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Murphy AT, Kravtsov S, Sangeux M, Rawicki B, New PW. Utilizing three dimensional clinical gait analysis to optimize mobility outcomes in incomplete spinal cord damage. Gait Posture 2019; 74:53-59. [PMID: 31446333 DOI: 10.1016/j.gaitpost.2019.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 06/25/2019] [Accepted: 08/03/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Three-dimensional gait analysis (3DGA) has not previously been considered by consensus panels of spinal cord experts for use in studies of patients with spinal cord damage (SCD), yet it is frequently used in other neurological populations, such as stroke and cerebral palsy. RESEARCH QUESTION How does 3DGA impairment based reporting guide individualised clinical decision-making in people with incomplete SCD? METHODS Retrospective open cohort case series recruited 48 adults with incomplete SCD (traumatic or non-traumatic spinal cord dysfunction) referred to the Clinical Gait Analysis Service (CGAS), Melbourne, Australia. Three-dimensional gait data were used to identify gait impairments by the multidisciplinary clinical team. Gait patterns were classified using the plantarflexor-knee extension couple index and the Gait Profile Score (GPS). The reason for referral and the recommendations made post-3DGA were collated in decision trees to extrapolate the potential value of 3DGA in decision making for targeted intervention in this population. RESULTS Participants with SCD generally walked at a reduced gait speed. When grouped by neurological level, the tetraplegia group had a significantly lower GPS, but no specific gait patterns emerged. Participants were primarily referred to the CGAS to direct clinical intervention decisions. The most frequent recommendation following 3DGA was the prescription of an ankle foot orthosis and in some cases, the recommendation was incongruent with the referrer's proposed intervention. SIGNIFICANCE 3DGA can provide specific guidance in management plans for gait of patients with incomplete SCD and may help to avoid inappropriate or unnecessary interventions. This sample of patients referred to the CGAS demonstrates its clinical utility in guiding clinicians in their decision making to target individualised intervention.
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Affiliation(s)
- Anna T Murphy
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia.
| | - Stella Kravtsov
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia.
| | - Morgan Sangeux
- Biomech-Intel, Marseille, France; The Murdoch Children's Institute, Parkville, VIC, 3052, Australia; The University of Melbourne, Parkville, VIC, 3052, Australia
| | - Barry Rawicki
- Clinical Gait Analysis Service, Kingston Centre, Monash Health, Cheltenham, VIC, 3192, Australia; Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia.
| | - Peter W New
- Faculty of Medicine, Nursing and Allied Health Sciences, Monash University, VIC, 3800, Australia; Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, VIC, 3162, Australia; Rehabilitation and Aged Services Program, Department of Medicine, Monash Health, Cheltenham, VIC, 3192, Australia; Epworth-Monash Rehabilitation Medicine Unit, Monash University, VIC, 3800, Australia.
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Berenpas F, Schiemanck S, Beelen A, Nollet F, Weerdesteyn V, Geurts A. Kinematic and kinetic benefits of implantable peroneal nerve stimulation in people with post-stroke drop foot using an ankle-foot orthosis. Restor Neurol Neurosci 2018; 36:547-558. [DOI: 10.3233/rnn-180822] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Frank Berenpas
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Sven Schiemanck
- Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Anita Beelen
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences research institute, Amsterdam, the Netherlands
| | - Frans Nollet
- Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences research institute, Amsterdam, the Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alexander Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
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A comprehensive protocol to test instrumented treadmills. Med Eng Phys 2015; 37:610-6. [DOI: 10.1016/j.medengphy.2015.03.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/27/2015] [Accepted: 03/31/2015] [Indexed: 11/24/2022]
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Takahashi KZ, Lewek MD, Sawicki GS. A neuromechanics-based powered ankle exoskeleton to assist walking post-stroke: a feasibility study. J Neuroeng Rehabil 2015; 12:23. [PMID: 25889283 PMCID: PMC4367918 DOI: 10.1186/s12984-015-0015-7] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/16/2015] [Indexed: 11/30/2022] Open
Abstract
Background In persons post-stroke, diminished ankle joint function can contribute to inadequate gait propulsion. To target paretic ankle impairments, we developed a neuromechanics-based powered ankle exoskeleton. Specifically, this exoskeleton supplies plantarflexion assistance that is proportional to the user’s paretic soleus electromyography (EMG) amplitude only during a phase of gait when the stance limb is subjected to an anteriorly directed ground reaction force (GRF). The purpose of this feasibility study was to examine the short-term effects of the powered ankle exoskeleton on the mechanics and energetics of gait. Methods Five subjects with stroke walked with a powered ankle exoskeleton on the paretic limb for three 5 minute sessions. We analyzed the peak paretic ankle plantarflexion moment, paretic ankle positive work, symmetry of GRF propulsion impulse, and net metabolic power. Results The exoskeleton increased the paretic plantarflexion moment by 16% during the powered walking trials relative to unassisted walking condition (p < .05). Despite this enhanced paretic ankle moment, there was no significant increase in paretic ankle positive work, or changes in any other mechanical variables with the powered assistance. The exoskeleton assistance appeared to reduce the net metabolic power gradually with each 5 minute repetition, though no statistical significance was found. In three of the subjects, the paretic soleus activation during the propulsion phase of stance was reduced during the powered assistance compared to unassisted walking (35% reduction in the integrated EMG amplitude during the third powered session). Conclusions This feasibility study demonstrated that the exoskeleton can enhance paretic ankle moment. Future studies with greater sample size and prolonged sessions are warranted to evaluate the effects of the powered ankle exoskeleton on overall gait outcomes in persons post-stroke. Electronic supplementary material The online version of this article (doi:10.1186/s12984-015-0015-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kota Z Takahashi
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 911 Oval Drive, Campus Box 7115, Raleigh, NC, 27695, USA.
