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Maki Y, Ii T, Yamada M, Tanabe S. Factors affecting the efficiency of walking independence in patients with subacute stroke following robot-assisted gait training with conventional rehabilitation. Int J Rehabil Res 2024; 47:26-33. [PMID: 38175700 DOI: 10.1097/mrr.0000000000000609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Factors affecting the efficiency of walking independence in patients with subacute stroke following robot-assisted gait training (RAGT) and conventional treatment (RAGT-CT) were examined. This retrospective cohort study included 37 patients with stroke [ n = 11 ischemic; n = 26 hemorrhagic; median poststroke interval, 28 days (interquartile range, IQR, 24-42)] who underwent RAGT using Welwalk for a median of 3 weeks (IQR, 2-4) followed by conventional training (median, 129 days; IQR, 114-146). The primary outcome was the change in functional independence measure (FIM)-walk item score from before to after RAGT (FIM-walk efficiency). The secondary outcome was the FIM-walk score at discharge. The independent variables included sensorimotor function [lower extremity (LE) motor and sensory scores and trunk function from the Stroke Impairment Assessment Set (SIAS) and Berg Balance Scale (BBS)] and cognitive function (FIM-cognitive, MMSE and Cognitive-related Behavioral Assessment) before RAGT-CT and RAGT dose duration per session, total steps and average treadmill speed at week 1, and number of sessions). We first determined the bivariate associations of each independent variable with the FIM-walk efficiency at the end of the RAGT period as decided by the therapists and with the FIM-walk score at discharge. Hierarchical multiple regression revealed that only the FIM-cognitive score was a significant predictor of the FIM-walk efficiency at the end of the RAGT period ( β = 0.47; P < 0.01, adjusted R2 = 0.21) after accounting for age, days post-stroke, SIAS-total lower extremity (SIAS-LE) motor score, and number of RAGT sessions (all nonsignificant). Furthermore, only the SIAS-trunk score was a significant predictor of the FIM-walk score at discharge ( β = 0.52; P < 0.01; adjusted R2 = 0.65) after accounting for age, days post-stroke, FIM-cognitive score, SIAS-LE motor score, and average treadmill speed at week 1 (all nonsignificant). Although patients with better cognition at the start of locomotor training achieved the pragmatic targets for terminating RAGT and proceeding with conventional therapy at a faster rate, the outcome at discharge is mainly dependent on early trunk function.
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Affiliation(s)
- Yoshiaki Maki
- Department of Rehabilitation, Ukai Rehabilitation Hospital, Nagoya
| | - Takuma Ii
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Masanari Yamada
- Department of Rehabilitation, Ukai Rehabilitation Hospital, Nagoya
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Aichi, Japan
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2
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Gonzalez-Hoelling S, Reig-García G, Bertran-Noguer C, Suñer-Soler R. The effects of rhythmic auditory stimulation on functional ambulation after stroke: a systematic review. BMC Complement Med Ther 2024; 24:45. [PMID: 38245704 PMCID: PMC10799424 DOI: 10.1186/s12906-023-04310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Several studies have reported the effect of rhythmic auditory stimulation (RAS) on functional ambulation in stroke patients, yet no systematic overview has yet been published. This study aims to synthesize the available evidence describing changes in stroke patients after RAS intervention for functional ambulation and the use of walking assistive devices, and to find out if the effect of RAS and music-based RAS differs depending on the lesioned area. METHODS The PubMed, PEDro, Cochrane Central Register of Controlled Trials, Web of Science, Scopus and CINAHL electronic databases were searched for reports evaluating the effect of RAS on walking in stroke patients, applying the PICOS criteria for the inclusion of studies. RESULTS Twenty one articles were included (948 stroke survivors). Most studies were of good methodological quality according to the PEDro scale, but they had a high risk of bias. The most consistent finding was that RAS improves walking and balance parameters in stroke patients in all phases compared to baseline and versus control groups with conventional treatment. Functional ambulation and the use of walking assistive devices were inconsistently reported. Several studies also suggest that RAS may be as good as other complementary therapies (horse-riding and visual cueing). CONCLUSIONS Despite the beneficial effects of RAS, the question remains as to whether it is better than other complementary therapies. Given the heterogeneity of the interventions, the interventions in control groups, the varied durations, and the different outcome measures, we suggest that care should be taken in interpreting and generalizing findings. PROSPERO REGISTRATION CRD42021277940.
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Affiliation(s)
- Samira Gonzalez-Hoelling
- Neurorehabilitation department, Hospital Sociosanitari Mutuam Girona, 17007, Girona, Catalonia, Spain
| | - Gloria Reig-García
- Department of Nursing, Faculty of Nursing, University of Girona, 17003, Girona, Spain
| | - Carme Bertran-Noguer
- Health and Health Care Research Group, University of Girona, 17003, Girona, Spain
| | - Rosa Suñer-Soler
- Health and Health Care Research Group, University of Girona, 17003, Girona, Spain.
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3
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Ustinova KI, Langenderfer JE. Feasibility of using the NewGait assistive device for correcting gait deviations in individuals with various neurological disorders: Case study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2055. [PMID: 37818770 DOI: 10.1002/pri.2055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/08/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023]
Abstract
PURPOSE Impaired gait is one of the earliest, most devastating, and long-lasting symptoms associated with neurological disorders. This study tested the feasibility of wearing the NewGait rehabilitative device in individuals with gait impairments due to the most common neurological disorders. METHODS Seven participants with gait impairments due to strokes, Multiple Sclerosis, peripheral neuropathies, Cerebral Palsy (CP) and Parkinson's Disease (PD) were included in the study. Their walking with and without wearing the NewGait was analyzed and compared using the Vicon T160 system for motion analysis. Gait velocity, step length, foot clearance, lateral displacement of the Center of Mass, gait deviation and symmetry indexes were compared using two standard deviation band method for each participant. RESULTS Participants subjectively assessed the NewGait as a comfortable device to wear and showed immediate gait improvements to varying degrees. Most improvements were observed in participants with muscle weakness due to peripheral neuropathies, stroke, MS, and CP. These participants improved their foot clearance, gait velocity, and step length. Participants with cerebellar stroke and PD increased their gait stability. All participants demonstrated a reduction in composite gait deviation indexes. Not all gait parameters, though, showed immediate changes. CONCLUSION The results suggest that the NewGait rehabilitative device is feasible and useful for correcting gait impairments caused by neurological deficits. Participants may need to wear this device for longer periods of time in order to achieve long lasting changes in the gait pattern, rather than an immediate correction.
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Affiliation(s)
- Ksenia I Ustinova
- Department of Physical Therapy, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Joseph E Langenderfer
- School of Engineering and Technology, Central Michigan University, Mount Pleasant, Michigan, USA
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Levin C, Bachar-Kirshenboim Y, Rand D. Daily steps, walking tests, and functioning in chronic stroke; comparing independent walkers to device-users. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2035. [PMID: 37432302 DOI: 10.1002/pri.2035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/04/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND AND PURPOSE Community mobility post-stroke is important for gaining independence in daily activities. Walking devices can facilitate mobility, but it remains unclear whether individuals who use a walking device walk as many daily steps as those who do not require a device. It is also unclear whether these groups differ in their independence in daily living. This study aimed (1) to compare daily steps, walking tests, and independence in basic and instrumental activities of daily living (IADL) six months post-stroke between individuals who walk independently and individuals who use a walking device, (2) within each group to assess correlations between daily steps and walking tests, independence in basic and IADL. METHODS Thirty-seven community-dwelling individuals with chronic stroke; 22 participants used a walking-device and 15 participants walked independently. Daily steps were calculated as a 3-day mean by hip accelerometers. Clinical walking tests included the 10-m-walk-test, Timed Up & Go and 'Walking While Talking'. Daily living was assessed using the Functional-Independence Measure and the IADL questionnaire. RESULTS Daily steps of the device-users were significantly lower than the independent-walkers (195-8068 versus 147-14010 steps/day) but independence in daily living was not significantly different. Different walking tests correlated with daily steps for device-users and independent-walkers. CONCLUSIONS This preliminary investigation in chronic stroke revealed that device-users walk significantly fewer daily steps but are as independent in daily living as independent-walkers. Clinicians should differentiate between individuals with and without a walking device and the use of different clinical walking tests to explain daily steps should be considered. Further research is needed to assess the impact of a walking device post-stroke.
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Affiliation(s)
- Chedva Levin
- Faculty of School of Life and Health Sciences, Nursing Department, The Jerusalem College of Technology-Lev Academic Center, Jerusalem, Israel
| | - Yishai Bachar-Kirshenboim
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Debbie Rand
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Odanye O, Steffensen E, Hinton E, Bierner S, Hsiao HY, Knarr B. Treadmill Handrail-Use Increases the Anteroposterior Margin of Stability in Individuals' Post-Stroke. J Mot Behav 2023; 56:253-262. [PMID: 37994869 PMCID: PMC10957321 DOI: 10.1080/00222895.2023.2285383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 10/28/2023] [Indexed: 11/24/2023]
Abstract
Treadmills are important rehabilitation tools used with or without handrails. The handrails could be used to attain balance, prevent falls, and improve the walking biomechanics of stroke survivors, but it is yet unclear how the treadmill handrails impact their stability margins. Here, we investigated how 3 treadmill handrail-use conditions (no-hold, self-selected support, and light touch) impact stroke survivors' margins of stability (MoS). The anteroposterior MoS significantly increased for both legs with self-selected support while the mediolateral MoS of the unaffected leg decreased significantly when the participants walked with self-selected support in comparison to no-hold in both cases. We concluded that the contextual use of the handrail should guide its prescription for fall prevention or balance training in rehabilitation programs.
