抄録
In this study, we report on the physical therapy given to a patient with hemiplegia on the left side caused by a cerebrovascular event, whose posture and behavior were badly affected by her longtime use of an ankle foot orthosis (AFO). Attaching the AFO caused in the patient's pain paralyzed foot and lowered durability of gait, resulting in reduced ADL. We examined the connection between gait and AFO again, and for the purpose of defining the mutual problems, we compared and examined it in physical therapy evaluation of walking both barefoot and with AFO. In barefoot walking, the subject's thoracic and lumbar spine showed a tendency to fall down flexing and rotating in the early stance phase of the paralyzed side on account of the lowered muscle tone of her abdominal muscles. As a result of chain reaction of movement, the subject showed an unusual posture in which her pelvis rotated anti-clockwise, her hip joint bent and knee joint extended excessively and she had difficulty in loading the left leg. In additon, we speculated that by attaching AFO, the range of motion was limited, resulting in the restriction of movement in the patient's knee joint which caused her thoracic and lumbar spine to fall down. For physical therapy, for the purpose of heightening the patient's muscle tone of her abdominal muscle, we got her to balance herself in the standing and sitting positions and to practice walking. As a result, the alignment of her thoracic and lumbar spine was improved, the unusual alignment of her pelvis and left leg were reduced and an increase in the load on the left leg was recognized. After treatment, however, in walking with AFO the problem of the patient's thoracic and lumbar spine falling down recurred. Therefore, if she made continuous use of the same AFO, she would have collateral difficulty because of being forced to assume the unusual posture. We suggest that equipment should not be used without an objective. Regarding prescription of equipment to a subject with hemiplegia on the left side caused by a cerebrovascular event, we thought it was important to recognize the behavior of the subject with AFO and to examine its necessity, period of use and timetable for removal.
