踝足矫形器在脑瘫儿童运动康复中的应用研究进展
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摘要
从踝足矫形器(AFO)设计的生物力学原理和临床适配性要求出发,围绕AFO在改善脑瘫患儿关节活动范围、提升粗大运动功能、提高平衡能力和纠正异常步态等临床应用方面进行综述,认为作为辅助踝关节运动的下肢矫形器,AFO特别适用于脑瘫患儿后遗症造成的运动功能障碍,但应避免由于其适配不当造成的临床疗效差异甚至弃用,提出逐步实现AFO在研究设计、生产制作、辅具教育和康复团队协作四个层面的结合,促进康复辅具事业的健康可持续发展.
Based on the biomechanical design principles and clinical adaptability of ankle-foot orthosis( AFO),this study focused on the clinical application of AFO in improving the range of joint activity in children with cerebral palsy,enhancing the motor function,improving the balance ability and correcting abnormal gait. AFO is particularly useful for motor dysfunction caused by sequelae of children with cerebral palsy,but should avoid improper clinical efficacy or even abandonment. It is proposed to realize the combination of AFO in research design,production,rehabilitation aids education and rehabilitation team collaboration to promote the healthy and sustainable development of rehabilitation aids.
Based on the biomechanical design principles and clinical adaptability of ankle-foot orthosis( AFO),this study focused on the clinical application of AFO in improving the range of joint activity in children with cerebral palsy,enhancing the motor function,improving the balance ability and correcting abnormal gait. AFO is particularly useful for motor dysfunction caused by sequelae of children with cerebral palsy,but should avoid improper clinical efficacy or even abandonment. It is proposed to realize the combination of AFO in research design,production,rehabilitation aids education and rehabilitation team collaboration to promote the healthy and sustainable development of rehabilitation aids.
引文
[1]关骅.临床康复学[M].北京:华夏出版社,2005:126-127.
[2]KIRBY R S,WINGATE M S,VAN NAARDEN BRAUN K,et al.Prevalence and functioning of children with cerebral palsy in four areas of the United States in 2006:a report from the autism and developmental disabilities monitoring network[J].Research in Developmental Disabilities,2011,2(2):462-469.
[3]徐晓莉,肖农,赵阳.脑瘫研究的一些新进展[J].中华物理医学与康复杂志,2012,34(5):393-395.
[4]社会福利和慈善事业促进司.窦玉沛副部长2014年中国(郑州)脑瘫功能重建与康复学术会致辞[EB/OL].[2014-10-08].http:∥www.mca.gov.cn/article/yw/shflhcssy/ldjh/201410/201410007098269.shtml.
[5]王月红,孙梅玲.踝足矫形器对小腿三头肌痉挛的脑瘫患儿康复治疗作用[J].中国康复医学杂志,2007,22(3):174-175.
[6]GOTTSCHALL J S,KRAM R.Energy cost and muscular activity required for propulsion during walking[J].J Appl Physiol,2003,94(5):1766-1772.
[7]方新,徐静.为脑瘫患儿设计的动态踝足矫形器[J].中国康复理论与实践,2003,9(12):712-713.
[8]FERRIS D P,CZERNIECKI J M,HANNAFORD B.An ankle-foot orthosis powered by artificial pneumatic muscles[J].J Appl Biomech,2005,21(2):189-197.
[9]GORDON K E,SAWICKI G S,FERRIS D P.Mechanical performance of artificial pneumatic muscles to power an anklefoot orthosis[J].J Biomech,2006,39(10):1832-1841.
[10]易南,王冰水,李玲.不同类型的踝足矫形器对痉挛型脑瘫患儿行走功能的影响[J].中国康复医学杂志,2002,17(2):100-102.
[11]熊宝林,周大伟,徐静.穿戴塑料踝足矫形器对下肢肌肉疲劳性的影响[J].中国组织工程研究,2014,18(25):4095-4100.
[12]钱竞光,宋雅伟.运动康复生物力学[M].北京:人民体育出版社,2008:353-354.
[13]张惠佳,颜华,刘宏,等.踝足矫形器矫治脑瘫患儿尖足初步疗效分析[J].临床小儿外科杂志,2004,3(3):169-171.
[14]舒彬.临床康复工程学[M].北京:人民卫生出版社,2013:180-181.
[15]周安艳.医师、技师、家长共同参与脑性瘫痪儿童使用下肢矫形器具的疗效分析及评估[J].现代康复,2001,5(5):31.
[16]张孝超,杨文兵,梁红英,等.踝足矫形器对脑性瘫痪患儿步行障碍的治疗作用[J].中国临床康复,2005,9(27):176-177.
[17]杨文兵,张孝超,陈述清.下肢矫形器在脑瘫临床上的应用效果分析[J].中国康复医学杂志,2004,19(11):852-853.
