| Summary: | 碩士 === 國立臺灣大學 === 物理治療學研究所 === 90 === Purposes: The purposes of this study were: first, to evaluate the reliability of in-shoe foot pressure measurement system for stroke patients walking at comfortable speeds; second, to investigate the dynamic foot-pressure loading patterns and the center of foot-pressure (COFP) loading patterns of stroke patients and healthy adults; third, to investigate the differences in the dynamic foot-pressure parameters of stroke patients and healthy adults in the whole foot and specific foot areas (heel, midfoot, and forefoot) during comfortable-speed walking.
Method: Thirteen mild to moderate stroke patients (mean age = 56.5 ± 15.2 years, post-stroke time = 21.7 ± 6.9 months, 8 males, 5 females) and 13 age-matched healthy adults participated in this study. Walking speed, Fugl-Meyer Assessment of lower extremity motor function, and Berg Balance Scale of stroke patients were 0.70 (± 0.26) m/s, 24.7 (± 15.3) score and 49.8 (± 4.0) score. Dynamic foot-pressure loading patterns and parameters were tested by using the Pedar in-shoe measurement system and GMII system in comfortable-speed walking for 6 runs (total 36 m). Seven of the stoke patients, whose post-onset time was longer than 6 months and the recovery of motor function was stable, also participated in the test-retest reliability test one week later. Dynamic foot-pressure loading patterns and parameters in the whole foot and three specific foot areas were analyzed with the Novel software (Novel gmbh, Munich, Germany). Intraclass correlation coefficient (ICC[3,1]) was used to test the reliability of the dynamic foot-pressure parameters. Descriptive statistics was used to describe the foot-pressure loading patterns. Chi-square test was used to test the distribution of COFP-on and off locations. One-way analysis of variance was used to test the differences in the dynamic foot-pressure parameters of the whole foot across the affected lower extremity, unaffected lower extremity, and healthy lower extremity. Two-way repeated measures of analysis of variance was used to test the differences in the dynamic foot-pressure parameters across three specific foot areas among the unaffected lower extremity, affected lower extremity, & healthy lower extremity.
Results: For both lower extremities of stroke patients, the loading time, average force, impulse, excursion of COFP, average speed of COFP, velocity of COFP in the anterior-posterior direction, and the anterior-posterior displacement of COFP of the affected extremities of stroke patients were all significantly reliable (ICC = 0.532 ~ 0.988, p < 0.05), except for the anterior-posterior displacement of COFP of the unaffected extremities (ICC = 0.461, p = 0.122). For healthy adults, the predominant foot-pressure loading patterns of the whole foot, heel, midfoot, and forefoot areas were the twin-peak pattern (77.6 %), smooth-single-peak pattern (86.0 %), smooth-flattened pattern (77.4 %), and smooth-single-peak pattern (62.5 %) respectively. For the unaffected extremity of stroke patients, the predominant foot-pressure loading patterns of the whole foot, heel, midfoot, and forefoot areas were the plateau-multipeak pattern (70.9 %), plateau-multipeak pattern (53.4 %), unsmooth-flattened pattern (83.3 %), and unsmooth-single-peak pattern (65.8 %) respectively. For the affected extremity of stroke patients, the predominant foot-pressure loading patterns of the whole foot, heel, and midfoot were the plateau-multipeak pattern (63.5 %), plateau-multipeak pattern (31.8 %), and unsmooth-flattened pattern (77.7 %) respectively. For the affected extremity of stroke patients, the primary foot-pressure loading patterns were the unsmooth-single-peak pattern (31.8 %) and plateau-multipeak pattern (24.9 %). Distribution of the COFP-on location was significantly different among healthy adults, affected extremity, and unaffected extremity (p < 0.017). For healthy adults, the COFP-on location was primarily in the heel area (96.5 %) . For the unaffected extremity of stroke patients, the COFP-on location was in the forefoot area (3.4 %) and midfoot area (0.4 %) in few trials. For the affected extremity of stroke patients, the COFP-on location was in the forefoot area (8.5 %) and midfoot area (15.8 %) in some trials. For the whole foot, the loading time, impulse, and excursion of COFP of the unaffected extremity in stroke patients were significantly greater than those of healthy adults (p < 0.017). The average force of the unaffected extremity of stroke patients was significantly greater than that of the affected extremity of the stroke patients (p < 0.017). The velocity of COFP in the anterior-posterior direction of the affected extremity of stroke patients was significantly greater than that of healthy adults (p < 0.017). There was no significant interaction between group and area factors for loading time, average force, and impulse (p = 0.484; p = 0.130; p = 0.140). However, the area effect showed that the loading time, average force, and impulse in the heel and forefoot areas were significantly greater than those in the midfoot area (p < 0.017). The group effect showed that the loading time and impulse of the unaffected extremity in all three foot areas were significantly greater than those of healthy adults (p < 0.017). The impulse of the unaffected extremity in these three areas were also significantly greater than those of the affected (p < 0.017).
Conclusion：All dynamic foot-pressure parameters, except the anterior-posterior displacement of COFP of the unaffected extremity of stroke patients, were significantly reliable. This result demonstrated good reliability of measuring the dynamic foot-pressure parameters using the in-shoe foot pressure measurement system in stroke patients during comfortable speed walking. Foot-pressure loading patterns can be used to evaluate the weight bearing ability of the lower extremity in stroke patients. The foot-pressure loading patterns of both lower extremities were quite different from those of healthy adults. For the unaffected extremity of stroke patients, the foot-pressure loading pattern in the heel areas was mostly affected, which showed no single-peak like plateau-multipeak patterns. For the affected extremity of stroke patients, the foot-pressure loading pattern in heel and forefoot areas were affected mostly, which showed various different patterns and lacked the predominant pattern. The distribution of COFP-on location of the unaffected and affected extremities were both significantly different form those of healthy adults. When assessing the weight bearing ability of the lower extremities of stroke patients, the dynamic foot-pressure loading patterns & parameters can be used to evaluate the gait deficits in stroke patients.
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