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Pradhan D, Mohanty RK. Impact of plantar flexion resistive moment of dynamic ankle foot orthosis on measures of center of pressure and clinical gait outcomes in individuals with post-stroke hemiparesis. Gait Posture 2024; 113:58-66. [PMID: 38850851 DOI: 10.1016/j.gaitpost.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/12/2024] [Accepted: 05/22/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND An ankle-foot orthosis (AFO) with plantar flexion resistance (PFR) can improve the first rocker function during gait, but the incremental changes in the resistive moment on balance and gait have not been well identified. OBJECTIVES To investigate the effect of changing the PFR moment of dynamic AFO (DAFO) on measures of the center of pressure (COP) and clinical gait outcomes in individuals with post-stroke hemiparesis. METHOD In this randomized repeated measure study of 36 stroke individuals, the customized DAFO using foot drop ankle units set in three PFR situations (low, medium, and high) was evaluated. The balance parameters for COP measures were investigated by HUMAC® Balance & Tilt System. Gait parameters and ankle kinematics were recorded using the 3D motion analysis through force platform and optoelectronic system. The comparison was made using a parametric ANOVA test and the P value was set at 0.05 for statistical significance. RESULTS Significant differences were observed for COP average velocity (1.30 ± 0.64, 1.10 ± 0.05, and 1.37 ± 0.43), COP path length (43.3 ± 4.6, 33.4 ± 4.3, and 36.3 ± 5.4), walking velocity (11.0 ± 3.1, 13.2 ± 4.4, and 9.9 ± 3.5), and cadence (31.5 ± 2.0, 33.0 ± 3.1, and 29.0 ± 1.6) respectively for low, medium and high PFR settings (P < 0.05). Except for the COP path length and cadence, posthoc multiple comparisons revealed significant differences between low and medium (P < 0.05) and medium and high (P < 0.05) PFR grades. PFR with medium resistance demonstrated near-normal maximal peak ankle dorsiflexion (mean deviation of 8 degrees, P < 0.05). CONCLUSION Medium PFR grade should be encouraged since it can enhance balance parameters like path length and average velocity of COP, increase cadence and average velocity during gait, and improve maximal peak ankle dorsiflexion.
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Affiliation(s)
- Diptirani Pradhan
- MPO section, Department of Prosthetics and Orthotics, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha 754010, India.
| | - Rajesh Kumar Mohanty
- MPO section, Department of Prosthetics and Orthotics, Swami Vivekanand National Institute of Rehabilitation Training and Research, Cuttack, Odisha 754010, India.
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LeCursi NA, Janka BM, Gao F, Orendurff MS, He Y, Kobayashi T. A proposed evidence-guided algorithm for the adjustment and optimization of multi-function articulated ankle-foot orthoses in the clinical setting. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1353303. [PMID: 39119264 PMCID: PMC11307126 DOI: 10.3389/fresc.2024.1353303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 07/05/2024] [Indexed: 08/10/2024]
Abstract
Individuals with neuromuscular pathologies are often prescribed an ankle-foot orthosis (AFO) to improve their gait mechanics by decreasing pathological movements of the ankle and lower limb. AFOs can resist or assist excessive or absent muscular forces that lead to tripping, instability, and slow inefficient gait. However, selecting the appropriate AFO with mechanical characteristics, which limit pathological ankle motion in certain phases of the gait cycle while facilitating effective ankle movement during other phases, requires careful clinical decision-making. The aim of this study is to propose an explicit methodology for the adjustment of multi-function articulated AFOs in clinical settings. A secondary aim is to outline the evidence supporting this methodology and to identify gaps in the literature as potential areas for future research. An emerging class of AFO, the multi-function articulated AFO, offers features that permit more comprehensive, iterative, and reversible adjustments of AFO ankle alignment and resistance to ankle motion. However, no standard method exists for the application and optimization of these therapeutic devices in the clinical setting. Here we propose an evidence-guided methodology applicable to the adjustment of multi-function articulated AFOs in the clinical setting. Characteristic load-deflection curves are given to illustrate the idealized yet complex resistance-angle behavior of multi-function articulated AFOs. Research is cited to demonstrate how these mechanical characteristics can help mitigate specific pathologic ankle and knee kinematics and kinetics. Evidence is presented to support the effects of systematic adjustment of high resistance, alignable, articulated AFOs to address many typical pathomechanical patterns observed in individuals with neuromuscular disorders. The published evidence supporting most decision points of the algorithm is presented with identified gaps in the evidence. In addition, two hypothetical case examples are given to illustrate the application of the method in optimizing multi-function articulated AFOs for treating specific gait pathomechanics. This method is proposed as an evidence-guided systematic approach for the adjustment of multi-function articulated AFOs. It utilizes observed gait deviations mapped to specific changes in AFO alignment and resistance settings as a clinical tool in orthotic treatment for individuals with complex neuromuscular gait disorders.
