右平均运动速度、运动椭圆面积、运动长度显著小于bare foot站立条件(P<0.05)。在睁眼状态下,使用hAFO站立时,左右摆动幅度标准差参数显著小于sAFO站立条件;在闭眼状态下,前后摆动幅度标准差显著小于sAFO条件(P<0.05)。使用sAFO的Tinetti POMA、POMA-B、POMA-G评分显著高于bare foot条件(P<0.05);使用hAFO的Tinetti POMA、POMA-B评分显著高于bare foot条件(P<0.05);使用sAFO的Tinetti POMA、POMA-G评分显著高于hAFO条件(P<0.05)。结论sAFO和hAFO均能改善老年脑卒中偏瘫病人的静态和动态平衡功能,而且sAFO改善步态功能更有效。

Objective To investigate the effects of bare foot,soft plastic ankle-foot orthosis(sAFO)and hard plastic ankle-foot orthosis(hAFO)on balance and gait in the elderly hemiplegic patients with stroke.Methods A total of fifty-two elderly hemiplegic patients with stroke(38 male,14 female)were enrolled in this study.Under the two status of opening and closing eyes respectively,the Pro-Kin balance evaluation training instrument was used to evaluate the static standing balance function under three conditions of bare foot,sAFO and hAFO.The feet stood at the optimal distance under each condition,and the main measurement parameters including the standard deviation of longitudinal swing(SDoLS),the standard deviation of horizontal swing(SDoHS),mean longitudinal velocity(MLV),mean horizontal velocity(MHV),the ellipse area of motion(EAM)and the length of motion(LM)were recorded.The Tinetti Performance-Oriented Mobility Assessment(POMA)was used to evaluate the dynamic balance and gait.Results The optimum distance between feet of bare foot,sAFO and hAFO was(15.46±4.65)cm,(17.87±5.5)cm,(18.43±5.45)cm respectively.In the state of opening the eyes,MHV,EAM,LM of standing with the sAFO condition were significantly lower than those with the bare-foot condition(P<0.05);In the state of closing the eyes,SDoHS,MHV,EAM,LM of standing with the sAFO condition were significantly lower than those with the bare-foot condition(P<0.05);In the state of opening the eyes,SDoLS,SDoHS,MHV,EAM,LM of standing with the hAFO condition were significantly lower than those with the bare-foot condition(P<0.05);In the state of closing the eyes,SDoLS,SDoHS,MHV,EAM,LM of standing with the hAFO condition were significantly lower than those with the bare-foot condition(P<0.05);In the state of opening the eyes,SDoHS of standing with hAFO condition was significantly lower than that with sAFO condition(P<0.05);In the state of closing the eyes,SDoLS of standing with hAFO condition was significantly lower than that with sAFO condition(P<0.05).The scores of Tinetti POMA,POMA-B and POMA-G with the sAFO condition were significantly higher than those with the bare-foot condition(P<0.05);The scores of Tinetti POMA and POMA-B with the hAFO condition were significantly higher than those of the bare-foot condition(P<0.05);The scores of Tinetti POMA and POMA-G with the sAFO condition were significantly higher than those with the hAFO condition(P<0.05).Conclusions Both sAFO and hAFO can improve the static and dynamic balance function of the elderly hemiplegic patients with stroke,and sAFO is more effective in improving gait function.