| | - Michael D Lewek
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, 321 South Columbia St, Campus Box 7135, Chapel Hill, NC, 27599, USA.
| | - Gregory S Sawicki
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 911 Oval Drive, Campus Box 7115, Raleigh, NC, 27695, USA.
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Effect of ankle-foot orthosis on postural control after stroke: A systematic review. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2011.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Vistamehr A, Kautz SA, Neptune RR. The influence of solid ankle-foot-orthoses on forward propulsion and dynamic balance in healthy adults during walking. Clin Biomech (Bristol, Avon) 2014; 29:583-9. [PMID: 24698166 PMCID: PMC5893997 DOI: 10.1016/j.clinbiomech.2014.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/21/2014] [Accepted: 02/26/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND In post-stroke hemiparetic subjects, solid polypropylene ankle-foot-orthoses are commonly prescribed to assist in foot clearance during swing while bracing the ankle during stance. Mobility demands, such as changing walking speed and direction, are accomplished by accelerating or decelerating the body and maintaining dynamic balance. Previous studies have shown that the ankle plantarflexors are primary contributors to these essential biomechanical functions. Thus, with ankle-foot-orthoses limiting ankle motion and plantarflexor output during stance, execution of these walking subtasks may be compromised. This study examined the influence of a solid polypropylene ankle-foot-orthosis on forward propulsion and dynamic balance in healthy adults. METHODS Kinematic and kinetic data were recorded from 10 healthy adults walking with and without a unilateral ankle-foot-orthosis at steady-state slow (0.6m/s) and moderate (1.2m/s) speeds, and during accelerated (0-1.8m/s at 0.06m/s(2)) and decelerated (1.8-0m/s at -0.06m/s(2)) walking. Propulsion was quantified by propulsive and braking impulses (i.e., time integral of the anterior-posterior ground reaction force) while dynamic balance was quantified by the peak-to-peak range of whole-body angular momentum. FINDINGS The propulsive impulses decreased in the leg with ankle-foot-orthosis compared to the contralateral leg and no ankle-foot-orthosis condition. Further, the ankle-foot-orthosis resulted in a greater range of angular momentum in both the frontal and sagittal planes, which were correlated with the reduced peak hip abduction and reduced ankle plantarflexor moments, respectively. INTERPRETATION Solid ankle-foot-orthoses limit the successful execution of important mobility subtasks in healthy adults and that the prescription of ankle-foot-orthosis should be carefully considered.
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Affiliation(s)
- Arian Vistamehr
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Steven A Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA; Ralph H Johnson VA Medical Center, Charleston, SC, USA
| | - Richard R Neptune
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA.
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Nair PM, Phadke CP, Behrman AL. Phase dependent modulation of soleus H-reflex in healthy, non-injured individuals while walking with an ankle foot orthosis. Gait Posture 2014; 39:1086-91. [PMID: 24598077 DOI: 10.1016/j.gaitpost.2014.01.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 01/11/2014] [Accepted: 01/22/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the dynamic modulation of the soleus H-reflex while walking with a posterior leaf spring ankle foot orthosis (PAFO). METHODS Soleus H-reflexes were evoked on randomly chosen lower limb of fourteen healthy individuals (age range of 22-36 years, 7 women) while walking on a treadmill with and without a PAFO. In order to capture excitability across the duration of the gait cycle, H-reflexes were evoked at heel strike (HS), HS+100ms, HS+200ms, HS+300ms, HS+400ms in the stance phase and at toe-off (TO), TO+100ms, TO+200ms, TO+300ms, TO+400ms in the swing phase respectively. RESULTS H-reflex excitability was significantly higher in the form of greater slope of the rise in H-reflex amplitude across the swing phase (p=0.024) and greater mean H-reflex amplitude (p=0.014) in the swing phase of walking with a PAFO. There was no change in the slope (p=0.25) or the mean amplitude of H-reflexes (p=0.22) in the stance phase of walking with a PAFO. Mean background EMG activity between the two walking conditions was not significantly different for both the tibialis anterior (p=0.69) and soleus muscles (p=0.59). CONCLUSION PAFO increased reflex excitability in the swing phase of walking in healthy individuals. Altered sensory input originating from joint, muscle and cutaneous receptors may be the underlying mechanism for greater reflex excitability. The neurophysiological effect of PAFOs on reflex modulation during walking needs to be tested in persons with neurological injury. The relationship between the sensory input and the reflex output during walking may assist in determining if there exists a neurological disadvantage of using a compensatory device such as a PAFO.
