Effects of a knee-ankle-foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum
Effects of a knee-ankle-foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum
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DOI：
10.1016/j.clinbiomech.2012.09.007
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发表时间：
2013-01-01
影响因子：
1.8
通讯作者：
Pradon, D.
中科院分区：
文献类型：
--
作者：
Boudarham, J.;Zory, R.;Pradon, D.
背景：在步态的站立阶段，膝关节-脚踝-足部矫形器可用于预防膝反弯。它还可以在摆动阶段限制异常的足底屈曲。目的是改善偏瘫患者的步态，防止膝关节退变。然而，膝-踝-足矫形器在步态中对偏瘫和非偏瘫肢体的影响还没有被评估。本研究的目的是量化偏瘫患者在步态过程中配戴膝关节-踝足矫形器对偏瘫和非偏瘫肢体的生物力学适应性。方法：11例偏瘫患者进行了两种步态分析(未佩戴膝关节-踝足矫形器和配戴膝关节-踝足矫形器)。在步态周期的站立和摆动阶段，使用仪表化步态分析系统对双腿的时空步态、运动学和运动学步态参数进行量化。瘫痪侧站立时膝关节过度伸展减少，踝关节屈膝和髋关节屈曲增加。在摆动阶段，偏瘫患肢踝关节背屈增加，非偏瘫患肢膝关节伸展增加。瘫痪肢体膝关节屈曲力矩也降低。解释：配戴膝-踝-足矫形器改善了膝反弯偏瘫患者的步态参数。它通过改善节奏、步长和非瘫痪步长来提高步态速度。这些时空适应性似乎主要是由于站立阶段膝关节过度伸展的减少，以及步态周期的两个阶段瘫痪肢体踝关节背屈的增加。(C)2012爱思唯尔有限公司。保留所有权利。
Background: A knee-ankle-foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee-ankle-foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee-ankle-foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait.Methods: Eleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee-ankle-foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle.Findings: The knee-ankle-foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased.Interpretation: Wearing a knee-ankle-foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle. (C) 2012 Elsevier Ltd. All rights reserved.