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Affiliation(s)
- Oluwaseye Odanye
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Emily Steffensen
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Erica Hinton
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Samuel Bierner
- Department of Physical Medicine and Rehabilitation, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Hao-Yuan Hsiao
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, USA
| | - Brian Knarr
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, Nebraska, USA
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Hwang S, Song CS. Assistive Technology Involving Postural Control and Gait Performance for Adults with Stroke: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:2225. [PMID: 37570466 PMCID: PMC10418390 DOI: 10.3390/healthcare11152225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to comprehensively summarize assistive technology devices for postural control and gait performance in stroke patients. In the study, we searched for randomized controlled trials (RCTs) published until 31 December 2022 in four electrical databases. The most frequently applied assistive technology devices involving postural stability and gait function for stroke patients were robot-assistive technology devices. Out of 1065 initially retrieved citations that met the inclusion criteria, 30 RCTs (12 studies for subacute patients and 18 studies for chronic patients) were included in this review based on eligibility criteria. The meta-analysis included ten RCTs (five studies for subacute patients and five for chronic patients) based on the inclusion criteria of the data analysis. After analyzing, the variables, only two parameters, the Berg balance scale (BBS) and the functional ambulation category (FAC), which had relevant data from at least three studies measuring postural control and gait function, were selected for the meta-analysis. The meta-analysis revealed significant differences in the experimental group compared to the control group for BBS in both subacute and chronic stroke patients and for the FAC in chronic stroke patients. Robot-assistive training was found to be superior to regular therapy in improving postural stability for subacute and chronic stroke patients but not gait function. This review suggests that robot-assistive technology devices should be considered in rehabilitative approaches for postural stability and gait function for subacute and chronic stroke patients.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan 31065, Republic of Korea;
- The Graduate School of Health Welfare, Baekseok University, Seoul 06695, Republic of Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju 61452, Republic of Korea
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Daryabor A, Kobayashi T, Yamamoto S, Lyons SM, Orendurff M, Akbarzadeh Baghban A. Effect of ankle-foot orthoses on functional outcome measurements in individuals with stroke: a systematic review and meta-analysis. Disabil Rehabil 2022; 44:6566-6581. [PMID: 34482791 DOI: 10.1080/09638288.2021.1970248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine and compare the effect of ankle-foot orthosis (AFOs) types on functional outcome measurements in individuals with (sub)acute or chronic stroke impairments. METHODS PubMed, Web of Knowledge, Embase, Scopus, ProQuest, and Cochrane were searched from inception until September 2020. Methodological quality assessment of 30 studies was conducted based on the Downs and Black checklist. Functional indices were pooled according to their standardized mean difference (SMD) and 95% confidence intervals (CI) in a random-effect model. A narrative analysis was performed where data pooling was not feasible. RESULTS Overall pooled results indicated improvements in favor of AFOs versus without for the Berg Balance Scale (SMD: 0.54, CI: 0.19-0.88), timed-up and go test (SMD: -0.45, CI: -0.67 to -0.24), Functional Ambulatory Categories (SMD: 1.72, CI: 1.25-2.19), 6-Minute Walking Test (SMD: 0.91, CI: 0.53-1.28), Timed Up-Stairs (SMD: -0.35, CI: -0.64 to 0.05), and Motricity Index (SMD: 0.65, CI: 0.38-0.92). Heterogeneity was non-significant for all outcomes (I2 < 50%, p > 0.05) except the Berg Balance Scale and Functional Ambulatory Categories. Additionally, there was not sufficient evidence to determine the effectiveness of specific orthotic designs over others. CONCLUSIONS An AFO can improve ambulatory function in stroke survivors. Future studies should explore the long-term effects of rehabilitation using AFOs and compare differences in orthotic designs.IMPLICATIONS FOR REHABILITATIONAn AFO can improve functional performance and ambulation in survivors of strokes.Wearing an AFO in rehabilitation care during the subacute phase post stroke may have beneficial effects on functional outcomes measured.There was no evidence as to the effectiveness of specific AFO designs over others.
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Affiliation(s)
- Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Sumiko Yamamoto
- Department of Assistive Technological Science, Graduate School, International University of Health and Welfare, Tokyo, Japan
| | - Samuel M Lyons
- Motion Analysis and Sports Performance Lab, Department of Orthopedic Sports Medicine, Lucile Packard Children's Hospital, Stanford, CA, USA
| | | | - Alireza Akbarzadeh Baghban
- Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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8
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Wiley E, Noguchi KS, Moncion K, Stratford PW, Tang A. Sex Differences in Functional Capacity in Older Adults With Stroke: An Analysis of Data From the National Health and Aging Trends Study. Phys Ther 2022; 102:6604583. [PMID: 35689806 DOI: 10.1093/ptj/pzac077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/20/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Women experience greater disability following stroke, but biological sex differences in both overall and specific domains of functional capacity are not well understood. The primary objective of this study was to examine sex differences in overall functional capacity (Short Physical Performance Battery [SPPB] score) cross-sectionally and longitudinally over a 3-year follow-up period. The secondary objective was to determine whether sex differences exist in specific domains of functional capacity of walking speed and lower extremity functional strength. METHODS This study was a secondary analysis of data of individuals with stroke from the National Health and Aging Trends Study. For the cross-sectional analyses, general linear models were used to examine differences between 293 men and 427 women in SPPB, walking speed, and the 5-Times Sit-to-Stand Test (5XSST). For the longitudinal analysis, survey-weighted, multivariable-adjusted generalized linear mixed models were used to compare 3-year trajectories in SPPB scores between the sexes (87 men, 153 women). RESULTS Women had lower SPPB scores at baseline (difference = 0.9, linearized SE = 0.3) and over 3 years. SPPB scores declined similarly between men and women. Women had lower walking speed (difference = 0.08 m/s, SE = 0.02) as compared with men, but men and women had similar 5XSST scores (difference = 0.6 seconds, SE = 0.5). CONCLUSION Older women with stroke have clinically meaningfully lower overall functional capacity as compared with older men but decline at a similar rate over time. Walking speed was lower in older women with stroke, but similar between sexes in 5XSST. IMPACT Women with stroke have poorer functional capacity compared with men, which reinforces the importance of targeted stroke rehabilitation strategies to address these sex-specific disparities. LAY SUMMARY Women with stroke have poorer outcomes in terms of their ability to move around the community when compared with men. However, both men and women with stroke have similar physical functioning over time.
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Affiliation(s)
- Elise Wiley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth S Noguchi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Moncion
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Paul W Stratford
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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9
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Nojiri E, Wada Y, Mochizuki M, Sugiyama M, Kawate N. Immediate effect of different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle on walking ability in individuals with chronic stroke: a randomized crossover trial. J Phys Ther Sci 2022; 34:485-491. [PMID: 35784608 PMCID: PMC9246403 DOI: 10.1589/jpts.34.485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate how different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle affect the walking ability in individuals with chronic stroke. [Participants and Methods] In this randomized crossover study, participants underwent a 10-m walking test and walked on a WalkWay MW-1000 three times under these conditions: (1) without ankle-foot orthosis; (2) with ankle-foot orthosis with an adjustable posterior strut at 5° of fixed dorsiflexion; and (3) with ankle-foot orthosis with an adjustable posterior strut at 5-20° of restricted dorsiflexion. The primary outcome was walking speed on the 10-m walking test. The secondary outcomes were walking speed and spatiotemporal factors measured by the WalkWay MW-1000. [Results] Fifteen individuals (mean [standard deviation] age, 60.9 [8.6] years; male, 12) were enrolled. Walking speeds of the ankle-foot orthosis with fixed and restricted dorsiflexion groups were significantly higher than those without the orthosis; however, no outcomes differed significantly between ankle-foot orthosis with fixed versus restricted dorsiflexion groups. [Conclusion] In individuals with chronic stroke, ankle-foot orthosis function may be less important than the dorsiflexed setting of initial ankle joint angle in the ankle-foot orthosis.