[18]GODIDSTEIN M,HARPER D C.Management of cerebral palsy:equines gait[J].Dev Mec Child Neurol,2001,43:563-569.
[19]罗颖,刘夕东,梅洪.踝足矫形器(AFO)对痉挛型脑瘫运动功能及ADL的作用[J].中国康复,2011,26(6):469-470.
[20]江晓峰,荣湘江.踝足矫形器对脑瘫患儿异常步态的影响[J].中国康复医学杂志,2005,20(11):863-865.
[21]赵晓科,肖农,张跃.踝足矫形器佩戴时间对痉挛型脑性瘫痪儿童运动功能的影响[J].中华物理医学与康复杂志,2009,31(5):327-330.
[22]张进华,王玉霞,杨正.动态与静态踝足矫形器对痉挛型脑性瘫痪儿童的疗效比较[J].中国康复医学杂志,2009,24(1):45-48.
[23]张伟涛,唐银燕.34例脑瘫儿童配戴硬踝足矫形器前后的行走功能比较[J].宁夏医学院学报,2003,25(5):353-354.
[24]商鑫飞.AFO(踝足矫形器)对痉挛型脑瘫儿站立姿势的影响[C]∥第8届北京国际康复论坛,北京:中国康复医学中心,2013:674-678.
[25]RUSSELL D,ROSENBAUM P L,AVERY L M,et al.Gross motor function measure(GMFM-66&GMFM-88)user's manual[M].London:Mac Keith,2002:30-123.
[26]MORRIS Christopher.Orthotic management of children with cerebral palsy[J].JPO Journal of Prosthetics&Orthotics,2002,14(4):150-158.
[27]朱俞岚,孙莉敏,张备.下肢矫形器在小儿脑性瘫痪的应用研究进展[J].神经损伤与功能重建,2015,10(2):151-154.
[28]梅洪,金荣疆,刘夕东.膝踝足矫形器对痉挛型脑瘫儿童下肢运动功能的影响[J].中国康复,2013,26:281-282.
[29]白国芳,李彦根,陈素菊,等.踝背屈牵拉器治疗痉挛型脑瘫下肢运动功能障碍疗效分析[J].河北医药,2007,29:1205-1207.
[30]史惟,陈冬冬.粗大运动功能测试量表在脑性瘫痪中的应用研究进展[J].中华儿科杂志,2006,44(7):550-552.
[31]程晶,马舒音.踝足矫形器结合低频电刺激对痉挛型脑瘫患儿运动功能的研究[J].齐齐哈尔医学院学报,2012,33:1558-1559.
[32]杨宜,舒世琼,鲍同柱.儿童踝足矫形器对于儿童矫形生理学影响与治疗效果[J].河北医学,2012,34:1363-1366.
[33]王月红,孙梅玲.踝足矫形器对小腿三头肌痉挛的脑瘫患儿康复治疗作用[J].中国康复,2007,22(3):174-175.
[34]周陶成,童光磊,张敏.踝足矫形器联合肉毒毒素治疗痉挛型脑性瘫痪儿童尖足畸形的疗效观察[J].中华物理医学与康复杂志,2015,37(10):761-764.
[35]金建华,王浙东,顾琴.踝足矫形器对迟缓型脑性瘫痪患儿步行功能的影响[J].苏州大学学报(医学版),2008,28(1):123.
[36]BAKER R,MCGINLEY J L,SCEWARTZ M H,et al.The gait profile score and movement analysis profile[J].Gait&Posture,2009,30(3):265-269.
[37]CIMOLIN V,GALLI M.Summary measures for clinical gait analysis:a literature review[J].Gait&Posture,2014,39(4):1005-1010.
[38]解益,董安琴.踝足矫形器矫治52例脑瘫患儿异常步态的疗效观察[C]∥中国康复医学会康复治疗专业委员会康复辅助器具学组成立暨全国康复辅助器具学术研讨会,北京:中国康复医学会,2011:82-84.
[39]黄宏亮,黄方.踝足矫形器对脑瘫患儿步行周期的影响[J].中国康复医学杂志,2008,23(2):175-177.
[40]RADTKA S A,SKINNER S R,JOHANSON M E.A comparison of gait with solid and hinged ankle-foot orthosis in children with spastic diplegic cerebral palsy[J].Gait Posture,2005,21:303-310.
[41]周安艳,李海.佩戴踝足矫形器对痉挛型脑性瘫痪儿童足底压力步态的作用[J].中国组织工程研究与临床康复,2010,14(17):3127-3130.
[42]HAYEK S,HEMO Y,CCHAMIS S,et al.The effect of community-prescribed ankle-foot orthosis on gait parameters in children with spastic cerebral palsy[J].J Child Orthop,2007,1(6):325-332.
