Combined Ankle/Knee Stretching and Pivoting Stepping Training for Children With Cerebral Palsy.
Combined Ankle/Knee Stretching and Pivoting Stepping Training for Children With Cerebral Palsy.
复制标题
脑瘫儿童的踝/膝拉伸和旋转步进联合训练。
DOI：
10.1109/tnsre.2019.2934139
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Zhang,Li-Qun
中科院分区：
文献类型：
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作者：
Lee,SongJoo;Jin,Dongmei;Kang,SangHoon;Gaebler-Spira,Deborah;Zhang,Li-Qun
尽管已经研究了各种治疗方法来减少脑瘫（CP）儿童的痉挛和内八字步态，但缺乏根据儿童的具体需要同时减少内八字步态和相关踝/膝关节僵硬和痉挛的方法。本研究旨在制定一项训练计划，以改善步行功能和横向（旋转）神经肌肉控制，并减少痉挛和足尖步态偏差。 8 名患有双瘫 CP 和内八字步态的儿童参加了为期 6 周的联合机器人踝关节和/或膝关节智能拉伸和旋转神经肌肉控制训练计划（Subject-specific Stretching and Pivoting Off-axis Neuromuscular control Training，[SSPOINT]）。使用神经力学、功能和临床结果指标评估 SS-POINT 的效果，并与之前研究中单独参加枢转神经肌肉控制训练 (POINT) 的 8 名患有 CP 和内八字步态的儿童进行比较。 结果 SS-POINT 项目后，患有 CP 的受试者表现出膝关节僵硬和内八字角度降低，关节和腿部功能得到改善，包括踝关节和膝关节主动活动范围、踝关节背屈肌力量、本体感觉、行走速度、平衡和最小旋转角度。此外，SS-POINT后本体感觉敏锐度和最小旋转角度的改善均大于POINT后。结论SS-POINT方法可作为针对特定主题的训练计划，用于改善腿部和步行功能，减少步态中的内八字。意义该方法可以作为关节和步行层面的个体化干预，通过调整训练目标、顺序和强度来满足脑瘫儿童的个体需求，从而最大限度地提高干预效果。
Although various treatment methods have been investigated to reduce spasticity and intoeing gait in children with cerebral palsy (CP), methods to concurrently reduce an intoeing gait and associated ankle/knee stiffness and spasticity according to a child's specific needs are lacking. This study aimed to develop a training program to improve walking function and transverse-plane (pivoting) neuromuscular control and reduce spasticity and intoeing gait deviations. Eight children with diplegic CP and intoeing gait participated in this 6-week combined robotic ankle and/or knee intelligent stretching and pivoting neuromuscular control training program (Subject-specific Stretching and Pivoting Off-axis Neuromuscular control Training, [SSPOINT]). The effects of SS-POINT were evaluated using neuromechanical, functional, and clinical outcome measures and compared to those for eight children with CP and intoeing gait who participated in pivoting neuromuscular control training (POINT) alone in a previous study.ResultsAfter the SS-POINT program, subjects with CP showed reduced knee stiffness and intoeing angle, and improvements in both joint and leg functions in terms of ankle and knee active range of motion, ankle dorsiflexor strength, proprioception, walking speed, balance, and minimum pivoting angle. Furthermore, improvements in proprioceptive acuity and minimum pivoting angle after the SS-POINT were greater than those after the POINT.ConclusionThe SS-POINT approach can be used as a subject-specific training program for improving leg and walking functions and reducing intoeing during gait.SignificanceThis approach can serve as an individualized intervention at the joint and walking levels to maximize intervention effects by adjusting training targets, sequences, and intensities to meet the individual needs of children with CP.