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Affiliation(s)
- Eri Nojiri
- Department of Rehabilitation Medicine, Graduate School of Medicine, Showa University, Japan.,Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan
| | - Yoshitaka Wada
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University: 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - Midori Mochizuki
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan
| | - Mizuki Sugiyama
- Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan
| | - Nobuyuki Kawate
- Department of Rehabilitation Medicine, Graduate School of Medicine, Showa University, Japan.,Department of Rehabilitation Medicine, Showa University Fujigaoka Rehabilitation Hospital, Japan
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10
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Avelino PR, Nascimento LR, Menezes KKP, Ada L, Teixeira-Salmela LF. Canes may not improve spatiotemporal parameters of walking after stroke: a systematic review of cross-sectional within-group experimental studies. Disabil Rehabil 2022; 44:1758-1765. [PMID: 32857674 DOI: 10.1080/09638288.2020.1808088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To examine whether using a cane would improve spatiotemporal parameters of walking, i.e., speed, stride length, cadence, and symmetry after stroke. MATERIAL AND METHODS Searches were conducted in eight databases. The experimental condition was walking with a cane. Four outcomes were of interest: walking speed, stride length, cadence, and symmetry. RESULTS Twelve studies were included. Results from nine studies suggested that individuals with stroke walked 0.01 m/s (SD 0.06) slower with a single-point cane, compared with no cane. Two studies suggested a reduction in cadence (MD-5 steps/min, SD2) and an increase in stride length (MD 0.08 m, SD 0.01). Three studies suggested that individuals walked 0.06 m/s (SD 0.07) slower with a four-point cane, compared with no cane. Four studies suggested that individuals walked 0.06 m/s (SD 0.04) faster with a single- point cane compared with a four-point cane. Results regarding other outcomes were inconclusive. CONCLUSIONS Results showed no worthwhile improvements in spatiotemporal parameters of walking with a single-point cane and a slight reduction with a four-point cane, compared with no cane. Individuals walked slightly faster with a single-point cane compared with a four-point cane, but the evidence is insufficient to support this superiority.IMPLICATIONS FOR REHABILITATIONA single-point cane may not improve spatiotemporal parameters of walking after stroke.Walking with a four-point cane may slightly decrease spatiotemporal parameters of walking.Canes may be prescribed without the fear of negatively impairing walking kinematics.
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Affiliation(s)
- Patrick R Avelino
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Lucas R Nascimento
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Espírito Santo, Brazil
| | - Kênia K P Menezes
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Luci F Teixeira-Salmela
- NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Zarezadeh R, Arazpour M, Aminian G. The effect of anterior ankle-foot orthosis and posterior ankle-foot orthosis on functional ambulation in stroke patients. J Rehabil Assist Technol Eng 2022; 9:20556683221082451. [PMID: 36394001 PMCID: PMC9644154 DOI: 10.1177/20556683221082451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022] Open
Abstract
Background The goal of rehabilitation after stroke is to restore safe and sufficient
function to hemiplegic patients, and prescription of an ankle-foot orthosis
(AFO) to improve speed and functional ambulation is a part of this
program. Objective This crossover randomized interventional study aimed to evaluate the effect
of an anterior ankle-foot orthosis (AAFO) and posterior leaf-spring
ankle-foot orthosis (PLS AFO) on speed and functional ambulation in
hemiplegic stroke patients. Method Clinical assessments were performed on 11 hemiplegic stroke patients by the
AAFO, PLS AFO, and wearing shoes. Functional ambulation was measured by the
6-min walking test, Timed Up and Go Test, Time Up and Down Stair Test, and
Functional Ambulation Category. Walking speed was measured by the 10-m
test. Results Both PLS AFO and AAFO significantly improved the performance of TUDS and TUG
tests in hemiplegic patients. However, by using PLS AFO, walking distance
was significantly greater than walking with shoes. There was no significant
effect on the walking speed improvement using PLS AFO or AAFO compared to
wearing shoes. Conclusions The positive effects of the AAFO and PLS AFO on functional ambulation were
significant. By using PLS AFO, hemiplegic patients could walk a longer
distance than wearing shoes.
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Affiliation(s)
- Reihaneh Zarezadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Gholamreza Aminian
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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12
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Choo YJ, Chang MC. Effectiveness of an ankle-foot orthosis on walking in patients with stroke: a systematic review and meta-analysis. Sci Rep 2021; 11:15879. [PMID: 34354172 PMCID: PMC8342539 DOI: 10.1038/s41598-021-95449-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/20/2021] [Indexed: 12/04/2022] Open
Abstract
We conducted a meta-analysis to investigate the effectiveness of ankle–foot orthosis (AFO) use in improving gait biomechanical parameters such as walking speed, mobility, and kinematics in patients with stroke with gait disturbance. We searched the MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, and Scopus databases and retrieved studies published until June 2021. Experimental and prospective studies were included that evaluated biomechanics or kinematic parameters with or without AFO in patients with stroke. We analyzed gait biomechanical parameters, including walking speed, mobility, balance, and kinematic variables, in studies involving patients with and without AFO use. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies, and the level of evidence was evaluated using the Research Pyramid model. Funnel plot analysis and Egger’s test were performed to confirm publication bias. A total of 19 studies including 434 participants that reported on the immediate or short-term effectiveness of AFO use were included in the analysis. Significant improvements in walking speed (standardized mean difference [SMD], 0.50; 95% CI 0.34–0.66; P < 0.00001; I2, 0%), cadence (SMD, 0.42; 95% CI 0.22–0.62; P < 0.0001; I2, 0%), step length (SMD, 0.41; 95% CI 0.18–0.63; P = 0.0003; I2, 2%), stride length (SMD, 0.43; 95% CI 0.15–0.71; P = 0.003; I2, 7%), Timed up-and-go test (SMD, − 0.30; 95% CI − 0.54 to − 0.07; P = 0.01; I2, 0%), functional ambulation category (FAC) score (SMD, 1.61; 95% CI 1.19–2.02; P < 0.00001; I2, 0%), ankle sagittal plane angle at initial contact (SMD, 0.66; 95% CI 0.34–0.98; P < 0.0001; I2, 0%), and knee sagittal plane angle at toe-off (SMD, 0.39; 95% CI 0.04–0.73; P = 0.03; I2, 46%) were observed when the patients wore AFOs. Stride time, body sway, and hip sagittal plane angle at toe-off were not significantly improved (p = 0.74, p = 0.07, p = 0.07, respectively). Among these results, the FAC score showed the most significant improvement, and stride time showed the lowest improvement. AFO improves walking speed, cadence, step length, and stride length, particularly in patients with stroke. AFO is considered beneficial in enhancing gait stability and ambulatory ability.
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Affiliation(s)
- Yoo Jin Choo
- Production R&D Division Advanced Interdisciplinary Team, Medical Device Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea. .,Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 317-1, Daemyungdong, Namku, Daegu, 705-717, Republic of Korea.
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Effects of using assistive devices on the components of the modified instrumented timed up and go test in healthy subjects. Heliyon 2021; 7:e06940. [PMID: 34007923 PMCID: PMC8111581 DOI: 10.1016/j.heliyon.2021.e06940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Evaluation of the changes in gait spatiotemporal parameters and functional mobility with using assistive devices (ADs) would provide useful information and mutual assistance when prescribing such ambulatory devices. This study aimed to investigate the spatiotemporal gait and functional mobility parameters in healthy adults when walking using different ADs. Methods A group of healthy subjects participated in the study. The instrumented modified Timed Up and Go test (iTUG) was used to investigate the impact of different types of ADs on spatiotemporal and functional mobility parameters. Results Subjects showed a significant difference in the gait task performance (P = .001) in stride velocity, stride length, and cadence when walking with and without ADs. A significant difference was also found in the performance of the turn-to-sit task (P = .001) in both velocity and duration when walking with and without ADs. The time to complete sit-to-stand was significantly slower when using a walker (98.3 ± 22.3°/sec, P = .004) and a cane (78.2 ± 21.9°/sec, P = .004) compared to walking without an AD (78.2 ± 21.8°/sec). No significant difference was found between walking with a cane group versus walking with a four-wheeled walker group (P = .94). Conclusion ADs altered gait and functional mobility parameters differently in healthy subjects. Using a four-wheeled walker showed a tendency to increase stride velocity, cadence, stride length, and slow sit-to-stand velocity compared to using a cane. The findings highlight using more caution clinically when prescribing ADs and providing gait training.
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Johnston TE, Keller S, Denzer-Weiler C, Brown L. A Clinical Practice Guideline for the Use of Ankle-Foot Orthoses and Functional Electrical Stimulation Post-Stroke. J Neurol Phys Ther 2021; 45:112-196. [PMID: 33675603 DOI: 10.1097/npt.0000000000000347] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Level of ambulation following stroke is a long-term predictor of participation and disability. Decreased lower extremity motor control can impact ambulation and overall mobility. The purpose of this clinical practice guideline (CPG) is to provide evidence to guide clinical decision-making for the use of either ankle-foot orthosis (AFO) or functional electrical stimulation (FES) as an intervention to improve body function and structure, activity, and participation as defined by the International Classification of Functioning, Disability and Health (ICF) for individuals with poststroke hemiplegia with decreased lower extremity motor control. METHODS A review of literature published through November 2019 was performed across 7 databases for all studies involving stroke and AFO or FES. Data extracted included time post-stroke, participant characteristics, device types, outcomes assessed, and intervention parameters. Outcomes were examined upon initial application and after training. Recommendations were determined on the basis of the strength of the evidence and the potential benefits, harm, risks, or costs of providing AFO or FES. RESULTS/DISCUSSION One-hundred twenty-two meta-analyses, systematic reviews, randomized controlled trials, and cohort studies were included. Strong evidence exists that AFO and FES can each increase gait speed, mobility, and dynamic balance. Moderate evidence exists that AFO and FES increase quality of life, walking endurance, and muscle activation, and weak evidence exists for improving gait kinematics. AFO or FES should not be used to decrease plantarflexor spasticity. Studies that directly compare AFO and FES do not indicate overall superiority of one over the other. But evidence suggests that AFO may lead to more compensatory effects while FES may lead to more therapeutic effects. Due to the potential for gains at any phase post-stroke, the most appropriate device for an individual may change, and reassessments should be completed to ensure the device is meeting the individual's needs. LIMITATIONS This CPG cannot address the effects of one type of AFO over another for the majority of outcomes, as studies used a variety of AFO types and rarely differentiated effects. The recommendations also do not address the severity of hemiparesis, and most studies included participants with varied baseline ambulation ability. SUMMARY This CPG suggests that AFO and FES both lead to improvements post-stroke. Future studies should examine timing of provision, device types, intervention duration and delivery, longer term follow-up, responders versus nonresponders, and individuals with greater impairments. DISCLAIMER These recommendations are intended as a guide for clinicians to optimize rehabilitation outcomes for people with poststroke hemiplegia who have decreased lower extremity motor control that impacts ambulation and overall mobility.A Video Abstract is available as supplemental digital content from the authors (available at: http://links.lww.com/JNPT/A335).