[43]张旻,冯美兰,瞿佩玉.痉挛型脑瘫儿童佩戴不同类型踝足矫形器后下肢生物力学的变化[J].中国康复,2011,26(3):195-197.
[44]MANUELA Galli,VERONICA Cimolin,CHIARA Rigoldi,et al.Quantitative evaluation of the effects of ankle foot orthosis on gait in children with cerebral palsy using the gait profile score and gait variable scores[J].Journal of Developmental and Physical Disabilities,2016,28(3):367-379.
[45]徐淑玲,赵向,郭晓.痉挛型脑性瘫痪尖足患儿临床治疗及其踝足矫形器的应用[J].中国组织工程与临床康复,2009,13(34):6781-6784.
[46]赵辉三.发展中国家下肢矫形器学共识[J].中国康复理论与实践,2007,13(4):307-308.
[2]KIRBY R S,WINGATE M S,VAN NAARDEN BRAUN K,et al.Prevalence and functioning of children with cerebral palsy in four areas of the United States in 2006:a report from the autism and developmental disabilities monitoring network[J].Research in Developmental Disabilities,2011,2(2):462-469.
[3]徐晓莉,肖农,赵阳.脑瘫研究的一些新进展[J].中华物理医学与康复杂志,2012,34(5):393-395.
[4]社会福利和慈善事业促进司.窦玉沛副部长2014年中国(郑州)脑瘫功能重建与康复学术会致辞[EB/OL].[2014-10-08].http:∥www.mca.gov.cn/article/yw/shflhcssy/ldjh/201410/201410007098269.shtml.
[5]王月红,孙梅玲.踝足矫形器对小腿三头肌痉挛的脑瘫患儿康复治疗作用[J].中国康复医学杂志,2007,22(3):174-175.
[6]GOTTSCHALL J S,KRAM R.Energy cost and muscular activity required for propulsion during walking[J].J Appl Physiol,2003,94(5):1766-1772.
[7]方新,徐静.为脑瘫患儿设计的动态踝足矫形器[J].中国康复理论与实践,2003,9(12):712-713.
[8]FERRIS D P,CZERNIECKI J M,HANNAFORD B.An ankle-foot orthosis powered by artificial pneumatic muscles[J].J Appl Biomech,2005,21(2):189-197.
[9]GORDON K E,SAWICKI G S,FERRIS D P.Mechanical performance of artificial pneumatic muscles to power an anklefoot orthosis[J].J Biomech,2006,39(10):1832-1841.
[10]易南,王冰水,李玲.不同类型的踝足矫形器对痉挛型脑瘫患儿行走功能的影响[J].中国康复医学杂志,2002,17(2):100-102.
[11]熊宝林,周大伟,徐静.穿戴塑料踝足矫形器对下肢肌肉疲劳性的影响[J].中国组织工程研究,2014,18(25):4095-4100.
[12]钱竞光,宋雅伟.运动康复生物力学[M].北京:人民体育出版社,2008:353-354.
[13]张惠佳,颜华,刘宏,等.踝足矫形器矫治脑瘫患儿尖足初步疗效分析[J].临床小儿外科杂志,2004,3(3):169-171.
[14]舒彬.临床康复工程学[M].北京:人民卫生出版社,2013:180-181.
[15]周安艳.医师、技师、家长共同参与脑性瘫痪儿童使用下肢矫形器具的疗效分析及评估[J].现代康复,2001,5(5):31.
[16]张孝超,杨文兵,梁红英,等.踝足矫形器对脑性瘫痪患儿步行障碍的治疗作用[J].中国临床康复,2005,9(27):176-177.
[17]杨文兵,张孝超,陈述清.下肢矫形器在脑瘫临床上的应用效果分析[J].中国康复医学杂志,2004,19(11):852-853.
[18]GODIDSTEIN M,HARPER D C.Management of cerebral palsy:equines gait[J].Dev Mec Child Neurol,2001,43:563-569.
[19]罗颖,刘夕东,梅洪.踝足矫形器(AFO)对痉挛型脑瘫运动功能及ADL的作用[J].中国康复,2011,26(6):469-470.
[20]江晓峰,荣湘江.踝足矫形器对脑瘫患儿异常步态的影响[J].中国康复医学杂志,2005,20(11):863-865.
[21]赵晓科,肖农,张跃.踝足矫形器佩戴时间对痉挛型脑性瘫痪儿童运动功能的影响[J].中华物理医学与康复杂志,2009,31(5):327-330.
[22]张进华,王玉霞,杨正.动态与静态踝足矫形器对痉挛型脑性瘫痪儿童的疗效比较[J].中国康复医学杂志,2009,24(1):45-48.
