The effect of hinged ankle-foot orthoses on sit-to-stand transfer in children with spastic cerebral palsy

OBJECTIVE: To investigate the effectiveness of the hinged ankle-foot orthosis (AFO) on sit-to-stand (STS) transfers in children with spastic cerebral palsy. DESIGN: Before-after trial. SETTING: University-affiliated hospital. PARTICIPANTS: Nineteen spastic diplegic children (age range, 2-6 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The transitional movement of STS was tested in random order with children while wearing the barefoot and hinged AFOs. The temporal, kinematic, and kinetic data during the task were collected by using a motion analyzer (with 6 infrared cameras). Statistical comparison between barefoot and hinged AFO was done with the Wilcoxon signed-rank test. RESULTS: Total duration of STS transfer was significantly shortened with the hinged AFO (P <.05). The initial knee flexion, the initial angle, and the final angle of ankle dorsiflexion were increased with the AFO, compared with when barefoot (P <.05). However, the increased pelvic tilt and hip flexion while barefoot was not reduced with the AFO. The maximal moment and power of hip and knee joints were significantly increased with the AFO (P <.05), whereas the maximal moment and power of the ankle joint were not significantly changed when wearing the AFO. CONCLUSIONS: Although proximal compensatory strategy of increased pelvic tilt and hip flexion did not change with the hinged AFO, some improvements of temporal, kinematic, and kinetic parameters were identified during the task. These findings suggest that a hinged AFO is beneficial for STS transfer activity for children with spastic diplegia.     

治疗小儿脑性瘫痪的常用矫形器

本文通过10年来的临床实践,对脑性瘫痪(脑瘫)患儿康复中应用矫形器及其它辅助器具的目的、常用种类、作用、流程、评定、应用注意事项等内容做了简介。临床实践表明矫形器及其它辅助器具的应用在脑瘫患儿康复中起到了应有的作用。     

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。     

辅助器具在小儿脑性瘫痪康复中的选用探讨

本文针对小儿脑性瘫痪(脑瘫)康复中辅助器具的作用和选用进行探讨,并介绍了60多种供个人使用和训练用的相关辅助器具。在小儿脑瘫的康复过程中需要应用辅助器具来改善脑瘫患儿的功能障碍、帮助建立正常的运动模式、防止畸形进一步加重和提高他们的生活自理能力。为此着重提出了小儿脑瘫肢体残疾辅助器具选用时要考虑的3个因素即按照儿童运动发育规律、按照脑瘫儿功能障碍的身体部位、按照脑瘫儿的日常生活能力来选用。此外,有部分辅助器具将伴随脑瘫儿一生,成为他们回归社会的无障碍通道。     

Measuring impairment and functional limitations in children with cerebral palsy

Objective.?The disablement model provides a theoretical framework for the assessments of individuals with cerebral palsy (CP). The purpose of this study was to evaluate the relative validity of multiple measures for impairment and functional limitations and to estimate the relationship between the two global factors using confirmatory factor analysis.

Methods.?Over 50 measures of impairment and functional limitations were collected for 57 children with spastic CP. There were 12, 10, 5, 7 and 23 children who were classified in Gross Motor Function Classification System (GMFCS) Levels I to V, respectively.

Results.?The measures of impairment with the highest factor loadings were several single-item ratings of spasticity; the Modified Ashworth hamstring and biceps ratings, and goniometric measures. All of the functional limitation measures had high factor loadings, including the gross motor function measure, GMFCS, the Paediatric Evaluation of Disability Inventory and WeeFIM self care and mobility scales. The correlation between the global factors of impairment and functional limitations was 0.96, indicating that the two factors are highly correlated in spastic CP.

Conclusion.?The disablement model is a valuable theoretical tool that can be used to organise assessments in CP and to explain how they are related.     

