Comparison of different orthosis for improving gait in patients with spinal cord injury

doi:10.3969/j.issn.2095-4344.2013.22.023

Abstract

Abstract:

BACKGROUND: Drop ring lock knee-ankle-foot orthosis has been widely used in patients with higher level spinal cord injury, with one primary limitation in ambulation being attributable to the absence of knee flexion in swing phase. As a result, an individual is forced to use compensatory upper body motions to advance the legs. At present, the research on the comparison between different knee-ankle-foot orthoses is rare.
OBJECTIVE: To investigate and compare the clinical effect of E-MAG and drop ring lock knee-ankle-foot orthosis in the treatment of the patients with spinal cord injury.
METHODS: With the approach of case crossover study, the application effect of drop ring lock knee-ankle-foot orthosis in combination with an E-MAG on a patient with a T10 spinal cord injury was observed. With the measurement of three-dimensional gait data, a comparison was made between the scenarios of having the knees locked during the entire gait cycle to that of allowing the knees to flex freely during the swing phase, yet still be locked for stability during stance.
RESULTS AND CONCLUSION: Qualitative observation and kinematic three-dimensional gait data demonstrated that this patient ambulated with a faster, more efficient gait pattern when using E-MAG. Despite having no voluntary control of knees, this orthotic option afforded the ability to walk safely and smoothly with both knees flexing during swing and knee lock in stance phase, and with less upper body compensation. Compared with drop ring lock knee-ankle-foot orthosis, E-MAG active orthosis contains stance phase control, so it has higher degree of acceptance and practicality

Key words: bone and joint implants, clinical practice of bone and joint, spinal cord injury, gait, E-MAG active orthosis, kinematics, knee flexion, drop ring lock knee joint, orthotic intervention, three-dimensional gait analysis, energy expenditure, rehabilitation, clinical application

CLC Number:

R318

Wu Qiang1, Ma Zong-hao2, He Cheng-qi3. Comparison of different orthosis for improving gait in patients with spinal cord injury[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(22): 4152-4160.

Figures/Tables 3

2.3 三维运动学步态数据在2种情况下，患者都呈现躯干向后倾的趋势，即骨盆向后倾斜，身体重心移动至髋关节之后。由于患者的损伤平面较高，在图1和表2中可以观察到患者使用E-MAG活跃型矫形器时的平均身体屈曲和伸展的偏移较大，尽管此时他的速度是其他情况的2倍。在膝关节锁定的情况下，患者躯干在步态周期后1/4(摆动期)稍向后倾斜，但并未达到支撑期躯干向前的最大倾斜。相对于膝关节锁定时，患者使用E-MAG活跃型矫形器时躯干向两侧屈曲多3°，躯干旋转多6°。躯干的运动由患者本人自主产生，而髋关节和膝关节的任何运动则由躯干或矫形器带动。与躯干较小的偏移运动差异不同的是，患者使用E-MAG活跃型矫形器时髋关节和膝关节屈曲远大于使用落环锁膝踝足矫形器，髋关节是其2倍，膝关节是其10倍以上。这些数据显著说明在相同的髋关节屈曲情况下，使用E-MAG活跃型矫形器时所产生的向前的行进远大于使用落环锁膝踝足矫形器。另外，试验过程中患者肘关节屈伸和用眼观察到的情况相同，见图1。在膝关节锁定情况下，患者肘关节在步态周期大部分时间中伸直，只有当举起助行器时才会屈曲肘关节。在正常步态中，髋关节和膝关节屈曲可以减少下肢长度，协助足部离开地面。但是，在膝关节锁定情况下，髋关节和膝关节屈曲缺失，导致患者需要向一侧倾斜或提升整个躯体来使对侧下肢离开地面开始摆动期。该患者上肢肌力较好，可以在行走时借助助行器来抬起下肢，这补偿了患者缺失的髋关节和膝关节屈曲，但需要较高的肌力和努力，因此制约了患者对落环锁膝踝足矫形器的选择。除了时间-空间数据差异外，运动学数据也显示使用膝关节锁定式膝踝足矫形器与使用E-MAG活跃型矫形器大不相同，这表明膝关节锁定时行走非常困难。"

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