ANKLE FOOT ORTHOSES FOR MANAGEMENT OF SPASTIC DIPLEGIA

患有脑瘫(CP)和痉挛双瘫的儿童倾向于行走 难度很大，耗费了相当大的精力。脚踝的脚 矫形器(AFO)通常被选为治疗这些疾病的首要手段。 孩子们。然而，没有公认的客观标准来衡量 AFO的处方：其疗效存在争议，其成本也是 这可不是小事。这项研究的长期目标是改善 力学，从而应用于脑性瘫痪儿童的步态 适当的AFO。AFO的明显好处是：控制 不良运动，稳定虚弱的肌肉，减少异常 肌肉紧张度。我们推测AFO控制着脚踝的扭矩， 这些效应沿着腿部向上传播到近端关节。我们 假设对于患有痉挛双瘫的儿童来说，标准和 与单独穿鞋相比，动态AFO将：(1)产生 关节扭矩轮廓更正常；(2)促进肌肉更正常 激活模式；以及(3)提高效率(由V02衡量 消费)。我们进一步假设阿司匹林的相对疗效 标准AFO与动态AFO之间的对比可用于测试 以上三个依赖措施。这项工程完成后， 将实现以下具体目标：批准或 不赞成前三个假设；确立目标 标准和动态AFO处方的基本标准.验证 步态分析作为治疗脑性瘫痪儿童的决策工具； 并确定神经肌肉功能障碍的潜在原因， 而不仅仅是记录效果。我们将分析36名儿童 在三种情况下：仅穿鞋；使用标准AFO；以及 具有动态AFO。一种重复测量交叉设计与分析 将使用方差。姿势和步态的计算机评估 都会被制造出来。为了量化功能的改进，我们将测量 使用三维动态步态分析的空间、运动和肌电变量 系统，同时将测量V02以评估能源效率。

Children who have cerebral palsy (CP) and spastic diplegia tend to walk with great difficulty and expend considerable energy. An ankle foot orthosis (AFO) is often chosen as the first means of treating these children. However, there are no accepted objective criteria for the prescription of AFOs: their efficacy is controversial, and their cost is not trivial. The long term goal of this research is to improve the mechanics and therefore the gait of children with CP by the application of appropriate AFOs. The apparent benefits of the AFO are: to control undesirable motions, to stabilize weak muscles, and to reduce abnormal muscle tone. We theorize that the AFO controls the ankle joint torques, and these effects propagate up the legs to the proximal joints. We hypothesize that for a child with spastic diplegia the standard and dynamic AFOs, when compared to wearing shoes alone, will: (1) produce a more normal joint torque profile; (2) facilitate more normal muscle activation patterns; and (3) increase efficiency (as measured by V02 consumption). We further hypothesize that the relative efficacy of standard versus dynamic AFOs to enhance locomotion can be tested with the above three dependent measures. Upon completion of this project, the following specific objectives will have been realized: approval or disapproval of the first three hypotheses; establishment of objective criteria to base prescription of standard and dynamic AFOs; validation of gait analysis as a decision-making tool for treating children with CP; and identification of underlying causes of neuromuscular disability, rather than merely documenting effects. We will analyze 36 children under each of three conditions: with shoes alone; with standard AFOs; and with dynamic AFOs. A repeated measures crossover design with an analysis of variance will be used. Computer assessment of both posture and gait will be made. To quantify improvement in function we will measure spatial, kinetic and EMG variables using a 3D dynamic gait analysis system, while V02 will be measured to assess energy efficiency.