Immediate effects of using ankle-foot orthoses in the kinematics of gait and in the balance reactions in Charcot-Marie-Tooth disease

The Charcot-Marie-Tooth (CMT) disease is a peripheral hereditary neuropathy with progressive distal muscle atrophy and weakness, mainly in lower limbs, that evolves limiting the gait and balance. The objective of the study was to analyse the immediate effects of using Ankle-Foot Orthosis (AFO) in the gait's kinematics and balance in patients with CMT. Nine individuals were evaluated by Tinetti scales and Dynamic Gait Index (DGI) and gait's kinematics parameters through the motion capturing system. These evaluations were done before and during the use of AFO. Two-Way repeated analysis of variance was done to try the main or interaction effects related to "orthoses" and "repetition". A significant interaction effect was observed between the gait cycle and use the AFO to the average velocity (Wilks' Lambda=0.156, p=0.030, η2=0.844) like significant main effects in the ankle joint to the gait cycle (Wilks' Lambda=0.091, p=0.008, η2=0.909) and the use of AFO (Wilks' Lambda=0.444, p=0.013, η2=0.556). It was observed a significant change in the DGI scale during the use of AFO (p<0.05). The use of AFO promoted immediate effects on gait kinematics and in balance reactions. The results suggest that the use of AFO is an efficient strategy to stabilize the ankle joint, besides avoiding foot drop in patients with CMT.

夏科-马里-图思病（Charcot-Marie-Tooth, CMT）是一种遗传性周围神经病，以进行性远端肌肉萎缩无力为主要特征，病变主要累及下肢，病情进展会导致患者行走与平衡能力受限。本研究旨在探讨踝足矫形器（Ankle-Foot Orthosis, AFO）使用对夏科-马里-图思病患者步态运动学指标与平衡能力的即刻影响。研究纳入9名受试者，分别采用廷尼特量表、动态步态指数（Dynamic Gait Index, DGI）以及运动捕捉系统采集的步态运动学参数进行评估，所有评估均在佩戴AFO前及佩戴AFO期间完成。采用双向重复测量方差分析检验与“矫形器使用”及“测量次数”相关的主效应与交互效应。结果显示，步态周期与AFO使用在平均步速上存在显著交互效应（威尔克斯λ值=0.156，p=0.030，η²=0.844）；踝关节相关的步态周期主效应（威尔克斯λ值=0.091，p=0.008，η²=0.909）以及AFO使用的主效应（威尔克斯λ值=0.444，p=0.013，η²=0.556）均具有统计学意义。佩戴AFO期间，受试者的动态步态指数得分存在显著变化（p<0.05）。佩戴AFO可对步态运动学指标与平衡反应产生即刻改善效果，研究结果表明，该策略能够有效稳定踝关节，同时避免夏科-马里-图思病患者出现足下垂。