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Affiliation(s)
| | | | - Fan Gao
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, United States
| | | | - Yufan He
- Deparment of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Toshiki Kobayashi
- Deparment of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Lee P, Chen TB, Lin HY, Yeh LR, Liu CH, Chen YL. Integrating OpenPose and SVM for Quantitative Postural Analysis in Young Adults: A Temporal-Spatial Approach. Bioengineering (Basel) 2024; 11:548. [PMID: 38927784 PMCID: PMC11200693 DOI: 10.3390/bioengineering11060548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/12/2024] [Accepted: 05/25/2024] [Indexed: 06/28/2024] Open
Abstract
Noninvasive tracking devices are widely used to monitor real-time posture. Yet significant potential exists to enhance postural control quantification through walking videos. This study advances computational science by integrating OpenPose with a Support Vector Machine (SVM) to perform highly accurate and robust postural analysis, marking a substantial improvement over traditional methods which often rely on invasive sensors. Utilizing OpenPose-based deep learning, we generated Dynamic Joint Nodes Plots (DJNP) and iso-block postural identity images for 35 young adults in controlled walking experiments. Through Temporal and Spatial Regression (TSR) models, key features were extracted for SVM classification, enabling the distinction between various walking behaviors. This approach resulted in an overall accuracy of 0.990 and a Kappa index of 0.985. Cutting points for the ratio of top angles (TAR) and the ratio of bottom angles (BAR) effectively differentiated between left and right skews with AUC values of 0.772 and 0.775, respectively. These results demonstrate the efficacy of integrating OpenPose with SVM, providing more precise, real-time analysis without invasive sensors. Future work will focus on expanding this method to a broader demographic, including individuals with gait abnormalities, to validate its effectiveness across diverse clinical conditions. Furthermore, we plan to explore the integration of alternative machine learning models, such as deep neural networks, enhancing the system's robustness and adaptability for complex dynamic environments. This research opens new avenues for clinical applications, particularly in rehabilitation and sports science, promising to revolutionize noninvasive postural analysis.
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Affiliation(s)
- Posen Lee
- Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Tai-Been Chen
- Department of Radiological Technology, Faculty of Medical Technology, Teikyo University, Tokyo 173-8605, Japan;
| | - Hung-Yu Lin
- Department of Occupational Therapy, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan;
| | - Li-Ren Yeh
- Department of Anesthesiology, E-DA Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Chin-Hsuan Liu
- Department of Occupational Therapy, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Yen-Lin Chen
- Department of Computer Science and Information Engineering, College of Electrical Engineering and Computer Science, National Taipei University of Technology, Taipei 10608, Taiwan;
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Jor A, Lau NWK, Daryabor A, Kobayashi T. Effects of ankle-foot orthoses on step activities in the community: a systematic review. Disabil Rehabil 2024; 46:464-477. [PMID: 36710007 DOI: 10.1080/09638288.2023.2169774] [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: 07/16/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine the effects of ankle-foot orthoses (AFO) on step-based physical activities in individuals with neurological, orthopaedic, or cardiovascular disorders. METHODS Electronic searches of databases such as Scopus, PubMed, Web of Science, Embase, ProQuest, Cochrane Library, and EBSCO were conducted. Two evaluators independently searched with keywords focusing on step-based physical activities, and either articulated or non-articulated AFO. Study quality was assessed using a modified Downs and Black quality scale. RESULTS Eleven studies that met the inclusion criteria were selected, including four being classified as good, four as fair, and three as poor in quality. The majority of these trials found no significant effects of AFO on step activities. Only a few studies reported improvements in step counts and active times in step activity with a limited to moderate level of evidence. Subjective evaluations such as user satisfaction, and physical functionality during step activity, on the other hand, showed substantial changes with the use of AFO interventions, although there was no evidence of improvement in the quality of life. CONCLUSIONS Although the AFO did not seem to have a substantial effect on step activity, it appeared to play a vital role in improving the patient satisfaction level of step activity.IMPLICATIONS FOR REHABILITATIONAnkle-foot orthoses (AFO) may not significantly affect the step activity of individuals with impaired ankle-foot complex.AFO may enhance patient-reported satisfaction, physical functioning, participation, and fatigue level during step activity.The patient's perception that the AFO is beneficial is in contrast to objective data showing no significant increase in real-world activity.