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Affiliation(s)
- Therese E Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania and Ossur, Foothill Ranch, California (T.E.J.); Department of Physical Therapy, College of Health Sciences, Midwestern University, Downers Grove, Illinois (S.K.); Kessler Institute for Rehabilitation, Chester, New Jersey (C.D.-W.); and Boston University College of Health and Rehabilitation Sciences: Sargent, Boston, Massachusetts (L.B.)
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Trujillo-León A, Ady R, Reversat D, Bachta W. Robotic Cane Controlled to Adapt Automatically to Its User Gait Characteristics. Front Robot AI 2021; 7:105. [PMID: 33501272 PMCID: PMC7805843 DOI: 10.3389/frobt.2020.00105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
Research on robotic assistance devices tries to minimize the risk of falls due to misuse of non-actuated canes. This paper contributes to this research effort by presenting a novel control strategy of a robotic cane that adapts automatically to its user gait characteristics. We verified the proposed control law on a robotic cane sharing the main shape features of a non-actuated cane. It consists of a motorized telescopic shaft mounted on the top of two actuated wheels driven by the same motor. Cane control relies on two Inertial Measurement Units (IMU). One is attached to the cane and the other to the thigh of its user impaired leg. During the swing phase of this leg, the motor of the wheels is controlled to enable the tracking of the impaired leg thigh angle by the cane orientation. The wheels are immobilized during the stance phase to provide motionless mechanical support to the user. The shaft length is continuously adjusted to keep a constant height of the cane handle. The primary goal of this work is to show the feasibility of the cane motion synchronization with its user gait. The control strategy looks promising after several experiments. After further investigations and experiments with end-users, the proposed control law could pave the road toward its use in robotic canes used either as permanent assistance or during rehabilitation.
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Affiliation(s)
- Andrés Trujillo-León
- CNRS, UMR 7222, INSERM, U1150, Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
| | - Ragou Ady
- CNRS, UMR 7222, INSERM, U1150, Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
| | - David Reversat
- CNRS, UMR 7222, INSERM, U1150, Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
| | - Wael Bachta
- CNRS, UMR 7222, INSERM, U1150, Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, Paris, France
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Comparison the effect of kinetic parameters of innovative storing-restoring hybrid passive (comfort gait) ankle-foot orthosis (AFO) with posterior leaf spring AFO in drop-foot patients: a prospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2020. [DOI: 10.1097/bco.0000000000000915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Fatone S, Jerousek S, Slater BCS, Deutsch A, LaVela SL, Peterson M, Soltys NT, McPherson V, Heinemann AW. Identifying Instruments to Assess Care Quality for Individuals With Custom Ankle Foot Orthoses: A Scoping Review. Arch Phys Med Rehabil 2020; 102:709-734. [PMID: 32791070 DOI: 10.1016/j.apmr.2020.06.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES We conducted 2 complementary scoping reviews to identify instruments that assess the experience and outcomes of custom ankle-foot orthosis (AFO) care in individuals with neurologic and traumatic conditions and to determine to what extent they might be psychometrically sound for AFO users. A stakeholder advisory committee considered to what extent the identified and psychometrically sound instruments might be feasible for use in developing quality measures for custom AFO users. DATA SOURCES Both scoping reviews were conducted using PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, and Cochrane Systematic Reviews. The following were used for the first scoping review only: Cochrane Central Register of Controlled Trials and the Physiotherapy Evidence Database. STUDY SELECTION The initial scoping review yielded 79 articles with 82 instruments, 16 of which were used in 4 or more studies. The second scoping review yielded 57 articles reporting psychometric properties. DATA EXTRACTION Psychometric properties for populations who use AFOs were summarized for 15 of the 16 instruments. The advisory committee eliminated 2 insrtruments, noted overlap between 4 instruments in terms of the constructs measured, and suggested 6 potential contemporary substitutes. DATA SYNTHESIS Most instruments assessed activity (specifically mobility) and pertained to the National Quality Forum domain of "Health-Related Quality of Life." The 10-meter walk test, 6-minute walk test, Berg Balance Scale, Timed Up and Go, and Rivermead Mobility Index were reported to have adequate reliability and validity, and were considered feasible for administration in a clinical setting. CONCLUSIONS Complementary scoping reviews demonstrated that some instruments with reasonable psychometric properties are available that are feasible to use in developing quality measures for custom AFO care. However, experience of care instruments suitable for this population were not identified but are needed for a comprehensive evaluation of care quality for AFO users.
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Affiliation(s)
- Stefania Fatone
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Sara Jerousek
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL
| | | | - Anne Deutsch
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; The Shirley Ryan Ability Lab, Chicago, IL; RTI International, Chicago, IL
| | - Sherri L LaVela
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL
| | | | | | | | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; The Shirley Ryan Ability Lab, Chicago, IL
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Bunketorp-Käll L, Pekna M, Pekny M, Blomstrand C, Nilsson M. Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke. NeuroRehabilitation 2019; 45:483-492. [PMID: 31868694 PMCID: PMC7029334 DOI: 10.3233/nre-192905] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Persons with stroke commonly have residual neurological deficits that seriously hamper mobility. OBJECTIVE To investigate whether horse-riding therapy (H-RT) and rhythm and music-based therapy (R-MT) affect functional mobility in late phase after stroke. METHODS This study is part of a randomized controlled trial in which H-RT and R-MT was provided twice weekly for 12 weeks. Assessment included the timed 10-meter walk test (10 mWT), the six-minute walk test (6 MWT) and Modified Motor Assessment Scale (M-MAS). RESULTS 123 participants were assigned to H-RT (n = 41), R-MT (n = 41), or control (n = 41). Post-intervention, the H-RT group completed the 10 mWT faster at both self-selected (-2.22 seconds [95% CI, -3.55 to -0.88]; p = 0.001) and fast speed (-1.19 seconds [95% CI, -2.18 to -0.18]; p = 0.003), with fewer steps (-2.17 [95% CI, -3.30 to -1.04]; p = 0.002 and -1.40 [95% CI, -2.36 to -0.44]; p = 0.020, respectively), as compared to controls. The H-RT group also showed improvements in functional task performance as measured by M-MAS UAS (1.13 [95% CI, 0.74 to 1.52]; p = 0.001). The gains were partly maintained at 6 months among H-RT participants. The R-MT did not produce any immediate gains. However, 6 months post-intervention, the R-MT group performed better with respect to time; -0.75 seconds [95% CI, -1.36 to -0.14]; p = 0.035) and number of steps -0.76 [95% CI, -1.46 to -0.05]; p = 0.015) in the 10 mWT at self-selected speed. CONCLUSIONS The present study supports the efficacy of H-RT in producing immediate gains in gait and functional task performance in the late phase after stroke, whereas the effectiveness of R-MT is less clear.
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Affiliation(s)
- Lina Bunketorp-Käll
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Center for Advanced Reconstruction of Extremities C.A.R.E. Institute of Clinical Sciences, Sahlgrenska University Hospital/Mölndal, Sweden
| | - Marcela Pekna
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
| | - Milos Pekny
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- University of Newcastle, New South Wales, Australia
| | - Christian Blomstrand
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neuroscience, Stroke Center West, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Michael Nilsson
- Center for Brain Repair, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Florey Institute of Neuroscience and Mental Health, Parkville, Melbourne, Australia
- Centre for Rehab Innovations (CRI), University of Newcastle and Hunter Medical Research Institute (HMRI) Newcastle, Australia
- LKC School of Medicine, Nanyang Technological University, Singapore
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Ota T, Hashidate H, Shimizu N, Yatsunami M. Early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke. J Phys Ther Sci 2019; 31:127-131. [PMID: 30858650 PMCID: PMC6382479 DOI: 10.1589/jpts.31.127] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/02/2018] [Indexed: 01/23/2023] Open
Abstract
[Purpose] The purpose of this study was to evaluate the early effects of a
knee-ankle-foot orthosis on static standing balance in people with subacute stroke.