A method to measure the accuracy of loads in knee-ankle-foot orthoses using conventional gait analysis, applied to persons with poliomyelitis

Andrysek J, Redekop S, Matsui NC, Kooy J, Hubbard S. A method to measure the accuracy of loads in knee-ankle-foot orthoses using conventional gait analysis, applied to persons with poliomyelitis.

Objectives

To determine (1) the forces and moments passing through knee-ankle-foot orthoses (KAFOs) during walking and (2) the accuracy with which these loads can be measured using conventional gait analysis techniques.

Design

Comparative case series.

Setting

Rehabilitation facility with human movement laboratory (gait lab).

Participants

Four patients with poliomyelitis wearing KAFOs.

Interventions

KAFOs were instrumented with a load cell, and walking data were concurrently collected using conventional gait analysis.

Main Outcome Measures

Load measurements and gait parameters.

Results

Predominant orthotic loads (knee joint forces and moments) were composed of knee flexion moments and axial compression forces. With conventional gait analysis, peak knee joint moments were substantially underestimated compared with those directly measured using the load cell. Defining the knee axis anatomically versus at the orthotic axis, tracking it dynamically, and compensating for each patient's corrected knee flexion contracture resulted in considerable improvements in the gait lab estimates of knee joint moments.

Conclusions

A practical method that directly measures moments and forces in conventional KAFOs has been applied to show that conventional gait analysis techniques substantially underestimate knee joint moments in the KAFOs of persons with poliomyelitis. Underestimation of orthotic loads could result in underdesigned orthotic components and ultimately higher incidence of component failure in clinical applications.     

踝足矫形器对脑瘫患儿异常步态的影响

目的:研究踝足矫形器对改善痉挛型脑瘫患儿步态的影响。方法:对30例脑瘫患儿配戴踝足矫形器前、后进行步态分析。结果:脑瘫患儿配戴踝足矫形器后,跨步长、步速明显提高,其中跨步长由0.38±0.13m增加至0.45±0.17m,步速由0.36±0.19m/s增加至0.47±0.14m/s;首次着地时踝关节的跖屈角度明显减少,由-11.98±8.43°减至-3.94±4.31°;髋关节站立相最大伸展角度由-7.41±10.06°增加至-14.10±10.60°;迈步相踝关节最大背屈角度明显提高,平均由-8.19±9.63°增至-4.25±3.71°;矢状面踝关节角度活动范围明显降低,平均由14.44±9.99°减至9.40±5.77°。结论:配戴踝足矫形器可以明显减轻脑瘫患儿异常步态模式的程度。     

Evaluation of a parent-report diary of the home use of assistive devices by young children with cerebral palsy

Purpose.?To develop and evaluate the preliminary measurement properties of a parent-report diary of the home use of seating and mobility devices by young children with cerebral palsy (CP).

Method.?Four AT experts reviewed the home use of technology for children (HUTCH) diary to confirm its coverage of AT devices, and six parents of young children with CP examined its content, wording and organization. A random sample of 12 other parents independently completed a HUTCH diary daily for 1 week to record their child's use of seating, mobility and orthotic devices at home. Two to three weeks later, parents completed a second diary of AT device use over another seven consecutive days.

Results.?The face validity, content validity and test–retest reliability (ICC = 0.91; 95% CI = 0.69–0.97) of the HUTCH were very good. Parents reported that they completed the diary quickly and easily.

Conclusions.?The HUTCH diary shows promise as a reliable and practical way to record the frequency and number of hours that children use different types of seating and mobility-related devices at home. Testing the concurrent validity of the HUTCH diary against an acceptable criterion measure will improve its acceptance as measure of AT device use.     

