Prosthetics & Orthotics 단국대학교 일반대학원 물리 · 작업치료전공 강권영

A new hip-knee-ankle-foot sling: Kinematic comparison with a traditional ankle-foot orthosis JRRDJRRD Journal of Rehabilitation Research & Development 41;(5): Arturo zancan, MD; Maria V. Beretta; Micaela Schmid, PhD; Marco Schieppati, MD Human Phsiology Section, Department of Experimental Medicine, University of Pavia, Italy

INTRODUCTION Hemiplegic patients walking pattern (kinematic) 변화와 slow walking speed. Walking 시 better heel-strike, dynamic balance and lower energy expenditure 를 위해 편마비 환자에게 AFO 가 처방된다. KAFO 는 무게와 걷는데 방해가 되어 많이 사용되지 않는다. 비정상적 foot posture 를 교정하는 동시에 하지의 swing phase 를 facilitation 시키기에 developed a device 를 연구한 논문이다. Affected lower limb 의 strap-based linkage system. New, simple, low-cost sling 과 AFO 를 비교했다.

METHODS A single-case study design. 74-year old male. ischemic stroke: right-side hemiplegia (without aphasia, apraxia, spatial neglect) ischemic lesion: left- middle cerebral artery territory condition A spasticity of affected triceps surae muscle (ashworth score=2) with no equinus deformity. No limitation in the ROM of the lower-limb joints was present. The lower limb presented flexion and extension synergies without capability of isolated movements.

Experimental procedure Single session. three condition ( use of no orthosis, use of AFO and use of sling). Walking alone for a distance of 6m. Six walking test (2-min. intervals between tests) The first two consecutive tests were performed with no orthosis, Two consecutive tests with the spring AFO, and The last two consecutive tests with the sling.

Data Acquisition and Analysis ELITE movement analysis system (BTS, Italy). 6 개의 적외선 카메라 (100 Hz) 로 구성. acromion, ASIS, trochanter major, head of fibula, lateral malleolus, fifth metatarsal head 에 body points 로 마크한다 다음의 변수들을 기록하고 측정한다 hip, knee, ankle mean angle/ROM. center of mass(COM). temporal sequence of the heel strike forefoot contact/ heel off forefoot off. duration of stance phase. stride length. stride duration. walking speed.

Statistical Analysis One-way ANOVA no orthosis/ with the spring AFO/ with the new sling (p<.05) Two-way ANOVA heel strike-forefoot contact/ heel off- forefoot off no orthosis/ with the spring AFO/ with the new sling on the affected/ unaffected side (p<.05)

RESULTS AFO and sling significantly limited mobility of affected side ankle. AFO and sling significantly limited elevation of affected pelvis side

RESULTS Negative value indicates forefoot landing before heel. Sling induces a trend toward normalization of sequence.

RESULTS AFO and sling orthoses significantly reduced stance duration on affected lower limb. Sling, but not AFO, significantly increased stride length of both affected and unaffected lower limb.

RESULTS Sling, but not AFO, significantly diminished stride duration of both affected and unaffected lower limb. Walking speed with sling increased 64.7% and 29.4% with AFO

DISCUSSION 두 보조기가 hip/knee/ankle ROM 에 영향을 미친다. Sling /AFO equally limited the subject`s plantar flexion during walking. COM vertical displacement 에서는 AFO/sling 둘 다 affected pelvic elevation 의 감소를 보였다. 두 보조기의 운동학적 유사성에도 불구하고 실질적으로 sling 에 서 walking speed 가 더 좋았다. Affected ankle ROM 의 감소만으로 walking speed 의 증가를 설명 하기에는 충분하지 않다. no orthosis/AFO walking 시 normal sequence 가 되지않는다 (the affected limb forefoot hit the ground before the heel did). Sling 을 사용하면 normal pattern sequence 에 가까워진다.

DISCUSSION action mechanism 으로 설명하기 어렵지만 linkage(normal body side 와 affected lower-limb 의 연결장치 ) 가 walking speed 의 증가 를 설명할 수 있을 것이다. affected side 의 ASIS 가 forward rotation 되면 하지의 sling 은 tight/pulls forward 된다. ->reciprocating gait orthosis (RGO). pelvic thrust/inward rotation 될 때, stance leg 의 extension 이 swing leg 의 flexion 으로 바뀌는데, 이것이 sling action 의 mechanism 일 것이다.

CONCLUSIONS Sling improved the affected side's ankle kinematics equally to the traditional AFO. Sling also improved some variables of walking pattern in this hemiplegic subject. Greater increase of walking speed than the AFO.