Study of gait rehabilitation of hemiplegic patients in early stage of rehabilitation using ankle-foot-orthoses

偏瘫患者康复早期的步态训练十分重要。在这个阶段，步态中的矫形辅助是必不可少的，AFOS的功能根据每个患者的情况进行调整是可取的。然而，没有一种AFO的功能可以很容易地改变。本研究旨在探讨AFO在急性偏瘫患者中的功能，并将其应用于急性偏瘫患者的步态训练。试练AFO由一个产生助攻时刻的弹簧组成。试验用AFO的踝关节活动范围和背屈辅助力矩的大小可以很容易地改变。采用三维步态分析系统(VICON512)和测力板对AFO步态进行测量。结果发现，急性偏瘫患者所需的辅助力矩远小于慢性偏瘫患者。研究还发现，助力弹簧的反弹力有时对急性偏瘫步态有害。基于这些结果，讨论了用于急性偏瘫患者步态训练的AFO的理想规格。对于急性偏瘫患者的AFO辅助装置，油压阻尼器是第二种可能的方案，它能产生对足屈的反作用力而不产生排斥力。未来将开发一种带油阻尼器的AFO。

Gait training at the early stage of rehabilitation is quite important for hemiplegic patients. Orthotic assist during gait is indispensable at this stage and the adjustability of functions of AFOs to the condition of each patient is desirable. However, there is no AFO whose function can be changed easily. The purpose of this study is to investigate the function of AFOs for acute hemiplegic patients.A trial AFO was developed and used for the gait training of acute hemiplegic patients. The trial AFO consisted of a spring that produced the assist moment. The range of motion of the ankle joint and magnitude of the dorsiflexion assist moment of the trial AFO could be changed easily. The gaits with AFO were measured by three dimensional gait analysis system (VICON512) and force plates. As results, it was found that the magnitude of assist moment necessary for acute hemiplegic patients was much smaller than for chronic patients. And it was also found that the repulse force of the assist spring was sometimes harmful for acute hemiplegic gait. Based on these results the desirable specification of an AFO for gait training of acute hemiplegic patients was discussed. Oil damper which generates the reaction force to plantarflexion but does not generate the repulse force is second possibility for the assist device of the AFO for acute hemiplegic patients. An AFO with oil damper will be developed in the future.