PDF(Pubmed)
Abstract：
Individuals with neuromuscular pathologies are often prescribed an ankle-foot orthosis (AFO) to improve their gait mechanics by decreasing pathological movements of the ankle and lower limb. AFOs can resist or assist excessive or absent muscular forces that lead to tripping, instability, and slow inefficient gait. However, selecting the appropriate AFO with mechanical characteristics, which limit pathological ankle motion in certain phases of the gait cycle while facilitating effective ankle movement during other phases, requires careful clinical decision-making. The aim of this study is to propose an explicit methodology for the adjustment of multi-function articulated AFOs in clinical settings. A secondary aim is to outline the evidence supporting this methodology and to identify gaps in the literature as potential areas for future research. An emerging class of AFO, the multi-function articulated AFO, offers features that permit more comprehensive, iterative, and reversible adjustments of AFO ankle alignment and resistance to ankle motion. However, no standard method exists for the application and optimization of these therapeutic devices in the clinical setting. Here we propose an evidence-guided methodology applicable to the adjustment of multi-function articulated AFOs in the clinical setting. Characteristic load-deflection curves are given to illustrate the idealized yet complex resistance-angle behavior of multi-function articulated AFOs. Research is cited to demonstrate how these mechanical characteristics can help mitigate specific pathologic ankle and knee kinematics and kinetics. Evidence is presented to support the effects of systematic adjustment of high resistance, alignable, articulated AFOs to address many typical pathomechanical patterns observed in individuals with neuromuscular disorders. The published evidence supporting most decision points of the algorithm is presented with identified gaps in the evidence. In addition, two hypothetical case examples are given to illustrate the application of the method in optimizing multi-function articulated AFOs for treating specific gait pathomechanics. This method is proposed as an evidence-guided systematic approach for the adjustment of multi-function articulated AFOs. It utilizes observed gait deviations mapped to specific changes in AFO alignment and resistance settings as a clinical tool in orthotic treatment for individuals with complex neuromuscular gait disorders.
摘要：
患有神经肌肉病变的个体通常被规定为踝足矫形器（AFO），以通过减少踝关节和下肢的病理运动来改善他们的步态力学。AFO可以抵抗或协助过度或缺乏导致跳闸的肌肉力量，不稳定性,和缓慢低效的步态。然而,选择具有机械特性的合适的AFO，在步态周期的某些阶段限制病理性踝关节运动，同时在其他阶段促进有效的踝关节运动，需要谨慎的临床决策。这项研究的目的是提出一种明确的方法，用于在临床环境中调整多功能关节型AFO。次要目的是概述支持这种方法的证据，并确定文献中的空白作为未来研究的潜在领域。一类新兴的AFO,多功能铰接式AFO，提供允许更全面的功能，迭代，和AFO踝关节对齐的可逆调整和对踝关节运动的阻力。然而,在临床环境中没有标准的方法来应用和优化这些治疗设备。在这里，我们提出了一种证据指导的方法，适用于在临床环境中调整多功能关节型AFO。给出了特征载荷-挠度曲线，以说明多功能铰接式AFO的理想但复杂的阻力角行为。引用研究来证明这些机械特性如何帮助减轻特定的病理性踝关节和膝关节运动学和动力学。提供的证据支持系统调整高抗性的效果，可对齐,铰接式AFO以解决在患有神经肌肉疾病的个体中观察到的许多典型的病理力学模式。已发布的支持算法大多数决策点的证据在证据中具有已识别的差距。此外,给出了两个假设的案例示例，以说明该方法在优化多功能铰接式AFO以治疗特定步态病理力学中的应用。该方法被提出作为一种证据指导的系统方法，用于调整多功能关节式AFO。它利用观察到的步态偏差映射到AFO对准和阻力设置的特定变化，作为患有复杂神经肌肉步态障碍的个体的矫正治疗的临床工具。
