新型油液阻尼可调式踝足矫形器的跖屈阻尼在脑卒中患者步态中对胸廓和骨盆运动的影响

doi:10.3969/j.issn.1006-9771.2021.06.003

Abstract

Abstract: Objectives

To investigate the effects of different plantarflexion resistance of an ankle foot orthosis (AFO) on the motion of the thorax and pelvis during the gait of stroke patients.

Methods

From June, 2020 to January, 2021, 26 stroke inpatients in Beijing Bo'ai Hospital wore AFO with oil damper (OD) ankle hinge, and measured thorax and pelvis during stroke gait under three plantarflexion resistance (OD1, OD2.5, OD4) of the AFO with a three-dimensional motion capture system. The main parameters were pelvic (P) and thoracic (T) angles at the following time or phases: initial contact (IC), contralateral foot off (CFO), contralateral initial contact (CIC), foot off (FO); the change of thoracic angle in gait cycle (T_cycle_x), the change of thoracic angle in stance phase (T_ST_x) and the change of thoracic angle in single stance phase (T_SS_x). Thoracic and pelvic motions were defined on three coordinate axes: forward/backward tilt (x), oblique (y) and rotation (z).

Results

The loading response times were significant different among different plantarflexion resistance conditions (χ² = 7.923, P = 0.019), as well as between OD2.5 and in OD4 (P = 0.017). P_CFO_x, P_CFO_z, P_CIC_x and P_Fo_x; T_CFO_x, T_CFO_y, T_CFO_z and T_FO_x; relative angle of thorax to pelvis TP_IC_x, TP_CFO_x and TP_CIC_x; and T_SS_x were significant different among three resistance conditions (χ² > 6.077, P < 0.05). Forward tilt of pelvis decreased in condition OD2.5 and increased in condition OD4 during each timing. When CFO, the thoracic forward/backward tilt angle was less in OD2.5 than in OD4 (P < 0.05), the thoracic rotation angle was less in OD1 than in OD4 (P < 0.05).

Conclusion

Plantarflexion resistance has a significant effect on the motion of the thorax and pelvis in the gait of stroke patients. Under the middle magnitude of resistance, the pelvic and thoracic posture becomes more upright, the oblique angle is reduced, showing the improvement of the upright posture. On the contrary, the pelvic forward tilt and thoracic oblique are increased when resistance become low or high, compensation of rotational motion appeared in high resistance, posture getting worse.

Key words: stroke, hemiplegia, gait, plantarflexion resistance, thorax, pelvis, kinetics

CLC Number:

R496

Hua LING,Sumiko YAMAMOTO,Li-fei CAI,Hao ZHOU. Effect of Plantarflexion Resistance of A New Adjustable Oil Damper Joint Ankle Foot Orthosis on Thorax and Pelvis in Gait after Stroke[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(6): 637-644.

Figures/Tables 5

References 40

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项目	值
性别(男/女，n)	26/0
年龄(岁)	47.1±14.2
身高(m)	1.72±0.33
体质量(kg)	74.8±9.3
体质量指数(kg/m²)	25.2±2.6
偏瘫侧(左/右，n)	11/15
病程(d)	153.8±76.4
偏瘫侧下肢Brunnstrom分期(Ⅲ/Ⅳ/Ⅴ，n)	7/17/2
功能性步行分级(2级/3级/4级，n)	6/14/6
Fugl-Meyer评定量表平衡部分	9.92±1.96
Berg平衡量表	44.73±3.99

项目	OD1	OD2.5	OD4	χ²值	P值	P值^a	P值^b	P值^c
步行速度(m/s)	0.247±0.139	0.229±0.117	0.270±0.146	4.692	0.096
步长(偏瘫侧-非瘫痪侧)(%身高)	0.158±0.053	0.151±0.050	0.156±0.049	5.615	0.060
步长(非偏瘫侧-瘫痪侧)(%身高)	0.136±0.052	0.133±0.049	0.141±0.049	2.846	0.241
步态周期(s)	2.282±0.599	2.332±0.581	2.149±0.628	3.308	0.191
LR (s)	0.823±0.375	0.871±0.382	0.799±0.364	7.923	0.019	0.214	0.017	0.995
SS (s)	0.336±0.087	0.332±0.088	0.354±0.126	2.769	0.250
PS (s)	0.560±0.257	0.553±0.233	0.557±0.275	0.077	0.962
摆动期(s)	0.563±0.134	0.582±0.116	0.561±0.131	2.583	0.275

