Serial casting in idiopathic toe-walkers and children with spastic cerebral palsy
Serial casting in idiopathic toe-walkers and children with spastic cerebral palsy
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DOI：
10.1097/00004694-200003000-00017
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发表时间：
2000-03-01
影响因子：
1.7
通讯作者：
Olney, SJ
中科院分区：
文献类型：
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作者：
Brouwer, B;Davidson, LK;Olney, SJ
对于特发性趾步行者（ITW）和痉挛性脑性瘫痪（CP）儿童，主张采用连续铸造来伸展跖屈肌，但结果尚未得到充分研究。对8例CP患儿（平均年龄7.1岁）和8例ITW患儿（平均年龄7.5岁）进行了3 ~ 6周的神经肌肉功能和步态检查。基线比较表明，与ITW相比，CP儿童产生了较低的等长跖屈肌扭矩（p < 0.02），伴随着显著的共同收缩（p < 0.001），更大的踝关节活动度（p < 0.02）和更高的反射兴奋性（p < 0.001）。石膏固定后，两组背屈范围增加（p < 0.001），被动牵拉阻力降低（p < 0.005），背屈位跖屈肌扭矩最大（p < 0.001）。CP组反射兴奋性降低（p < 0.05）。铸造后立即，没有孩子脚趾走路，但两个CP恢复digitegrade模式6周后。步态速度和步长无明显变化（p > 0.05）。连续铸造产生了积极的结果，可能是更持久的ITW。
Serial casting to stretch the plantarflexors has been advocated for idiopathic toe-walkers (ITW) and children with spastic cerebral palsy (CP), although outcomes have not been well studied. Neuromuscular function and gait were examined in eight children with CP (mean age, 7.1 years) and eight ITW (mean age, 7.5 years) casted for 3 to 6 weeks. Baseline comparisons indicated that children with CP produced lower isometric plantarflexor torques (p < 0.02) concomitant with marked co-contraction (p < 0.001), greater ankle mobility (p < 0.02), and higher reflex excitability (p < 0.001) than ITW. After casting, both groups increased dorsiflexion range (p < 0.001), decreased resistance to passive stretch (p < 0.005), and produced maximal plantarflexor torques in dorsiflexed positions (p < 0.001). Reflex excitability was reduced in CP (p < 0.05). Immediately postcasting, no children toe-walked, but two with CP resumed a digitigrade pattern 6 weeks later. Gait velocity and stride length did not change (p > 0.05). Serial casting yielded positive outcomes that may be longer lasting in ITW.