上田正法治疗脑性瘫痪儿童的疗效初步评价

目的通过对上田正法的应用,探讨及评价治疗脑性瘫痪(CP)儿童的新方法。方法对22例8个月～10.8岁的CP儿作治疗前,后的运动功能变化进行动态观察及量化评价,并以同期年龄相对应的15例CP儿应用Vojta等法治疗作对照(包括单用上田正法11例,单用Vojta等法4例,自身对照11例,即先用Vojta法后用上田正法）。结果上田正法治疗后运动功能发育评价较治疗前增加10分,Vojta等法治疗后增加8分/月(P>0.05）。对重度,极重度CP儿两种方法分别增加11分/月,7分/月(P<0.05）。结论上田正法亦是治疗小儿CP的有效方法,且优于Vojta等法,尤其是对以前Vojta等法较棘手的重度CP儿也有较好的疗效。     

脑瘫患儿气质特征研究

目的探讨脑瘫患儿气质特征。方法采用修订的Carey儿童气质问卷中文电子软件版 ,对 3 64例 4个月— 7岁脑瘫患儿进行气质分析 ,比较不同临床类型、独走和未独走患儿气质特征。结果脑瘫患儿有明显消极气质 ,表现为活动性低、注意力欠集中、坚持性差、情绪本质消极等 ;痉挛型双瘫和徐动型患儿趋避性有明显区别 ;不同智力水平脑瘫患儿未见气质差异 ;不能独走患儿的消极气质明显。结论脑瘫患儿有明显的消极气质。     

脑性瘫痪患儿踝足矫形器配戴前后对运动功能的量化评价

Becauseofmotordisablementofpatientswithcerebralpalsy,providingandsupportingthemakindofwayorasuitableassistanttechnologyforexploringtheirsurroundingsincorrespondingphaseswillimprovegreatlytheiropportunitiesofgettingindependence犤1犦.Children'motorfunctionwasassessedwithself-madequantitativeassessmentscaleaccordingtotheforth,fifthfunctionareaofmotorassessmentscaleofchildrenwithcerebralpalsyafteroneweekofwearingorthopedicinstruments.Thisarticleexplorestheroleofanklefootorthopedicinstrumentsinenha…     

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.     

不同病情程度脑瘫患儿的表面肌电图特征初探

目的：探讨不同病情程度脑瘫患儿的表面肌电图特征.方法：脑瘫患儿100例作为观察组,30例正常儿童作为对照组,2组均给予双侧肱二头肌、肱三头肌、腓肠肌、胫骨前肌的表面肌电图测试;分为被动活动和最大等长收缩（MIVC）2种状态,测试指标为肌电积分值（iEMG）、中值频率（MF）和协同收缩率（CR）.结果：在被动活动状态下,随着病情程度加重,患儿肱二头肌、腓肠肌iEMG值逐渐增高（P＜0.05）;在MIVC状态下,随着病情程度加重,各组患儿肌肉iEMG值及MF值逐渐降低,肱三头肌、胫骨前肌CR逐渐增高（均P＜0.05）.结论：脑瘫患儿的表面肌电图特征与正常儿童存在显著性差异,随着病情程度的加重,脑瘫患儿时域、频域指标呈现相应的特征.     

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。     

436例脑瘫患儿的脑电图分析

目的 :探讨脑瘫患儿的脑电图与脑瘫型别、瘫痪类型、脑瘫程度及并发症之间的关系。方法 :采用国际 10 / 2 0导系统电极放置法 ,为 436例脑瘫患儿做脑电图检查和分析。结果 :脑瘫患儿的脑电图异常率为 72 .7% ,手足徐动型脑瘫的脑电图异常率较低 ,偏瘫组的脑电图异常率较高 ,重度脑瘫组的脑电图异常率较高 ,伴有癫痫发作、智力障碍、小头畸形患儿的脑电图异常率较高。结论 :脑瘫患儿的脑电图异常率与大脑损伤的部位和程度有关。     

The use and impact of assistive devices and other environmental modifications on everyday activities and care in young children with cerebral palsy

Purpose.?The study describes use of assistive devices and other environmental modifications, and their impact on everyday activities and care in young children with cerebral palsy (CP).