[Participants and Methods] Timed static standing balance in four standing conditions (feet
apart with eyes open, feet apart with eyes closed, feet together with eyes open, and
tandem stance with eyes open) was assessed in 29 inpatients (mean age: 67.3 ± 13.3 years)
with subacute stroke with and without a knee-ankle-foot orthosis on the paretic lower
limb. [Results] In the group of participants who were unable to stand without a
knee-ankle-foot orthosis, the proportion of participants who were able to stand with a
knee-ankle-foot orthosis was significantly increased in the following conditions: feet
apart with eyes open and feet apart with eyes closed. In the group of participants who
were able to stand without a knee-ankle-foot orthosis, the mean duration of time for which
the participants with a knee-ankle-foot orthosis were able to stand was significantly
longer than that for those without a knee-ankle-foot orthosis for all standing conditions.
[Conclusion] A knee-ankle-foot orthosis may be a useful assistive device to support static
standing balance for people with subacute stroke.
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Affiliation(s)
- Tomohiro Ota
- Department of Health Science, Graduate School, Kyorin University: 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan.,Hatsudai Rehabilitation Hospital, Japan
| | - Hiroyuki Hashidate
- Department of Physical Therapy, School of Health Science, Kyorin University, Japan
| | - Natsuki Shimizu
- Department of Health Science, Graduate School, Kyorin University: 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan.,Hatsudai Rehabilitation Hospital, Japan
| | - Mitsunobu Yatsunami
- Department of Physical Therapy, School of Health Science, Kyorin University, Japan
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Lee SH, Choi C, Lee D, Lee S, Song S, Pyo S, Hong S, Lee G. A novel hinged ankle foot orthosis for gait performance in chronic hemiplegic stroke survivors: a feasibility study. Biomed Eng Lett 2019; 8:301-308. [PMID: 30603214 DOI: 10.1007/s13534-018-0074-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 11/29/2022] Open
Abstract
Stroke survivors with gait disturbances may use ankle foot orthoses (AFOs). However, most AFOs come in one-piece styles, which make it difficult for spasticity-affected stroke survivors to don. AFOs are also limited since they do not properly prevent ankle joint for foot drop by itself. Therefore, the present study developed a novel hinged AFO by adding a locking device to a hinged joint. We then tested its feasibility in 9 hemiplegic stroke survivors by investigating temporal-spatial gait parameters using the GAITRite in the following 3 conditions: no AFO, traditional AFO, and novel hinged AFO. There was no significant difference in spatiotemporal gait parameters among the different conditions. There were greater decreases in gait velocity, cadence, step length, and stride length in the novel hinged AFO group than in the no AFO and traditional AFO groups. This novel hinged AFO was developed to prevent foot drop. However, the AFO did not show significant differences in gait parameters because it consists of metal with extra weight and volume. Functionally, it prevented foot drop. It also improved convenience by its releasable design. Thus, further studies are needed to develop an AFO that improves gait and is convenient to use for hemiplegic stroke survivors.
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Affiliation(s)
- Se-Han Lee
- 1Department of Mechanical Engineering, Kyungnam University, Changwon, Republic of Korea
| | - ChangMin Choi
- 2Department of Advanced Engineering, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - DongGeon Lee
- 3Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - SeungHoo Lee
- 3Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - SunHae Song
- 3Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - SeungHyeon Pyo
- 3Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - SoungKyun Hong
- 3Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, Republic of Korea
| | - GyuChang Lee
- 4Department of Physical Therapy, Kyungnam University, 7 Kyungnamdaehak-ro, Masanhappo-gu, Changwon, Gyeongsangnam-do 51767 Republic of Korea
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Oh S, Song M, Kim J. Validating attentive locomotion training using interactive treadmill: an fNIRS study. J Neuroeng Rehabil 2018; 15:122. [PMID: 30572919 PMCID: PMC6302412 DOI: 10.1186/s12984-018-0472-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 12/07/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Existing treadmill-based locomotion training, which has been used for gait function recovery, still has limitations, such as less attentive training. Interactive treadmills (ITMs) were developed to overcome these limitations, but it has not yet been verified that ITMs can make the user pay closer attention to walk training. METHODS An experimental comparison between ITMs and conventional treadmills was conducted by measuring the level of the user's attention using functional near-infrared spectroscopy (fNIRS). To consider the effect of task complexity on the subject's attention, we provided two (slow and fast) speed conditions for walking on both treadmills. RESULTS Both the cortical activity images and oxygenated hemoglobin (oxyHb) changes showed that the level of attention to walking induced by the ITM was significantly higher than that induced by the conventional treadmill. We found that the walking speed on the ITM also affected the level of attention. CONCLUSION ITM-based locomotion training would be a promising solution to the limitations of existing treadmill-based locomotion training currently used to improve gait function recovery. TRIAL REGISTRATION DGIST-HR-150309-03-02 . Registered 01 March 2015.
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Affiliation(s)
- Seunghue Oh
- Department of Robotics Engineering, DGIST (Daegu Gyeongbuk Institute of Science and Technology), 333 Techno Jungang-daero, Daegu, 42988 Republic of Korea
| | - Minsu Song
- Department of Robotics Engineering, DGIST (Daegu Gyeongbuk Institute of Science and Technology), 333 Techno Jungang-daero, Daegu, 42988 Republic of Korea
| | - Jonghyun Kim
- Department of Robotics Engineering, DGIST (Daegu Gyeongbuk Institute of Science and Technology), 333 Techno Jungang-daero, Daegu, 42988 Republic of Korea
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Boland P, Levack WMM, Graham FP, Perry MA. User perspective on receiving adaptive equipment after stroke: A mixed-methods study. The Canadian Journal of Occupational Therapy 2018; 85:297-306. [PMID: 30449152 DOI: 10.1177/0008417418800834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND. Adaptive equipment (AE) is frequently provided during stroke rehabilitation by occupational therapists. PURPOSE. This study aimed to identify the AE that people typically use after a stroke and the outcomes achieved as a result, and to explore people's experiences obtaining and using AE, to inform both practice and policy in this field. METHOD. A mixed-methods study, involving a postal questionnaire and interviews, used descriptive statistics and grounded theory to analyze the quantitative and qualitative data, respectively. FINDINGS. Questionnaire data ( n = 258) revealed mobility AE was issued most frequently, with increased safety as the primary reported outcome. Interview data ( n = 15) indicated relationships with health professionals and the hospital environment shaped early AE selection and use. Once home, making sense of AE and community participation were more influential. IMPLICATIONS. Therapeutic relationships and reflection time are critical to maximize AE use after stroke. Policy and related funding for AE need to prioritize community participation.
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Ota T, Hashidate H, Shimizu N, Saito A. Difference in independent mobility improvement from admission to discharge between subacute stroke patients using knee-ankle-foot and those using ankle-foot orthoses. J Phys Ther Sci 2018; 30:1003-1008. [PMID: 30154590 PMCID: PMC6110217 DOI: 10.1589/jpts.30.1003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/07/2018] [Indexed: 01/19/2023] Open
Abstract
[Purpose] To verify differences in independent mobility improvements between people with
subacute stroke with knee-ankle-foot orthoses (KAFOs) and those with ankle-foot orthoses
(AFOs) from admission to discharge, and to identify the relationship between mobility
improvements and their characteristics. [Participants and Methods] This study included 381
hospitalized patients with subacute stroke who required complete mobility assistance at
admission and for whom KAFOs (KAFO group) or AFOs (AFO group) were prescribed after
admission. The functional independence measure (FIM) score at admission and discharge, FIM
gain, age, Brunnstrom stage (BS) of the paretic lower limb at admission, and the period
from admission to prescription for lower limb orthoses were investigated. [Results]
Repeated-measures two-way analysis of variance revealed a significant group × time
interaction in the walk/wheelchair and stair-climbing items of the FIM. Improvements in
the scores in the KAFO group were significantly lower than those in the AFO group. Age,
BS, FIM at admission, and period from admission to lower limb orthosis prescription
significantly correlated with FIM gain in the walk/wheelchair and stair-climbing items.
[Conclusion] A more effective intervention using lower limb orthoses with consideration of
the influence of age, motor paralysis, and activities of daily living at admission is
required to promote the improvements of people with subacute stroke prescribed KAFOs or
AFOs.