项目	OD1	OD2.5	OD4	χ²值	P值	P值^a	P值^b	P值^c
P_IC_x	-7.096±3.180	-6.734±3.214	-8.098±2.924	5.846	0.054
P_IC_y	2.114±3.115	1.792±2.725	1.913±2.826	0.231	0.891
P_IC_z	-2.082±5.930	-2.400±5.850	-1.686±5.854	0.077	0.962
P_CFO_x	-10.241±4.463	-9.834±4.418	-10.614±4.493	8.240	0.016	0.198	0.014	0.967
P_CFO_y	-3.813±2.971	-3.745±3.004	-3.693±2.661	2.846	0.241
P_CFO_z	3.205±5.634	3.030±5.274	4.556±5.511	6.077	0.048	1.000	0.214	0.055
P_CIC_x	-11.382±4.489	-10.628±4.635	-12.049±4.674	19.760	< 0.001	0.359	< 0.001	0.014
P_CIC_y	-1.664±2.781	-1.865±2.354	-1.386±3.114	0.560	0.756
P_CIC_z	0.079±5.251	0.128±5.150	-0.031±4.724	1.040	0.595
P_FO_x	-10.966±3.659	-10.122±4.081	-11.989±4.027	29.308	< 0.001	0.038	< 0.001	0.011
P_FO_y	1.295±2.735	1.211±2.616	1.174±3.449	0.077	0.962
P_FO_z	-5.168±5.067	-5.425±5.049	-5.469±5.187	1.000	0.607
T_IC_x	1.793±4.071	1.540±4.105	1.453±3.783	2.077	0.354
T_IC_y	0.719±3.176	1.165±3.205	1.138±2.878	2.154	0.341
T_IC_z	-2.194±4.550	-2.047±4.680	-1.408±4.711	3.769	0.152
T_CFO_x	0.351±3.909	0.092±3.821	0.801±4.131	10.692	0.005	0.080	0.004	0.995
T_CFO_y	-4.202±2.775	-3.411±2.980	-4.502±2.502	12.538	0.002	0.055	0.002	0.802
T_CFO_z	2.875±4.447	3.078±4.227	4.625±4.033	14.077	0.001	0.288	0.113	0.001
T_CIC_x	-0.902±3.761	-0.320±4.051	-1.137±4.039	4.923	0.085
T_CIC_y	-3.341±2.732	-3.207±2.761	-3.148±2.719	1.000	0.607
T_CIC_z	1.637±4.236	1.755±4.283	2.401±4.531	0.538	0.764
T_FO_x	0.039±3.462	0.353±3.728	-1.008±3.885	12.000	0.001	1.000	0.001	0.029
T_FO_y	0.412±2.866	0.763±2.941	0.391±2.826	0.923	0.630
T_FO_z	-3.186±4.520	-3.310±4.665	-3.390±4.846	1.462	0.482
TP_IC_x	8.315±5.546	7.727±5.623	9.075±5.030	13.462	0.001	1.000	0.002	0.017
TP_CFO_x	10.060±5.714	9.362±5.768	11.081±5.343	22.640	< 0.001	0.967	< 0.001	0.001
TP_CIC_x	9.708±5.961	9.549±5.909	10.301±5.789	8.720	0.013	1.000	0.022	0.049
TP_FO_x	10.101±5.967	9.615±6.135	10.049±5.737	1.923	0.382
T_cycle_x	6.029±2.670	6.164±2.716	6.241±2.435	0.077	0.962
T_ST_x	5.681±2.696	5.512±2.790	5.510±2.493	1.000	0.607
T_SS_x	2.013±0.705	1.800±0.683	2.259±0.948	8.385	0.015	1.000	0.025	0.055

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Effect of Plantarflexion Resistance of A New Adjustable Oil Damper Joint Ankle Foot Orthosis on Thorax and Pelvis in Gait after Stroke

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