Method.?Ninety-five children (55 boys, 40 girls; mean age 58 months, SD 18 months) and their parents were studied using a cross-sectional design. The Pediatric Evaluation of Disability Inventory (PEDI) was applied to assess daily activities using the three measurement scales: functional skills, caregiver assistance, and modifications of the environment. Use of modifications was described related to the five severity levels of the Gross Motor Function Classifications System (GMFCS). Impact was rated on the Caregiver Assistance scale of the PEDI and on a five-point Likert scale.

Results.?Out of the 1075 provided environmental modifications, 980 were in regular use to support mobility, self-care and social function among 84 children. The number increased with GMFCS levels; children at levels IV and V used 80% of the modifications, with large variations between the children at same level. Adaptations of housing and transportation facilitated effective use of assistive devices. Half of the parents rated the modifications to have moderate to very large effect on the child's mobility, 25% on self-care skills, and 20% on social function. Furthermore, 65% reported that the modifications lightened the caregiving for mobility, 75% for self-care and 25% for social function. Functional independence and care demands often benefited from different types of modifications.

Conclusion.?The variations in use and benefits of environmental modifications indicate need of comprehensive assistive technology assessments, including child factors, family factors, technology factors and service system factors.     

小儿脑瘫智能评定研究

目的 改进脑瘫患儿合并智能障碍的评定，充分发挥患儿的智力水平，防止造成患儿2次精神心理障碍。方法 对107例脑瘫患儿进行康复前后的智力测定，作出智障诊断并采用综合手段全面康复治疗1个疗程（3个月）。结果 220例脑瘫患儿中合并智力障碍164例，占74．5％；重度脑瘫儿合并智障者高达90%，康复显效患儿合并智障的比例低。结论 影响脑瘫患儿智力评定的因素很多，应综合判断分析，寻求更合理的评定方法。     

踝足矫形器佩戴时间对痉挛型脑性瘫痪儿童运动功能的影响

目的研究踝足矫形器（AFO）不同的佩戴时间对痉挛型脑性瘫痪（脑瘫）儿童运动功能的影响。 方法将52例痉挛型脑瘫儿童随机分为训练佩戴组16例、日间佩戴组19例和日夜佩戴组17例。3组患儿均给予常规康复治疗,训练佩戴组仅在运动训练时佩戴AFO;日间佩戴组平日运动时亦佩戴AFO,每日佩戴6~8 h;日夜佩戴组除清洗及进行部分训练项目时取下AFO外,其余时间均佩戴。3组患儿总疗程均为2个月。分别在康复治疗前、后测定患儿踝关节被动活动范围（APROM）,采用改良Ashworth量表（MAS）评定患儿痉挛情况,采用粗大运动功能测试量表（GMFM）中的D区及E区评定患儿的站立和步行能力。 结果3组患儿的APROM、MAS评分和GMFM评分治疗前比较,差异无统计学意义（P&rt;0.05）。治疗后,日间佩戴组、日夜佩戴组患儿的APROM、MAS评分和GMFM评分均高于训练佩戴组（P<0.05）,日间佩戴组和日夜佩戴组的APROM、MAS评分组间比较,差异无统计学意义（P&rt;0.05）,日间佩戴组GMFM评分明显高于日夜佩戴组（P<0.05）。 结论日间佩戴AFO 6~8 h对于缓解痉挛型脑瘫儿童踝跖屈肌群痉挛并提高其运动能力,较仅训练时佩戴AFO或日夜佩戴AFO更有效。     

42例痉挛型脑瘫患儿的步态分析

目的 探讨痉挛型脑瘫患儿的步态分析及其在脑瘫康复中的作用。方法 采用三维力台测试、红外摄相等技术,为42例脑瘫患儿做步态分析。得出时间历程、力台参数、关节角度变化范围3项数据。结果 对3项数据做统计学处理,表明各型别之间无显著性差异（P＞0．05）。结论 痉挛型脑瘫患儿的步态分析表现个体差异较大,对脑瘫康复的评价、训练、治疗、疗效评估均有一定帮助。