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Affiliation(s)
- Tomohiro Ota
- Major in Health Science, Graduate School of Kyorin University: 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan.,Hatsudai Rehabilitation Hospital, Japan
| | - Hiroyuki Hashidate
- Department of Physical Therapy, School of Health Science, Kyorin University, Japan
| | - Natsuki Shimizu
- Major in Health Science, Graduate School of Kyorin University: 5-4-1 Shimorenjaku, Mitaka, Tokyo 181-8612, Japan.,Hatsudai Rehabilitation Hospital, Japan
| | - Akihiko Saito
- Department of Rehabilitation, Faculty of Health Sciences, Tokyo Kasei University, Japan
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Cho KH, Pyo S, Shin GS, Hong SD, Lee SH, Lee D, Song S, Lee G. A novel one arm motorized walker for hemiplegic stroke survivors: a feasibility study. Biomed Eng Online 2018; 17:14. [PMID: 29378582 PMCID: PMC5789543 DOI: 10.1186/s12938-018-0446-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 01/17/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND A hemiplegic stroke survivor with a moderate to severe gait disturbance may have difficulty walking using a one-arm walker. This study aimed to test the safety and feasibility of a prototype one-arm motorized walker that uses a power-driven device to provide gait assistance to hemiplegic stroke survivors with moderate to severe gait disturbances. METHODS A one-arm motorized walker with a power-driven device was developed and tested with respect to 10 distinct variables, including weight, degrees of freedom, handle, handle substitution function, two-sided use function, variable handle height, redirecting function, electric moving parts through the handle control, brake function using the handle control, folding chairs, and design stability. Its safety and feasibility were tested in 19 hemiplegic stroke individuals using the Likert scale and a simple interview. RESULTS The walker consists of a frame platform including a handle, electric motor for driving, one wheel for driving, two wheels for turning, unlocking sensor, driving button, and turning buttons. The walker is programmed so that a touch sensor in the handle can unlock the locking system. Furthermore, it is programmed so that a user can propel it by pushing the handle downward or pressing a button and can control directions for turning right or left by pressing buttons. Safety and performance testing was achieved for 10 separate variables, and a Likert scale score of 3.5 of 5 was recorded. CONCLUSION This walker's novel design was developed for hemiplegic stroke survivors with moderate to severe gait disturbances. Our findings indicate that the walker is both safe and feasible for providing walking assistance to hemiplegic stroke survivors and establish the potential advantages of the one-arm motorized walker.
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Affiliation(s)
- Ki-Hun Cho
- Department of Physical Therapy, Korea National University of Transportation, Chungju, 27469 Republic of Korea
- Department of Rehabilitative & Assistive Technology, National Rehabilitation Research Institute, National Rehabilitation Center, Seoul, 01022 Republic of Korea
| | - SeungHyeon Pyo
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, 51767 Republic of Korea
| | - Gi-Su Shin
- Anytoy Co., Ltd., Changwon, 51233 Republic of Korea
| | | | - Se-Han Lee
- Department of Mechanical Engineering, Kyungnam University, Changwon, 51767 Republic of Korea
| | - DongGeon Lee
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, 51767 Republic of Korea
| | - SunHae Song
- Department of Physical Therapy, Graduate School of Kyungnam University, Changwon, 51767 Republic of Korea
| | - GyuChang Lee
- Department of Physical Therapy, Kyungnam University, 7 Kyungnamdaehak-ro, Masanhappo-gu, Changwon, Gyeongsangnam-do 51767 Republic of Korea
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Lee SM, Cynn HS, Yi CH, Yoon TL, Lee JH. Wearable tubing assistive walking device immediately enhances gait parameters in subjects with stroke: A randomized controlled study. NeuroRehabilitation 2016; 40:99-107. [PMID: 27935557 DOI: 10.3233/nre-161394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Stroke patients develop compensatory movements due to limitations of ankle dorsiflexion and knee flexion. To solve the limitations, there are many adjustable walking assistive devices such as robotic devices, ankle-foot orthoses, and functional electric stimulation in rehabilitation session. However, these assistive devices have some disadvantages, including expense and discomforts. Therefore, the development of a new assistive device for stroke patients is needed to assist ankle dorsiflexion and knee flexion. OBJECTIVE This study investigated the effects of a wearable tubing assistive walking device (WTAWD) on gait parameters (gait speed, cadence, and step length and stride length on affected and less affected sides) in patients with stroke. METHODS Gait parameters were measured using the GAITRite system. One-way repeated measures analysis of variance was used to determine gait differences under three conditions (WTAWD, barefoot, and conventional elastic band orthosis). RESULTS Gait speed, cadence, and step length and stride length on both affected and less affected sides were significantly greater with WTAWD, compared to barefoot and conventional elastic band orthosis conditions. CONCLUSION WTAWD could be effective for patients with stroke.
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Affiliation(s)
- Seung-Mi Lee
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of South Korea
| | - Heon-Seock Cynn
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of South Korea
| | - Chung-Hwi Yi
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of South Korea
| | - Tae-Lim Yoon
- Department of Physical Therapy, College of Health Science, Cheongju University, Cheongju, Republic of South Korea
| | - Ji-Hyun Lee
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, Graduate School, Yonsei University, Wonju, Republic of South Korea
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Yozu A, Hamada M, Sasaki T, Tokushige SI, Tsuji S, Haga N. Development of a novel system to quantify the spatial–temporal parameters for crutch-assisted quadrupedal gait. Adv Robot 2016. [DOI: 10.1080/01691864.2016.1244489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Arito Yozu
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Sasaki
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shin-ichi Tokushige
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shoji Tsuji
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
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Boland P, Levack W, Perry M, Graham F. Equipment provision after stroke: A scoping review of the use of personal care and mobility aids in rehabilitation. Br J Occup Ther 2016. [DOI: 10.1177/0308022616664910] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction The aim of this scoping review was to examine and synthesise literature on adaptive equipment use for personal care and mobility after stroke. Method We searched databases including Medline, EMBASE, AMED, CINAHL and Scopus to February 2016. Two authors independently screened 789 titles, identifying 28 studies for inclusion in the review. Results Findings were grouped into four themes: (1) stroke-specific impairments and consequences for equipment use and training; (2) meaning of equipment for people with stroke; (3) cost of equipment after stroke; and (4) conflicts between equipment provision and models of stroke rehabilitation. Conclusion The wide range of impairments after stroke increases complexity of how people use equipment. Nonetheless, training needs and the relationship between social context, identity and equipment use are increasingly better understood,. The findings highlight a tension between practice that seeks to re-train function by ‘normal’ movement without equipment and restoration of function by using compensation strategies involving use of equipment. However, there is no evidence that compensation strategies impede recovery of physical abilities. High-quality evidence about costs of equipment after stroke, which could inform policy decisions, is urgently needed.
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Affiliation(s)
- Pauline Boland
- Lecturer, MSc Occupational Therapy Programme, Clinical Therapies, University of Limerick, Republic of Ireland
- Senior Lecturer, Rehabilitation, Teaching and Research Unit, University of Otago, New Zealand
| | - William Levack
- Senior Lecturer, Rehabilitation, Teaching and Research Unit, University of Otago, New Zealand
| | - Meredith Perry
- Lecturer, Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Fiona Graham
- Senior Lecturer, Rehabilitation, Teaching and Research Unit, University of Otago, New Zealand
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Nikamp CDM, Buurke JH, van der Palen J, Hermens HJ, Rietman JS. Early or delayed provision of an ankle-foot orthosis in patients with acute and subacute stroke: a randomized controlled trial. Clin Rehabil 2016; 31:798-808. [DOI: 10.1177/0269215516658337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Corien DM Nikamp
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Job van der Palen
- Medisch Spectrum Twente, Medical School Twente, Enschede, The Netherlands
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Hermie J Hermens
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomedical Signals and Systems, University of Twente, Enschede, The Netherlands
| | - Johan S Rietman
- Roessingh Research and Development, Enschede, The Netherlands
- Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Amputation and Orthopaedics, Roessingh Centre for Rehabilitation, Enschede, The Netherlands
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Bouchalová V, Houben E, Tancsik D, Schaekers L, Meuws L, Feys P. The influence of an ankle-foot orthosis on the spatiotemporal gait parameters and functional balance in chronic stroke patients. J Phys Ther Sci 2016; 28:1621-8. [PMID: 27313385 PMCID: PMC4905924 DOI: 10.1589/jpts.28.1621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/06/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Observational study investigating the influence of various ankle-foot orthoses on the spatiotemporal gait parameters and functional balance in chronic stroke patients. [Subjects and Methods] Fifteen chronic stroke patients participated in this study after providing informed consent. Two groups of patients were differentiated based on the Timed Up and Go Test. Patients were tested in three different conditions: with standard prefabricated ankle-foot orthosis (Maramed), with individualized ankle-foot orthosis (Y-tech), and without any ankle-foot orthrosis. Spatiotemporal gait parameters were obtained by walking on an instrumented walkway (GAITRite(®)) at usual and fastest speed. Balance was assessed with Timed Up and Go Test, Step Test, and Four Square Step Test. [Results] Maramed and Y-tech significantly improved the spatiotemporal parameters while walking at usual and maximal speed (single support time affected side; double support time affected side and step length unaffected side). The Y-tech in addition improved velocity and cadence. Among the balance tests, only the Timed Up and Go test showed improvements in favor of Maramed and Y-tech. [Conclusion] Patients benefited from wearing orthosis at both usual and maximal speed, irrespective of whether they wore Maramed or Y-tech. Only severe stroke patients benefited from wearing an orthoses compared to mild impaired group.
