CAJ | 학술논문

背景：脑瘫患儿的步态异常较常见，如何控制改善步态是康复治疗的重点。目的：分析脑瘫患儿步态的生物力学参数，并观察支具控制对不随意运动型脑瘫患儿运动能力的影响。方法：研究对比脑瘫患儿和正常儿童在起步过程中以及步行中的生物力学参数，起步过程中的生物力学参数包括时空参数，膝、踝关节活动度的运动学参数以及动力学参数；步行中的生物力学参数包括时空参数。不随意运动型脑瘫患儿均接受支具控制辅助下徒手体位控制、减重步态训练、S-E-T 的3个月治疗，治疗前后采用88项粗大运动评价量表A区和视频对照进行疗效评估。结果与结论：脑瘫患儿和正常儿童在起步过程中的生物力学参数测试对比中，除了右脚为起步脚的额状轴地面反力峰值外，其余各项生物力学参数均有明显差异；步行中的生物力学参数测试对比中，脑瘫患儿较正常儿童支撑相和双足支撑相延长、步长和复步长缩短。支具控制脑瘫患儿观察中，与治疗前比较，GMFM88项A 区平均得分显著提高，视频示患儿治疗后不自主动作减少，头颈躯干较稳定，生活能力有好转，癫痫及认知障碍和基底节区有影像学改变的患儿进步幅度较小，舞蹈-徐动型和张力障碍型比徐动痉挛型患儿运动能力进步幅度大。
배경：뇌탄환인적보태이상교상견，여하공제개선보태시강복치료적중점。목적：분석뇌탄환인보태적생물역학삼수，병관찰지구공제대불수의운동형뇌탄환인운동능력적영향。방법：연구대비뇌탄환인화정상인동재기보과정중이급보행중적생물역학삼수，기보과정중적생물역학삼수포괄시공삼수，슬、과관절활동도적운동학삼수이급동역학삼수；보행중적생물역학삼수포괄시공삼수。불수의운동형뇌탄환인균접수지구공제보조하도수체위공제、감중보태훈련、S-E-T 적3개월치료，치료전후채용88항조대운동평개량표A구화시빈대조진행료효평고。결과여결론：뇌탄환인화정상인동재기보과정중적생물역학삼수측시대비중，제료우각위기보각적액상축지면반력봉치외，기여각항생물역학삼수균유명현차이；보행중적생물역학삼수측시대비중，뇌탄환인교정상인동지탱상화쌍족지탱상연장、보장화복보장축단。지구공제뇌탄환인관찰중，여치료전비교，GMFM88항A 구평균득분현저제고，시빈시환인치료후불자주동작감소，두경구간교은정，생활능력유호전，전간급인지장애화기저절구유영상학개변적환인진보폭도교소，무도-서동형화장력장애형비서동경련형환인운동능력진보폭도대。
BACKGROUND:Abnormal gaits are very common in children with cerebral palsy, and how to improve the gait is the focus of rehabilitation therapy. OBJECTIVE:To analyze the biomechanical parameters of gaits in cerebral palsy children and to observe the effects of brace control on the exercise capacity of dyskinetic cerebral palsy children. METHODS:In this paper, we compared the biomechanical parameters of children with cerebral palsy and normal children in the initial process of walking and during walking. Biomechanical parameters in the initial process of walking include spatial and temporal parameters, kinematic and kinetic parameters of the range of motion of the knee and ankle. Biomechanical parameters during walking include spatial and temporal parameters. With the aid of hand brace, dyskinetic cerebral palsy received postural control, gait training, and sling exercise therapy for 3 months. The Gross Motor Function Measure (GMFM-88) assessment and video control were conducted for evaluation of therapeutic efficiency. RESULTS AND CONCLUSION:Biomechanical parameters in the initial process of walking showed significant differences between children with cerebral palsy and normal children except for the peak of ground reaction force at frontal axis with the right foot to start walking. Biomechanical parameters during walking showed that the stance phase and bipedal stance phase were prolonged, while the step length and stride length were shortened in the children with cerebral palsy compared with the normal children. For cerebral palsy children with brace control, the GMFM-88 scores were significantly decreased after treatment, involuntary movements were reduced shown on the video, the neck and body were stable, and life skil s were improved. Children with epilepsy and cognitive impairment or who had imaging changes in the basal ganglia showed a little improvement, and children with dance-athetoid type and dystonia type had a better progress than those with athetoid spasm.