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Affiliation(s)
- Preeti M Nair
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Brain Rehabilitation Research Center, Malcolm Randall VA Medical Center, Gainesville, FL, USA; School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA.
| | - Chetan P Phadke
- Upper Motorneuron Disorder Spasticity Program, West Park Healthcare Centre, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Andrea L Behrman
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA; Brain Rehabilitation Research Center, Malcolm Randall VA Medical Center, Gainesville, FL, USA
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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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Sheffler LR, Bailey SN, Wilson RD, Chae J. Spatiotemporal, kinematic, and kinetic effects of a peroneal nerve stimulator versus an ankle foot orthosis in hemiparetic gait. Neurorehabil Neural Repair 2012. [PMID: 23192416 DOI: 10.1177/1545968312465897] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relative effect of a transcutaneous peroneal nerve stimulator (tPNS) and an ankle foot orthosis (AFO) on spatiotemporal, kinematic, and kinetic parameters of hemiparetic gait has not been well described. OBJECTIVE To compare the relative neuroprosthetic effect of a tPNS with the orthotic effect of an AFO using quantitative gait analysis (QGA). DESIGN In all, 12 stroke survivors underwent QGA under 3 device conditions: (1) no device (ND), (2) AFO, and (3) tPNS. A series of repeated-measures analyses of variance (rmANOVAs) were performed with dorsiflexion status (presence or absence of volitional dorsiflexion) as a covariate to compare selected spatiotemporal, kinematic, and kinetic parameters for each device condition. Post hoc pairwise comparisons and/or subset analysis by dorsiflexion status were performed for significant effect. RESULTS Stride length was improved with both the AFO (P = .035) and the tPNS (P = .029) relative to ND. Those with absent dorsiflexion had longer stride length with the tPNS relative to ND (P = .034) and a higher walking velocity with a tPNS relative to the AFO (P = .015). There was no device effect on dorsiflexion angle at initial contact; however, a significant Device × Dorsiflexion status interaction effect favored the AFO relative to ND (P = .025) in those with dorsiflexion present. CONCLUSION This study suggests that level of motor impairment may influence the relative effects of the tPNS and AFO devices in chronic hemiparetic gait; however, the small sample size limits generalizability. Future studies are necessary to determine if motor impairment level should be considered in the clinical prescription of these devices.
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Affiliation(s)
- Lynne R Sheffler
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH 22109, USA.
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Guerra Padilla M, Molina Rueda F, Alguacil Diego IM. Effect of ankle-foot orthosis on postural control after stroke: a systematic review. Neurologia 2011; 29:423-32. [PMID: 22178049 DOI: 10.1016/j.nrl.2011.10.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 10/05/2011] [Accepted: 10/10/2011] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Stroke is currently the main cause of permanent disability in adults. The impairments are a combination of sensory, motor, cognitive and emotional changes that result in restrictions on the ability to perform basic activities of daily living (BADL). Postural control is affected and causes problems with static and dynamic balance, thus increasing the risk of falls and secondary injuries. The purpose of this review was to compile the literature to date, and assess the impact of ankle-foot orthosis (AFO) on postural control and gait in individuals who have suffered a stroke. DEVELOPMENT The review included randomised and controlled trials that examined the effects of AFO in stroke patients between 18 and 80 years old, with acute or chronic evolution. No search limits on the date of the studies were included, and the search lasted until April 2011. The following databases were used: Pubmed, Trip Database, Cochrane library, Embase, ISI Web Knowledge, CINHAL and PEDro. Intervention succeeded in improving some gait parameters, such as speed and cadence. However it is not clear if there was improvement in the symmetry, postural sway or balance. CONCLUSIONS Because of the limitations of this systematic review, due to the clinical diversity of the studies and the methodological limitations, 0these results should be considered with caution.
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Affiliation(s)
- M Guerra Padilla
- Fisioterapia, Patología Neurológica, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España.
| | - F Molina Rueda
- Fisioterapia, Patología Neurológica, Departamento de Fisioterapia, Terapia Ocupacional, Medicina Física y Rehabilitación, Facultad de Ciencias de la Salud. Universidad Rey Juan Carlos, Madrid, España
| | - I M Alguacil Diego
- Medicina Física y Rehabilitación, Departamento de Fisioterapia, Terapia Ocupacional, Medicina Física y Rehabilitación, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España
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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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