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Affiliation(s)
- Vendula Bouchalová
- Department of Public Health and Preventive Medicine, Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Els Houben
- Rehabilitation Department of Ziekenhuis Oost-Limburg, Belgium
| | - Dorine Tancsik
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Lotte Schaekers
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Leni Meuws
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Peter Feys
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1516] [Impact Index Per Article: 189.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Pomeroy VM, Rowe P, Clark A, Walker A, Kerr A, Chandler E, Barber M, Baron JC. A Randomized Controlled Evaluation of the Efficacy of an Ankle-Foot Cast on Walking Recovery Early After Stroke: SWIFT Cast Trial. Neurorehabil Neural Repair 2015; 30:40-8. [PMID: 25931239 PMCID: PMC4704299 DOI: 10.1177/1545968315583724] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background. Timely provision of an ankle-foot orthosis (AFO) orthotist customized for individuals early after stroke can be problematic. Objective. To evaluate the efficacy of a therapist-made AFO (SWIFT Cast) for walking recovery. Methods. This was a randomized controlled, observer-blind trial. Participants (n = 105) were recruited 3 to 42 days poststroke. All received conventional physical therapy (CPT) that included use of “off-the-shelf” and orthotist-made AFOs. People allocated to the experimental group also received a SWIFT Cast for up to 6 weeks. Measures were undertaken before randomization, 6 weeks thereafter (outcome), and at 6 months after stroke (follow-up). The primary measure was walking speed. Clinical efficacy evaluation used analysis of covariance. Results. Use of a SWIFT Cast during CPT sessions was significantly higher (P < .001) for the SWIFT Cast (55%) than the CPT group (3%). The CPT group used an AFO in 26% of CPT sessions, compared with 11% for the SWIFT Cast group (P = .005). At outcome, walking speed was 0.42 (standard deviation [SD] = 0.37) m/s for the CPT group and 0.32 (SD = 0.34) m/s for the SWIFT Cast group. Follow-up walking speed was 0.53 (SD = 0.38) m/s for the CPT group and 0.43 (0.34) m/s for the SWIFT Cast group. Differences, after accounting for minimization factors, were insignificant at outcome (P = .345) and follow-up (P = .360). Conclusion and implications. SWIFT Cast did not enhance the benefit of CPT, but the control group had greater use of another AFO. However, SWIFT Cast remains a clinical option because it is low cost and custom-made by therapists who can readily adapt it during the rehabilitation period.
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Affiliation(s)
| | | | | | - Andrew Walker
- University of East Anglia, Norwich, UK University of Leeds, UK
| | | | | | - Mark Barber
- Stroke Managed Clinical Network NHS Lanarkshire, Airdrie, UK
| | - Jean-Claude Baron
- University of Cambridge and INSERM U894, Hopital Sainte-Anne, Sorbonne Paris Cité, Paris, France
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Braun T, Marks D, Zutter D, Grüneberg C. The impact of rollator loading on gait and fall risk in neurorehabilitation - a pilot study. Disabil Rehabil Assist Technol 2014; 10:475-481. [PMID: 24936570 DOI: 10.3109/17483107.2014.926568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Rollator loading is an application used clinically sometimes to improve functional integrity and security of the patients' gait. As empirical evidence supporting this intervention is equivocal, the purpose of this study was to examine the effects of rollator loading on several gait parameters and fall risk. METHODS An explicatory experiment with a follow-up cohort study of falls was conducted. In the experimental part of the study, participants (n = 25) were evaluated three times by means of different gait and fall risk assessments, whereby each trial was carried out with different rollator loading (0, 4.5 and 9 kg, respectively). Participants were blinded towards the applied load. In addition, the odds ratio of falls with respect to rollator loading in all-day rehabilitation life was determined. RESULTS No changes in spatio-temporal gait parameters and fall risk in relation to a particular load could be identified by clinical measures in the tested sample. A separate sub-group analysis (Parkinson's disease, hemiparesis and ataxia) showed only little impact of the load in each case. Rollator loading had no impact on the odds ratio of inpatient fall risk. CONCLUSION On the basis of our findings, weighting of rollators can neither be discouraged nor recommended. Implications for Rehabilitation Unless more research is has been conducted on this topic, rollator loading can neither be recommended nor discouraged in individuals suffering from neurologic diseases. There is more research needed to examine the impact on ambulation in distinct conditions such as severe ataxia and fear of falling.
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Affiliation(s)
- Tobias Braun
- a Hochschule für Gesundheit, University of Applied Sciences, Department of Applied Health Sciences, Physiotherapy Program , Bochum , Germany and.,b Rehaklinik Zihlschlacht, Neurorehabilitation Center , Zihlschlacht , Switzerland
| | - Detlef Marks
- b Rehaklinik Zihlschlacht, Neurorehabilitation Center , Zihlschlacht , Switzerland
| | - Daniel Zutter
- b Rehaklinik Zihlschlacht, Neurorehabilitation Center , Zihlschlacht , Switzerland
| | - Christian Grüneberg
- a Hochschule für Gesundheit, University of Applied Sciences, Department of Applied Health Sciences, Physiotherapy Program , Bochum , Germany and
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Effects of an Ankle-Foot Orthosis on Balance and Walking After Stroke: A Systematic Review and Pooled Meta-Analysis. Arch Phys Med Rehabil 2013; 94:1377-85. [PMID: 23416220 DOI: 10.1016/j.apmr.2012.12.025] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/13/2012] [Indexed: 11/23/2022]
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Arazpour M, Tajik HR, Aminian G, Bani MA, Ghomshe FT, Hutchins SW. Comparison of the effects of solid versus hinged ankle foot orthoses on select temporal gait parameters in patients with incomplete spinal cord injury during treadmill walking. Prosthet Orthot Int 2013; 37:70-5. [PMID: 22751217 DOI: 10.1177/0309364612448511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle foot orthoses (AFOs) are usually used for patients with incomplete spinal cord injury (ISCI) to provide support in walking. OBJECTIVES The aim of this study was to compare the effect of AFOs, with and without ankle hinges, on specific gait parameters during treadmill training by subjects with ISCI. STUDY DESIGN Quasi-experimental. METHODS Five patients with ISCI at the thoracic level participated in this study. Gait evaluation was performed when walking 1) barefoot 2) wearing a solid AFO and 3) wearing a hinged AFO. RESULTS The mean step length when walking barefoot was 26.3 ± 16.37 cm compared to 31.3 ± 17.27 cm with a solid AFO and 28.5 ± 15.86 cm with a hinged AFO. The mean cadence for walking barefoot was 61.59 ± 25.65 steps/min. compared to 50.94 ± 22.36 steps/min. with a solid AFO and 56.25 ± 24.44 steps/min with a hinged AFO. Significant differences in cadence and step length during walking were only demonstrated between the barefoot condition and when wearing a solid AFO. Significant difference was not observed between conditions in mean of ankle range of motion. CONCLUSION The solid AFO was the only condition which improved cadence and step length in patients during ISCI gait training. Clinical relevance A solid AFO could be used permanently to compensate for impaired ankle function or it could be used while retraining stepping.
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Affiliation(s)
- Mokhtar Arazpour
- University of Social Welfare and Rehabilitation Science, Tehran, Iran
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Abstract
Interacting with other people and the environment is fundamental to quality of life. Canes, walkers, and crutches increase, maintain, or improve functional capabilities of many individuals with neurologic disorders. Canes offer a choice of handle, shaft, and base. Walkers have various types of base, uprights, handgrips, platforms, and accessories. Crutch designs include underarm, triceps, forearm, and platform. Orthoses, particularly ankle foot orthoses and knee ankle foot orthoses, are often used to stabilize or immobilize lower limb segments while walking. Studies have shown the benefits of traditional assistive devices on gait, when prescribed and used properly.
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Ambulatory Function and Perception of Confidence in Persons with Stroke with a Custom-Made Hinged versus a Standard Ankle Foot Orthosis. Rehabil Res Pract 2012; 2012:206495. [PMID: 22685664 PMCID: PMC3362993 DOI: 10.1155/2012/206495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 02/07/2012] [Accepted: 03/16/2012] [Indexed: 11/20/2022] Open
Abstract
Objective. The aim was to compare walking with an individually designed dynamic hinged ankle foot orthosis (DAFO) and a standard carbon composite ankle foot orthosis (C-AFO). Methods. Twelve participants, mean age 56 years (range 26–72), with hemiparesis due to stroke were included in the study. During the six-minute walk test (6MW), walking velocity, the Physiological Cost Index (PCI), and the degree of experienced exertion were measured with a DAFO and C-AFO, respectively, followed by a Stairs Test velocity and perceived confidence was rated. Results. The mean differences in favor for the DAFO were in 6MW 24.3 m (95% confidence interval [CI] 4.90, 43.76), PCI −0.09 beats/m (95% CI −0.27, 0.95), velocity 0.04 m/s (95% CI −0.01, 0.097), and in the Stairs Test −11.8 s (95% CI −19.05, −4.48). All participants except one perceived the degree of experienced exertion lower and felt more confident when walking with the DAFO. Conclusions. Wearing a DAFO resulted in longer walking distance and faster stair climbing compared to walking with a C-AFO. Eleven of twelve participants felt more confident with the DAFO, which may be more important than speed and distance and the most important reason for prescribing an AFO.
