The Effects of Ankle-Foot-Orthoses on Standing Balance Ability and Walking Performance in Stroke Patients: A Comparison between Anterior and Posterior Ankle-Foot-Orthoses

[[abstract]]目的：本研究目的為比較低溫成型之前置型與後置型踝足裝具對中風病患動、靜態站立姿勢平衡反應與行走行為表現的效益，期望研究結果能作為臨床專業人員在選擇不同踝足裝具時的參考依據。方法：使用足底壓力量測系統以及足底感應器量測十五位中風偏癱病患在穿戴三種鞋具組合情境下（只穿布鞋，布鞋＋前置型踝足裝具，布鞋＋後置型踝足裝具）的動、靜態站立姿態平衡反應與功能性行走表現。結果：兩種踝足裝具均能明顯改善行走表現，但是對於大部分動、靜態站立姿勢平衡反應的參數，兩種踝足裝具的影響則是不顯著，僅只有呈現改善趨勢。在動、靜態站立姿勢平衡反應以及行走表現參數中，兩種踝足裝具的效益差異普遍未達顯著性，僅呈現後置型踝足裝具優於前置型踝足裝具的趨勢。結論：對中風病患而言，踝足裝具的確具有改善動、靜態站立姿勢平衡反應以及行走表現之臨床效益。雖然後置型踝足裝具所呈現之效益略高於前置型踝足裝具，但由於差異不大，再加上不同的踝足裝具所具有之生物力學特性不同，所以臨床職能治療師在給予踝足裝具時，必須考量中風病患個別化的需求，以避免過度依賴使用單一型態之踝足裝具於中風病患。 Purpose: There are two purposes of this study: (1) to investigate the effects of anterior ankle-foot-orthosis and posterior ankle-foot-orthosis on static standing balance, dynamic standing balance and walking performance in stroke patients. (2) to compare the effects between anterior ankle-foot-orthosis and posterior ankle-foot-orthosis on static standing balance, dynamic standing balance and walking performance in stroke patients. Methods: Fifteen first stroke patients participated in this study. The static and dynamic balance and walking performance were measured in the following three experimental conditions: wearing shoes only, wearing shoes and anterior ankle-foot-orthosis, wearing shoes and posterior ankle-foot-orthosis. The balance measures were collected by Rsscan pressure measurement system, and the footswitch was used to define the gait cycle during a 10-meter distance walking test. Repeated measure analysis of variance was used. Results: Two types of ankle-foot-orthosis affect the static and dynamic balance ability, and walking performance obviously. But the difference of the effects between two types of ankie-fool-orthosis was not significant. The posterior ankle-foot-orthosis tended to improve the standing balance ability and walking performance of stroke patients more prominently than the anterior ones did. Conclusion: The effects of two types of ankle-foot-orthosis might affect the static and dynamic standing balance differently. Posterior ankle-foot-orthosis might be another choice appropriate for stroke patients in Taiwan. Therapists should educate the patient the proper use of the orthosis and shoes to prevent negative effects