The impact of ankle-foot-orthosis (AFO) use on the compensatory stepping response required to avoid a fall during trip-like perturbations in young adults: Implications for AFO prescription and design.
The impact of ankle-foot-orthosis (AFO) use on the compensatory stepping response required to avoid a fall during trip-like perturbations in young adults: Implications for AFO prescription and design.
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DOI：
10.1016/j.jbiomech.2020.109703
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发表时间：
2020-04-16
影响因子：
2.4
通讯作者：
Honeycutt CF
中科院分区：
文献类型：
--
作者：
Nevisipour M;Honeycutt CF
脚踝-足部矫形器(AFO)通常用于治疗容易跌倒的人(如中风)的脚下垂和增强步行能力。AFO可以改善静态平衡，但AFO使用者仍有很高的跌倒风险。据我们所知，还没有人研究AFO对在动态条件下避免摔倒所需的代偿性踏步反应的生物力学影响，如绊倒，绊倒是摔倒的主要原因。本研究的目的是评估半刚性热塑性AFO对年轻健康个体在Trip-Like跑步机扰动后代偿性踏步反应的影响。我们发现，步进腿上的AFO(AFO-Step)降低了躯干的稳定性(增加了躯干角和角速度)，缩短了补偿步长，降低了动态稳定性(较小的COM-BOS)。支撑腿上的AFO(AFO-Support)与非AFO的情况只有轻微的不同。代偿性踏步反应的有害变化(例如躯干稳定性降低)与踏步推进冲量的减弱呈线性相关。综上所述，在步行腿上使用AFO与年轻人的代偿性踏步反应受损(例如躯干稳定性降低)和推进冲动降低有关。值得注意的是，AFO的使用增强了静态稳定性，并降低了绊倒/绊倒的发生概率，这表明它们对防止跌倒很重要。尽管如此，我们的结果表明，使用AFO可能会损害绊倒发生后的代偿性踏步反应，并可能表明保留足屈功能可能支持代偿性踏步反应。有必要进一步研究这些装置及其对跌倒倾向个体代偿性踏步反应的影响。
Ankle-foot-orthoses (AFOs) are commonly prescribed to treat foot drop and enhance walking in fall-prone individuals (e.g. stroke). AFOs improve static balance but AFO-users are still at high fall risk. To our knowledge, no one has studied the biomechanical effect of AFO-use on the compensatory stepping response required to avoid falling during dynamic conditions such as trip, the leading cause of falls. The objective of this study is to evaluate the impact of a semi-rigid thermoplastic AFO on the compensatory stepping response in young healthy individuals following trip-like treadmill perturbations. We found that the AFO on the stepping leg (AFO-step) decreased trunk stability (increased trunk angle and angular velocity), shortened the compensatory step length, and reduced dynamic stability (smaller COM-BOS). AFO on the support leg (AFO-support) was only marginally different from the No-AFO condition. Detrimental changes in compensatory stepping response (e.g. decreased trunk stability) were linearly correlated to diminished propulsive impulse of the step. In summary, AFO-use on the stepping leg is associated with impaired compensatory stepping response (e.g. reduced trunk stability) and decreased propulsive impulse in young adults. It is important to note that AFO-use enhances static stability and decreases the probability of a trip/stumble occurring indicating they are important for fall prevention. Still, our results suggest that AFO-use may impair the compensatory stepping response after a trip/stumble has occurred and may suggest that preserving plantarflexion function may support the compensatory stepping response. Further study of these devices and their impact on compensatory stepping response in fall-prone individuals is warranted.
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