比較關節式與地面應力型踝足矯具對腦性麻痺孩童站立穩定與坐到站表現之影響

研究目的﹕本研究目的在比較關節式與地面應力型踝足矯具對腦性麻痺孩童站立穩定與坐到站表現之影響。研究方法﹕9位雙側痙攣型腦性麻痺孩童參與重複測量設計之研究，使用3-D動作分析系統及力板蒐集受試者在靜態站立與從椅子上起立的運動學資料及動力學資料。使用魏克森符號等級檢定法來比較受試者穿戴地面應力型踝足矯具與關節式踝足矯具之站立穩定與坐到站表現的差異。研究結果﹕本研究結果顯示穿戴關節式踝足矯具與地面應力型踝足矯具比較(1)靜態站立時，足底壓力中心最大前後/左右距離、最大速率與面積皆無顯著差異(P>0.05)。(2)坐到站活動時，除了穿戴地面應力型踝足矯具其足底壓力中心最大正向力較大(P=0.018)外，軀幹、膝與踝關節角度、足底壓力中心向前最大速率、坐到站完成時間及髖、膝、踝關節內力皆無顯著差異(P>0.05)。結論﹕儘管兩種踝足矯具在站立穩定及坐到站表現無顯著差異，但發現有一些趨勢。這些發現顯示雙側痙攣型腦性麻痺孩童穿戴關節式踝足矯具也許較有利於站立穩定而穿戴地面應力型踝足矯具較有利於坐到站的表現。

Objective: The objective of this study was to compare the effects of hinged and floor-reaction ankle-foot orthoses (AFOs) on standing stability and sit-to-stand (STS) performance in children with cerebral palsy Method: Nine children with spastic diplegia participated in this repeated-measures design research. Kinematic and kinetic data were collected during static standing and STS using 3-D motion analysis system and force plates. Wilcoxon signed ranks test was used for comparing the differences of standing stability and STS performance between wearing hinged and floor-reaction AFOs.Results: The results showed that wearing hinged AFO compared with floor-reaction AFO (1) during static standing, there were no significant differences (P>0.05) in maximal anterior-posterior/mediolateral displacement, maximal velocity and sway area of center of pressure (COP). (2) during STS, except only the floor reaction force in normal direction was higher with floor-reaction AFO than with hinged AFO (P=0.018). There were no significant differences in range of motion in trunk, knee and ankle, maximal velocity of COP forward displacement, completion time and joint force of hip, knee and ankle joints (P>0.05). Conclusion: Although there were no significant differences in standing stability and STS performance between the two orthoses, some trends were identified. The findings suggest that the hinged AFO may be beneficial for standing stability and the floor-reaction AFO may be beneficial for STS performance for children with spastic diplegia.