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Affiliation(s)
- Abu Jor
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
| | - Noelle W K Lau
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Aliyeh Daryabor
- Department of Physiotherapy, 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
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Yamamoto S, Motojima N, Kobayashi Y, Osada Y, Tanaka S, Daryabor A. Ankle-foot orthosis with an oil damper versus nonarticulated ankle-foot orthosis in the gait of patients with subacute stroke: a randomized controlled trial. J Neuroeng Rehabil 2022; 19:50. [PMID: 35619141 PMCID: PMC9137172 DOI: 10.1186/s12984-022-01027-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Gait improvement in patients with stroke has been examined in terms of use or non-use of an ankle-foot orthosis (AFO), but the effects of different kinds of AFOs remain unclear. In this study, the effect on gait of using an AFO with an oil damper (AFO-OD), which has plantarflexion stiffness without dorsiflexion resistance, was compared with a nonarticulated AFO, which has both dorsiflexion and plantarflexion stiffness, in a randomized controlled trial. METHODS Forty-one patients (31 men, 10 women; mean age 58.4 ± 11.3 years) in the subacute phase of stroke were randomly allocated to two groups to undergo gait training for 1 h daily over 2 weeks by physiotherapists while wearing an AFO-OD or a nonarticulated AFO. A motion capture system was utilized to measure shod gait without orthosis at baseline and after training with the allocated AFO. Data analysis focused on the joint kinematics and kinetics, spatial and temporal parameters, ground reaction force, and shank-to-vertical angle. Unpaired t-test or Mann-Whitney U test was performed to clarify the difference in gait with an AFO between the two AFO groups after training, with a significance level of p = 0.05. RESULTS Thirty-six patients completed the study (17 in the AFO-OD group and 19 in the nonarticulated AFO group). The ankle joint was more dorsiflexed in single stance (p = 0.008, effect size r = 0.46) and peak ankle power absorption was larger in stance (p = 0.007, r = 0.55) in the AFO-OD group compared with the nonarticulated AFO group. Peak power absorption varied among patients in the AFO-OD group. Increased dorsiflexion angles were also found at initial contact (p = 0.008, r = 1.51), pre-swing (p = 0.045, r = 0.91), and the swing phase (p = 0.045, r = 0.91) in the AFO-OD group. There was no difference in peak plantarflexion moment, ankle power generation, spatial or temporal parameters, ground reaction force, or shank-to-vertical angle between the two groups. CONCLUSIONS The results of this study showed that an AFO with plantarflexion stiffness but without dorsiflexion resistance produced greater improvement in ankle joint kinematics and kinetics compared with the nonarticulated AFO, but the results of peak power absorption varied greatly among patients. Trial registration UMIN000028126, Registered 1 August 2017, https://upload.umin.ac.jp/cgi-bin/icdr/ctr_menu_form_reg.cgi?recptno=R000032197.
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Affiliation(s)
- Sumiko Yamamoto
- Graduate School, International University of Health & Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo, 107-8402 Japan
| | - Naoyuki Motojima
- Showa University School of Nursing and Rehabilitation Science, 1865 Tohkaichibacho, Midoriku, Yokohama, Kanagawa 226-8555 Japan
| | - Yosuke Kobayashi
- Nakaizu Rehabilitation Center, 1523-108 Hiekawa, Izu, Shizuoka 410-2507 Japan
| | - Yuji Osada
- Department of Health and Welfare, Tokushima Bunri University, Nishihamahoji-180, Yamashirocho, Tokushima, 770-8514 Japan
| | - Souji Tanaka
- Saiseikai Higashikanagawa Rehabilitation Hospital, 1-13-10 Nishikanagawa, Kanagawa-ku, Yokohama, Kanagawa 221-0822 Japan
| | - Aliyeh Daryabor
- School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Velenjak St., Shahid Chamran Highway, Tehran, Iran
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Lee P, Chen TB, Liu CH, Wang CY, Huang GH, Lu NH. Identifying the Posture of Young Adults in Walking Videos by Using a Fusion Artificial Intelligent Method. BIOSENSORS 2022; 12:bios12050295. [PMID: 35624595 PMCID: PMC9139042 DOI: 10.3390/bios12050295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/23/2022]
Abstract
Many neurological and musculoskeletal disorders are associated with problems related to postural movement. Noninvasive tracking devices are used to record, analyze, measure, and detect the postural control of the body, which may indicate health problems in real time. A total of 35 young adults without any health problems were recruited for this study to participate in a walking experiment. An iso-block postural identity method was used to quantitatively analyze posture control and walking behavior. The participants who exhibited straightforward walking and skewed walking were defined as the control and experimental groups, respectively. Fusion deep learning was applied to generate dynamic joint node plots by using OpenPose-based methods, and skewness was qualitatively analyzed using convolutional neural networks. The maximum specificity and sensitivity achieved using a combination of ResNet101 and the naïve Bayes classifier were 0.84 and 0.87, respectively. The proposed approach successfully combines cell phone camera recordings, cloud storage, and fusion deep learning for posture estimation and classification.