[23]张伟涛,唐银燕.34例脑瘫儿童配戴硬踝足矫形器前后的行走功能比较[J].宁夏医学院学报,2003,25(5):353-354.
[24]商鑫飞.AFO(踝足矫形器)对痉挛型脑瘫儿站立姿势的影响[C]∥第8届北京国际康复论坛,北京:中国康复医学中心,2013:674-678.
[25]RUSSELL D,ROSENBAUM P L,AVERY L M,et al.Gross motor function measure(GMFM-66&GMFM-88)user's manual[M].London:Mac Keith,2002:30-123.
[26]MORRIS Christopher.Orthotic management of children with cerebral palsy[J].JPO Journal of Prosthetics&Orthotics,2002,14(4):150-158.
[27]朱俞岚,孙莉敏,张备.下肢矫形器在小儿脑性瘫痪的应用研究进展[J].神经损伤与功能重建,2015,10(2):151-154.
[28]梅洪,金荣疆,刘夕东.膝踝足矫形器对痉挛型脑瘫儿童下肢运动功能的影响[J].中国康复,2013,26:281-282.
[29]白国芳,李彦根,陈素菊,等.踝背屈牵拉器治疗痉挛型脑瘫下肢运动功能障碍疗效分析[J].河北医药,2007,29:1205-1207.
[30]史惟,陈冬冬.粗大运动功能测试量表在脑性瘫痪中的应用研究进展[J].中华儿科杂志,2006,44(7):550-552.
[31]程晶,马舒音.踝足矫形器结合低频电刺激对痉挛型脑瘫患儿运动功能的研究[J].齐齐哈尔医学院学报,2012,33:1558-1559.
[32]杨宜,舒世琼,鲍同柱.儿童踝足矫形器对于儿童矫形生理学影响与治疗效果[J].河北医学,2012,34:1363-1366.
[33]王月红,孙梅玲.踝足矫形器对小腿三头肌痉挛的脑瘫患儿康复治疗作用[J].中国康复,2007,22(3):174-175.
[34]周陶成,童光磊,张敏.踝足矫形器联合肉毒毒素治疗痉挛型脑性瘫痪儿童尖足畸形的疗效观察[J].中华物理医学与康复杂志,2015,37(10):761-764.
[35]金建华,王浙东,顾琴.踝足矫形器对迟缓型脑性瘫痪患儿步行功能的影响[J].苏州大学学报(医学版),2008,28(1):123.
[36]BAKER R,MCGINLEY J L,SCEWARTZ M H,et al.The gait profile score and movement analysis profile[J].Gait&Posture,2009,30(3):265-269.
[37]CIMOLIN V,GALLI M.Summary measures for clinical gait analysis:a literature review[J].Gait&Posture,2014,39(4):1005-1010.
[38]解益,董安琴.踝足矫形器矫治52例脑瘫患儿异常步态的疗效观察[C]∥中国康复医学会康复治疗专业委员会康复辅助器具学组成立暨全国康复辅助器具学术研讨会,北京:中国康复医学会,2011:82-84.
[39]黄宏亮,黄方.踝足矫形器对脑瘫患儿步行周期的影响[J].中国康复医学杂志,2008,23(2):175-177.
[40]RADTKA S A,SKINNER S R,JOHANSON M E.A comparison of gait with solid and hinged ankle-foot orthosis in children with spastic diplegic cerebral palsy[J].Gait Posture,2005,21:303-310.
[41]周安艳,李海.佩戴踝足矫形器对痉挛型脑性瘫痪儿童足底压力步态的作用[J].中国组织工程研究与临床康复,2010,14(17):3127-3130.
[42]HAYEK S,HEMO Y,CCHAMIS S,et al.The effect of community-prescribed ankle-foot orthosis on gait parameters in children with spastic cerebral palsy[J].J Child Orthop,2007,1(6):325-332.
[43]张旻,冯美兰,瞿佩玉.痉挛型脑瘫儿童佩戴不同类型踝足矫形器后下肢生物力学的变化[J].中国康复,2011,26(3):195-197.
[44]MANUELA Galli,VERONICA Cimolin,CHIARA Rigoldi,et al.Quantitative evaluation of the effects of ankle foot orthosis on gait in children with cerebral palsy using the gait profile score and gait variable scores[J].Journal of Developmental and Physical Disabilities,2016,28(3):367-379.
[45]徐淑玲,赵向,郭晓.痉挛型脑性瘫痪尖足患儿临床治疗及其踝足矫形器的应用[J].中国组织工程与临床康复,2009,13(34):6781-6784.
[46]赵辉三.发展中国家下肢矫形器学共识[J].中国康复理论与实践,2007,13(4):307-308.