The Effect of Lateral Shoe Wedge on Stand Postural and Balance for Patient with Stroke

• Main Authors: Ta-Li, 鄭大立
• Other Authors: 王淳厚
• Format: Others
• Language: zh-TW
• Online Access: http://ndltd.ncl.edu.tw/handle/18895737436546417536

碩士 === 中山醫學大學 === 醫學研究所 === 94 === Background : Individuals with hemiparesis frequently shift most of their body weight to uninvolved side, showing a obviously asymmetry of standing posture and weight bearing pattern. Postural asymmetry places the individual with hemiparesis at a greater risk for falls. Asymmetry weight bearing contributes to gait abnormalities. Many studies showed that asymmetry weight bearing can be improved by some physical therapy techniques including sit-to-stand maneuvers, Bobath method, visual, tactile, verbal cues, and postural feedback to improve weight loading on the paretic limb. The other technique was so called “Constraint Induced Movement Technique” to apply a shoe lift or wedge under the stronger limb, providing a compelled shift of the body weight onto the paretic limb to increased ability of weight bearing. This technique helps patients achieving symmetry of stance and weight bearing and overcoming the learned disuse mechanism. Therefore, the purpose of this study was to investigate the effect of 5° lateral wedge on non-paretic limb improving symmetry of stance and weight bearing for stroke patients. Material and Method: Twenty-two stroke patients were recruited, 17 male and 5 female, all the subjects were stroke onset over 6 months and divided into 2 groups. The study group used 5° lateral wedge on non-paretic limb for 4 weeks and follow-up 2 weeks after removing the wedge; to assess symmetry of stance and weight bearing, sway index and PCI over a 10-meter walking. The control group received the same study protocol except the lateral wedge. In this study, we used the repeated measures, post hoc test and independent t-test to assess the changes between groups. Result: Three of six variables in BPM have good test-retest reliability (%BW ICC = 0.95, sway frequency ICC = 0.78, sway path ICC = 0.79), the others were not good enough (ICC < 0.6). Wearing the wedge study group（%BW、sway frequency）had the significant different in different time points. No difference was noted between the study group and control group except percentage of body weight（%BW）. In Physiological Cost Index（PCI）, no statistically significant difference was noted. Discussion and Conclusion: The study showed the 5° lateral wedge under the stronger limb can shift the body weight and forced patients to weight bearing on paretic limb. The effect can carry over till 2 weeks after removed the wedge. However, more studies are needed to examine in order to make it clear: (1) the effect of wearing wedge, and (2) the duration of the effect can last.