外側楔型鞋墊對中風患者步態之影響

Abstract

中文摘要 目的：本研究的目的，在探討可獨立行走的初次中風患者，健側下肢穿戴一個斜度5度的外楔型鞋墊後，於站立和行走時之生物力學改變。 方法： 16位來自臺大醫院復健部門診及住院的男性受試者均符合下列條件：（1）首次中風合併單側偏癱；（2）可獨立站立3分鐘以上，並能不用行走輔具，在平地獨立連續行走5公尺；（3）患側下肢行走時能將足部完全提離地面；（4）意識清楚，病情穩定，能了解並配合實驗指示者。沒有動作協調上的問題；排除合併有其他任何可能影響行走功能的嚴重骨骼、週邊神經、心肺系統方面問題者。利用三度空間動作分析系統與測力板，分析穿著外楔型鞋墊是否增加偏癱患者其站立與行走時患側腳承重，和姿勢的對稱性。 結果：健側腳穿戴5度外楔型鞋墊，其主要作用：（1）站立時增加患側下肢承重從體重的34.80%到38.00% (p=0.007)；（2）垂直方向的地面反作用力，其對稱性指標(SI) 有明顯改善，從60.82%到48.02% (p=0.005)；（3）走路時，整體站立期的SI有明顯改善，從18.55%到11.47% (p=0.033)；（4）在健側下肢，單獨支撐期的垂直地面反作用力總和明顯下降，從5.49 ± 0.34 N/kg/sec到4.86 ± 0.26 N/kg/sec (p=0.026)；以及整體站立期的反作用力平均值明顯下降，從7.21 ± 0.13N/kg 到6.94 ± 0.11 N/kg ( p=0.039)；（5）在健側下肢整個走路的周期中，對側腳離地發生時間的百分比明顯上升(26.80% to 29.85%, p=0.039)和單腳支撐期的時間(0.57 second to 0.52 second, p=0.058)有明顯下降；（6）身體軀幹在走路周期中，側向位移角度的總和有明顯下降(p=0.020)。 結論：可獨立行走的中風患者於健側腳穿戴五度的外楔型鞋墊，在靜止站立時可增加患側下肢承重與兩腳對稱性。但是在走路時，外楔型鞋墊對於步態的影響並效果不一致。

關鍵字：步態、腦中風、偏癱、外楔型鞋墊

Abstract Objective: To assess the biomechanical changes in ambulatory first stroke patients during stance and ambulation with and without wearing a 5° laterally wedged insole on the non-paretic side Method: Randomized cross-sectional design to compare the static standing and self-selected speed walking with and without the wedge under the non-paretic foot. The setting was in Department of Rehabilitation Medicine, National Taiwan University Hospital (NTUH) in Taiwan. The inclusive criteria of sixteen participants were unilateral cerebrovascular accident (CVA) males with hemiparesis, who were asymmetry (symmetry index>10%) in standing, being able to stand independently for up to 3 minutes without rest, to walk on the ground over 5 meters without assistive device, and to understand and follow instructions, as well as without other neurological, and musculoskeletal and disease. Three dimensional motion analysis system and force plates were used for the kinematic and kinetic parameters of gait. Results: The effect of wearing 5° lateral wedged insole on the non-paretic limb in hemiparetic patients were as follows. (1) It increased the paretic limb weight bearing from 34.80% to 38.00% of body weight. (2) The symmetry index (SI) of vertical ground reaction force (GRF) had been significantly improved after wearing 5° lateral wedged insole in static standing (60.82% to 48.02%, p=0.005). (3) During walking, there were significant improvement in the SI of stance time (18.55% to 11.47%, p=0.033). (4) On the non-paretic limb, the impulse of single support phase and the mean vertical GRF of stance phase decreased significantly (5.49 ± 0.34 N/kg/sec to 4.86 ± 0.26 N/kg/sec, p=0.026; 7.21 ± 0.13N/kg to 6.94 ± 0.11 N/kg,, p=0.039, respectively), but the changes in the paretic limb were not significant. (5) In one gait cycle, there were significant changes in the increase of the percentage of opposite foot off, and the decrease in the time of single support on non-paretic side limb. (26.80% to 29.85% gait cycle, p=0.039 and 0.57 second to 0.52 second, p=0.043, respectively). (6) The integrated area of the thorax lateral sway angle during one gait cycle showed significant decrease (p=0.02). Conclusion: The simple mechanical device like 5° lateral wedged insole on the non-paretic side would improve the weight bearing and symmetry in hemiparetic patients during stance, but the changes during ambulation were variable.

Keyword: gait, cerebrovascular accident, hemiplegia, lateral wedged insole