第十四屆 以實證醫學角度探討腦性麻痺兒童步態之足踝部矯具介入

Improving Gait Pattern in Children with Spastic Hemiplegic Cerebral Palsy: Evidence-Based Practice Application

陳明義^1,2

Ming-I Chen^1,2 

¹中山醫學大學附設醫院職能治療室、²中山醫學大學職能治療學系

¹ Occupational Therapy Department, Chung-Sun Medical University Hospital Taichung, Taiwan,²Occupational Therapy School, Chung-Sun Medical University, Taichung, Taiwan.

Background and Purpose：An 11-year-old boy diagnosed of cerebral palsy with R’t hemiplegia, he was suffered staggering gait during level walking. In Occupational Therapy Department assessment he needs a ankle foot orthosis for ankle stabilizing.

To identify the hinged ankle foot orthosis (HAFO) or posterior leaf spring (PLS) was benefited for the patients who suffering ankle instability and staggering gait. 

Methods:We used PubMed, Medline and Cochrane Library database year from 1966 to 2012. The key words we filled were Cerebral palsy, hinged ankle foot orthosis (HAFO), posterior leaf spring (PLS), solid ankle foot orthosis (SAFO), gait and randomized control trial (RCT).

Results: : From year 1966 to 2012, we included seven articles for initial evaluation(Buckon, Thomas et al. 2001, Balaban, Yasar et al. 2007, Carmick 2012, Chisholm and Perry 2012, Degelean, De Borre et al. 2012, Neto, Collange Grecco et al. 2012, Eddison and Chockalingam 2013) . Filtering with searching strategy we selected Buchon’s article (Buckon, Thomas et al. 2001) for evidence-based practice application. Participants: 30 children with spastic hemiplegia were included in this study. Study design:  All children were randomly selected to one of three sequences of AFO use: HAFO, SAFO, PLS; SAFO, PLS, HAFO; and PLS, HAFO, SAFO. All participants got Gait Analysis by 3D kinematic and kinetic gait data. Main Result: The HAFO was the most effective in controlling knee hyperextension in stance, while PLS was the most effective in promoting knee extension in children with >10° knee flexion in stance.

Conclusion:  By Evidence-Based Practice we found there was only “ONE” article for our request. It revealed a fact that the interventions in orthosis for children with spastic hemiplegic C. P.  were rare on randomized control trial study. Nevertheless, hinged ankle foot orthosis may be acceptable for CP children with hemiplegia in gait performance.

Keywords: Evidence based practice, cerebral palsy, gait pattern.