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The effects of walking sticks on gait kinematics and kinetics with chronic stroke survivors. Clin Biomech (Bristol, Avon) 2012; 27:131-7. [PMID: 21889240 DOI: 10.1016/j.clinbiomech.2011.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 07/18/2011] [Accepted: 08/03/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are robust clinical paradigms against the prescription of walking sticks for people with stroke. However, there is little information on the biomechanics of gait with and without these devices to guide clinical practice. Therefore, this study investigated how the use of walking sticks (canes or crutches) affected both the kinematics and kinetics of gait in people with chronic stroke after their walking had stabilized. METHODS Nineteen people with chronic stroke walked at both comfortable and fast speeds. A 3-D motion analysis system and one force platform were used to obtain kinematic and kinetic data of the paretic lower limb during four conditions: With and without walking sticks, and at comfortable and fast speeds. Outcomes included linear kinematics (walking speeds) and angular kinematics (maximum joint angles), power, and work of the paretic hip, knee and ankle joints in the saggital plane. FINDINGS The use of walking sticks resulted in increases in speed during both fast (P<0.001) and comfortable (P=0.001) walking, but did not result in changes in maximum joint angles. This also led to increases in ankle plantar flexion (P<0.01), knee extension (P<0.01), and hip flexion (P<0.001) power generation, but did not result in changes in work. There were no greater changes as a result of using walking sticks during fast versus comfortable walking for any outcome. INTERPRETATIN: The outcomes with the use of walking sticks were beneficial, which suggests that the prescription of these devices is not detrimental to walking that was stabilized in people with stroke.
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Patrick M, Ditunno P, Ditunno JF, Marino RJ, Scivoletto G, Lam T, Loffree J, Tamburella F, Leiby B. Consumer preference in ranking walking function utilizing the walking index for spinal cord injury II. Spinal Cord 2011; 49:1164-72. [PMID: 21788954 DOI: 10.1038/sc.2011.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Blinded rank ordering. OBJECTIVE To determine consumer preference in walking function utilizing the walking Index for spinal cord injury II (WISCI II) in individuals with spinal cord injury (SCI)from the Canada, the Italy and the United States of America. METHOD In all, 42 consumers with incomplete SCI (25 cervical, 12 thoracic, 5 lumbar) from Canada (12/42), Italy (14/42) and the United States of America (16/42) ranked the 20 levels of the WISCI II scale by their individual preference for walking. Subjects were blinded to the original ranking of the WISCI II scale by clinical scientists. Photographs of each WISCI II level used in a previous pilot study were randomly shuffled and rank ordered. Percentile, conjoint/cluster and graphic analyses were performed. RESULTS All three analyses illustrated consumer ranking followed a bimodal distribution. Ranking for two levels with physical assistance and two levels with a walker were bimodal with a difference of five to six ranks between consumer subgroups (quartile analysis). The larger cluster (N=20) showed preference for walking with assistance over the smaller cluster (N=12), whose preference was walking without assistance and more devices. In all, 64% (27/42) of consumers ranked WISCI II level with no devices or braces and 1 person assistance higher than multiple levels of the WISCI II requiring no assistance. These results were unexpected, as the hypothesis was that consumers would rank independent walking higher than walking with assistance. CONCLUSION Consumer preference for walking function should be considered in addition to objective measures in designing SCI trials that use significant improvement in walking function as an outcome measure.
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Affiliation(s)
- M Patrick
- Thomas Jefferson University, Regional SCI Center of the Delaware Valley, Department of Rehabilitation Medicine, Philadelphia, PA 19107, USA.
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Guillebastre B, Rougier PR, Sibille B, Chrispin A, Detante O, Pérennou DA. When might a cane be necessary for walking following a stroke? Neurorehabil Neural Repair 2011; 26:173-7. [PMID: 21734069 DOI: 10.1177/1545968311412786] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND For individuals with lateral postural imbalance after stroke, the decision to adopt a cane for walking often is not based on objective findings. OBJECTIVE The authors investigated the explanatory value of 2 posturographic criteria for lateral postural imbalance on the walking abilities of poststroke subjects. METHODS Indices of postural asymmetry (percentage of body weight on the less loaded lower limb) and instability (mediolateral variance of center-of-pressure displacements) were measured in 40 healthy individuals and 52 patients (mean 94.2 days after first hemispheric stroke), who stood still on a double force platform. Cut-off values (mean ± 2 standard deviations) were calculated and compared. The predictive value of both postural indices on walking abilities with or without a cane was analyzed. RESULTS Of the patients, 34.6% were unstable along the mediolateral axis (variance >7 mm(2)), and 44.2% were asymmetrical (body weight <40%); 30% needed a technical aid and 35% walked without a cane. The probability of being able to walk without a cane was less than 5% if the paretic lower limb was not loaded more than 40%. The postural instability index was less informative. CONCLUSIONS This study suggests that patients who do not load more than 40% of their body weight on their paretic lower limb may benefit from the prescription of a cane.
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Affiliation(s)
- Bastien Guillebastre
- Université de Savoie, Domaine Universitaire du Bourget-du-Lac, Bourget-du-Lac, France
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Preservation of the first rocker is related to increases in gait speed in individuals with hemiplegia and AFO. Clin Biomech (Bristol, Avon) 2011; 26:655-60. [PMID: 21550702 DOI: 10.1016/j.clinbiomech.2011.03.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Changes in impulse during the first rocker (braking force) and third rocker (propulsion force) may affect changes in gait speed after orthotic intervention. The purpose of this investigation was to objectively measure changes in impulse during double support and correlate those findings to changes in gait speed with and without ankle foot orthosis in individuals with hemiplegia. METHODS Fifteen adults with stroke-related hemiplegia walked with and without ankle foot orthosis while foot pressure data was collected bilaterally. Outcome measures included: gait cycle time (s), mean force (N), and impulse (Ns) in the wholefoot, hindfoot, forefoot, and toe box during initial double support and terminal double support. FINDINGS Time significantly decreased during the entire gait cycle, initial double support, and terminal double support, with the ankle foot orthosis. During initial double support, affected limb impulse significantly decreased with the ankle foot orthosis in the wholefoot (P=0.016), and hindfoot (P=0.006), and hindfoot impulse % change and gait speed % change were significantly correlated (P=0.007). During terminal double support, affected limb impulse was not significantly different in the wholefoot or forefoot and these changes were not significantly correlated to gait speed. INTERPRETATION Previous research found that orthotics increase gait speed in individuals with hemiplegia. This research suggests that the increase in speed is not due to increased propulsive forces at the end of terminal double support, but due to decreased braking forces during initial double support. Therefore, the orthosis preserved the first ankle rocker and provided a more efficient weight acceptance which positively affected gait speed.
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Williams G, Clark R, Schache A, Fini NA, Moore L, Morris ME, McCrory PR. Training Conditions Influence Walking Kinematics and Self-Selected Walking Speed in Patients with Neurological Impairments. J Neurotrauma 2011; 28:281-7. [DOI: 10.1089/neu.2010.1649] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gavin Williams
- Epworth Hospital, Melbourne, and Centre for Health Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ross Clark
- School of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anthony Schache
- School of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie A. Fini
- Caulfield Hospital, Alfred Healthcare, Melbourne, Victoria, Australia
| | - Liz Moore
- Epworth Hospital, Melbourne, Victoria, Australia
| | - Meg E. Morris
- School of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul R. McCrory
- Centre for Health Exercise and Sports Medicine, School of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
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Stepping with an ankle foot orthosis re-examined: a mechanical perspective for clinical decision making. Clin Biomech (Bristol, Avon) 2010; 25:618-22. [PMID: 20362373 DOI: 10.1016/j.clinbiomech.2010.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 02/25/2010] [Accepted: 03/01/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ankle foot orthoses are used to stabilize the ankle joint and aid toe clearance during stepping in persons after incomplete spinal cord injury. However, little is known about kinematics and kinetics of stepping with an orthosis during the transition from stance-to-swing and swing-to-stance. We intended to examine if an ankle foot orthosis impeded or facilitated optimal ankle, knee and hip joint kinematics, kinetics and spatiotemporal parameters during the transition phases of normal walking. METHODS Fourteen healthy participants walked on a split-belt instrumented treadmill with and without a posterior leaf spring ankle foot orthosis at 1.2m/s. Three dimensional motion data and ground reaction forces were captured during 30-second trials of steady state walking. FINDINGS During stance-to-swing, the orthosis significantly decreased hip extension [8.6 (5.5) to 6.7 (5.5) degrees, P=0.001], ankle plantarflexion [19.4 (5.7) to 12.0 (5.2) degrees, P<0.001] and plantarflexor power [0.18 (0.03) to 0.15 (0.03) watts/body weight, P<0.001]. During swing-to-stance, the orthosis significantly increased hip flexion [32.7 (4.7) to 35.6 (5.1) degrees, P=0.028] and ankle plantarflexion [8.4 (3.5) to 10.9 (4.7) degrees, P<0.001] and decreased loading rate [0.06 (0.01) to 0.05 (0.01) N/kg, P=0.018] and braking force [0.16 (0.02) to 0.15 (0.02) N/kg, P=0.013]. Double limb support time increased significantly with the orthosis [0.19 (0.02) to 0.22 (0.03) seconds, P<0.000]. INTERPRETATION An ankle foot orthosis affected joint kinematics and kinetics during the transition from stance-to-swing and vice-versa. The use of orthosis to improve transition phase kinematics and kinetics in individuals with incomplete spinal cord injury warrants assessment.
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