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Affiliation(s)
- Posen Lee
- Department of Occupation Therapy, I-Shou University, No. 8, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung 82445, Taiwan;
| | - Tai-Been Chen
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Road, Jiaosu Village Yanchao District, Kaohsiung 82445, Taiwan; (T.-B.C.); (C.-Y.W.); (N.-H.L.)
- Institute of Statistics, National Yang Ming Chiao Tung University, No. 1001, University Road, Hsinchu 30010, Taiwan;
| | - Chin-Hsuan Liu
- Department of Occupation Therapy, I-Shou University, No. 8, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung 82445, Taiwan;
- Department of Occupational Therapy, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kaisyuan 2nd Road, Lingya District, Kaohsiung 80276, Taiwan
- Correspondence: ; Tel.: +886-7-6151100 (ext. 7516)
| | - Chi-Yuan Wang
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Road, Jiaosu Village Yanchao District, Kaohsiung 82445, Taiwan; (T.-B.C.); (C.-Y.W.); (N.-H.L.)
| | - Guan-Hua Huang
- Institute of Statistics, National Yang Ming Chiao Tung University, No. 1001, University Road, Hsinchu 30010, Taiwan;
| | - Nan-Han Lu
- Department of Medical Imaging and Radiological Science, I-Shou University, No. 8, Yida Road, Jiaosu Village Yanchao District, Kaohsiung 82445, Taiwan; (T.-B.C.); (C.-Y.W.); (N.-H.L.)
- Department of Pharmacy, Tajen University, No. 20, Weixin Road, Yanpu Township, Pingtung County 90741, Taiwan
- Department of Radiology, E-DA Hospital, I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, Taiwan
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Elery T, Reznick E, Shearin S, McCain K, Gregg RD. Design and Initial Validation of a Multiple Degree-of-Freedom Joint for an Ankle-Foot Orthosis. J Med Device 2021. [DOI: 10.1115/1.4053200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
This paper presents the novel design of a Multi-Degree-Of-Freedom joint (M-DOF) for an Ankle-Foot Orthosis (AFO) that aims to improve upon the commercially available Double Action Joint (DAJ). The M-DOF is designed to maintain the functionality of the DAJ, while increasing dorsiflexion stiffness and introducing inversion/eversion. This increase in range of motion is designed to produce greater engagement from lower limb muscles during gait. The M-DOF was experimentally validated with one able-bodied and one stroke subject. Across walking speeds, the M-DOF AFO minimally affected the able-bodied subject's joint kinematics. The stroke subject's ankle dorsiflexion/plantarflexion and knee flexion were not heavily altered when wearing the M-DOF AFO, compared to the DAJ AFO. The new DOF allowed by the M-DOF AFO increased the inversion/eversion of the ankle by ~3°, without introducing any new compensations compared to their gait with the DAJ AFO.
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Affiliation(s)
- Toby Elery
- Department of Bioengineering, University of Texas at Dallas, Richardson, TX 75080
| | - Emma Reznick
- Robotics Institute, University of Michigan, Ann Arbor, MI 48109
| | - Staci Shearin
- School of Health Professions, UT Southwestern Medical Center, Dallas, TX 75390
| | - Karen McCain
- School of Health Professions, UT Southwestern Medical Center, Dallas, TX 75390
| | - Robert D. Gregg
- Department of Electrical and Computer Engineering, University of Michigan, Ann Arbor, MI, 48105
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A Review on the Control of the Mechanical Properties of Ankle Foot Orthosis for Gait Assistance. ACTUATORS 2019. [DOI: 10.3390/act8010010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In the past decade, advanced technologies in robotics have been explored to enhance the rehabilitation of post-stroke patients. Previous works have shown that gait assistance for post-stroke patients can be provided through the use of robotics technology in ancillary equipment, such as Ankle Foot Orthosis (AFO). An AFO is usually used to assist patients with spasticity or foot drop problems. There are several types of AFOs, depending on the flexibility of the joint, such as rigid, flexible rigid, and articulated AFOs. A rigid AFO has a fixed joint, and a flexible rigid AFO has a more flexible joint, while the articulated AFO has a freely rotating ankle joint, where the mechanical properties of the AFO are more controllable compared to the other two types of AFOs. This paper reviews the control of the mechanical properties of existing AFOs for gait assistance in post-stroke patients. Several aspects that affect the control of the mechanical properties of an AFO, such as the controller input, number of gait phases, controller output reference, and controller performance evaluation are discussed and compared. Thus, this paper will be of interest to AFO researchers or developers who would like to design their own AFOs with the most suitable mechanical properties based on their application. The controller input and the number of gait phases are discussed first. Then, the discussion moves forward to the methods of estimating the controller output reference, which is the main focus of this study. Based on the estimation method, the gait control strategies can be classified into subject-oriented estimations and phase-oriented estimations. Finally, suggestions for future studies are addressed, one of which is the application of the adaptive controller output reference to maximize the benefits of the AFO to users.
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