背景:脚和踝关节卸载在各种临床环境中是必不可少的,包括溃疡,肌腱断裂,和骨折。选择正确的辅助设备对于功能和恢复至关重要。然而,研究拐杖以外的设备的影响,特别是设计用于卸载脚踝和脚的踝足矫形器(AFO),是有限的。这项研究调查了三种类型的设备的影响-前臂拐杖,膝盖拐杖,和AFO-生物力学,新陈代谢,以及单侧踝足卸载行走过程中的主观参数。
方法:20名健康参与者在四种情况下以自己选择的速度行走:无辅助的健壮步态,使用三个卸载装置,即前臂拐杖,iWalk膝盖拐杖,和ZeroGAFO.全面的测量,包括动作捕捉,力板,和代谢系统,被用来评估各种时空,运动学,动力学,和代谢参数。此外,参与者通过问卷提供主观反馈。使用具有重复测量ANOVA的受试者内交叉研究设计来比较条件。
结果:在三种设备和健壮步态之间发现了显着差异。在这些设备中,ZeroG表现出明显更快的步行速度和更低的代谢成本。对于承重腿,ZeroG表现出最短的站立阶段,最低制动力,臀部和膝盖的角度与正常步态最相似。然而,使用ZeroG推脱后的踝关节前屈与正常步态最不同。IWalk和拐杖引起了明显更大的质心中外侧和垂直波动,分别。参与者将ZeroG评为最稳定的,但更多的参与者抱怨它导致过度的压力和疼痛。拐杖被评为最高的感知力和最低的舒适度,而对于这些参数,ZeroG和iWalk之间没有发现显着差异。
结论:在所有测量中发现了器械之间的显著差异,与以前对拐杖和iWalk的研究保持一致。ZeroG在大多数方面表现良好,强调AFO在需要卸载时增强步态康复的潜力。然而,ZeroG的舒适性差和不典型的声音侧踝关节运动学明显。这些发现可以帮助临床医生做出有关处方踝足卸载装置的明智决策,并指导克服现有解决方案局限性的改进装置的设计。
BACKGROUND: Foot and ankle unloading is essential in various clinical contexts, including ulcers, tendon ruptures, and fractures. Choosing the right assistive device is crucial for functionality and recovery. Yet, research on the impact of devices beyond crutches, particularly ankle-foot orthoses (AFOs) designed to unload the ankle and foot, is limited. This study investigates the effects of three types of devices-forearm crutches, knee crutch, and AFO-on biomechanical, metabolic, and subjective parameters during walking with unilateral ankle-foot unloading.
METHODS: Twenty healthy participants walked at a self-selected speed in four conditions: unassisted able-bodied gait, and using three unloading devices, namely forearm crutches, iWalk knee crutch, and ZeroG AFO. Comprehensive measurements, including motion capture, force plates, and metabolic system, were used to assess various spatiotemporal, kinematic, kinetic, and metabolic parameters. Additionally, participants provided subjective feedback through questionnaires. The conditions were compared using a within-subject crossover study design with repeated measures ANOVA.
RESULTS: Significant differences were found between the three devices and able-bodied gait. Among the devices, ZeroG exhibited significantly faster walking speed and lower metabolic cost. For the weight-bearing leg, ZeroG exhibited the shortest stance phase, lowest braking forces, and hip and knee angles most similar to normal gait. However, ankle plantarflexion after push-off using ZeroG was most different from normal gait. IWalk and crutches caused significantly larger center-of-mass mediolateral and vertical fluctuations, respectively. Participants rated the ZeroG as the most stable, but more participants complained it caused excessive pressure and pain. Crutches were rated with the highest perceived exertion and lowest comfort, whereas no significant differences between ZeroG and iWalk were found for these parameters.
CONCLUSIONS: Significant differences among the devices were identified across all measurements, aligning with previous studies for crutches and iWalk. ZeroG demonstrated favorable performance in most aspects, highlighting the potential of AFOs in enhancing gait rehabilitation when unloading is necessary. However, poor comfort and atypical sound-side ankle kinematics were evident with ZeroG. These findings can assist clinicians in making educated decisions about prescribing ankle-foot unloading devices and guide the design of improved devices that overcome the limitations of existing solutions.