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Rimaud D, Testa R, Millet GY, Calmels P. Effects of carbon versus plastic ankle foot orthoses on gait outcomes and energy cost in patients with chronic stroke. J Rehabil Med 2024; 56:jrm35213. [PMID: 39175453 PMCID: PMC11358842 DOI: 10.2340/jrm.v56.35213] [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: 12/19/2023] [Accepted: 07/15/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVE To compare the walking performances of hemiplegic subjects with chronic stroke under 3 conditions: with a new standard carbon fibre ankle foot orthosis (C-AFO), with a personal custom-made plastic AFO (P-AFO), and without any orthosis (No-AFO). DESIGN Randomized, controlled crossover design. PATIENTS Fifteen chronic patients with stroke (3 women and 12 men, 59 [10] years, 13 [15] years since injury). METHODS Patients performed 3 randomized sessions (with C-AFO, P-AFO, no-AFO), consisting of a 6-min walk test (6MWT) with VO2 measurement and a clinical gait analysis. Energy cost (Cw), walking speed, spatio-temporal, kinetic, and kinematic variables were measured. RESULTS No significant differences were found between the C-AFO and P-AFO conditions. Distance and walking speed in the 6MWT increased by 12% and 10% (p < 0.001) and stride width decreased by -8.7% and -13% (p < 0.0001) with P-AFO and C-AFO compared with the No-AFO condition. Cw decreased by 15% (p < 0.002), stride length increased by 10% (p < 0.01), step length on affected leg increased by 8% (p < 0.01), step length on contralateral leg by 13% (p < 0.01), and swing time on the contralateral leg increased by 6% (p < 0.01) with both AFO compared with the No-AFO condition. CONCLUSION The use of an off-the-shelf composite AFO (after a short habituation period) in patients with chronic stroke immediately improved energy cost and gait outcomes to the same extent as their usual custom-made AFO.
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Affiliation(s)
- Diana Rimaud
- Université Jean Monnet Saint-Etienne, CHU Saint-Etienne, Physical Medicine and Rehabilitation Department, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France.
| | - Rodolphe Testa
- Université Jean Monnet Saint-Etienne, CHU Saint-Etienne, Department of Orthopaedic Surgery, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France
| | - Guillaume Y Millet
- Université Jean Monnet Saint-Etienne, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France; Institut Universitaire de France (IUF)
| | - Paul Calmels
- Université Jean Monnet Saint-Etienne, CHU Saint-Etienne, Physical Medicine and Rehabilitation Department, Lyon 1, Université Savoie Mont-Blanc, Laboratoire Interuniversitaire de Biologie de la Motricité, Saint-Etienne, France
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Zhang X, Liu YX, Wang R, Gutierrez-Farewik EM. Soft ankle exoskeleton to counteract dropfoot and excessive inversion. Front Neurorobot 2024; 18:1372763. [PMID: 39234442 PMCID: PMC11371749 DOI: 10.3389/fnbot.2024.1372763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Wearable exoskeletons are emerging technologies for providing movement assistance and rehabilitation for people with motor disorders. In this study, we focus on the specific gait pathology dropfoot, which is common after a stroke. Dropfoot makes it difficult to achieve foot clearance during swing and heel contact at early stance and often necessitates compensatory movements. Methods We developed a soft ankle exoskeleton consisting of actuation and transmission systems to assist two degrees of freedom simultaneously: dorsiflexion and eversion, then performed several proof-of-concept experiments on non-disabled persons. The actuation system consists of two motors worn on a waist belt. The transmission system provides assistive force to the medial and lateral sides of the forefoot via Bowden cables. The coupling design enables variable assistance of dorsiflexion and inversion at the same time, and a force-free controller is proposed to compensate for device resistance. We first evaluated the performance of the exoskeleton in three seated movement tests: assisting dorsiflexion and eversion, controlling plantarflexion, and compensating for device resistance, then during walking tests. In all proof-of-concept experiments, dropfoot tendency was simulated by fastening a weight to the shoe over the lateral forefoot. Results In the first two seated tests, errors between the target and the achieved ankle joint angles in two planes were low; errors of <1.5° were achieved in assisting dorsiflexion and/or controlling plantarflexion and of <1.4° in assisting ankle eversion. The force-free controller in test three significantly compensated for the device resistance during ankle joint plantarflexion. In the gait tests, the exoskeleton was able to normalize ankle joint and foot segment kinematics, specifically foot inclination angle and ankle inversion angle at initial contact and ankle angle and clearance height during swing. Discussion Our findings support the feasibility of the new ankle exoskeleton design in assisting two degrees of freedom at the ankle simultaneously and show its potential to assist people with dropfoot and excessive inversion.
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Affiliation(s)
- Xiaochen Zhang
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Yi-Xing Liu
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Ruoli Wang
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Elena M Gutierrez-Farewik
- KTH MoveAbility, Department of Engineering Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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3
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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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Fallahtafti F, Samson K, Salamifar Z, Johanning J, Pipinos I, Myers SA. Enhancing walking performance in patients with peripheral arterial disease: An intervention with ankle-foot orthosis. Int J Cardiol 2024; 407:131992. [PMID: 38527630 DOI: 10.1016/j.ijcard.2024.131992] [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: 12/08/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 03/27/2024]
Abstract
Lower extremity peripheral artery disease (PAD) is a cardiovascular condition manifesting from narrowed or blocked arteries supplying the legs. Gait is impaired in patients with PAD. Recent evidence suggests that walking with carbon fiber ankle foot orthoses (AFOs) can improve patient mobility and delay claudication time. This study aimed to employ advanced biomechanical gait analysis to evaluate the impact of AFO intervention on gait performance among patients with PAD. Patients with claudication had hip, knee, and ankle joint kinetics and kinematics assessed using a cross-over intervention design. Participants walked over the force platforms with and without AFOs while kinematic data was recorded with motion analysis cameras. Kinetics and kinematics were combined to quantify torques and powers during the stance period of the gait cycle. The AFOs effectively reduced the excessive ankle plantar flexion and knee extension angles, bringing the patients' joint motions closer to those observed in healthy individuals. After 3 months of the AFO intervention, the hip range of motion decreased, likely due to changes occurring within the ankle chain. With the assistance of the AFOs, the biological power generation required from the ankle and hip during the push-off phase of walking decreased. Wearing AFOs resulted in increased knee flexor torque during the loading response phase of the gait. Based on this study, AFOs may allow patients with PAD to maintain or improve gait performance. More investigation is needed to fully understand and improve the potential benefits of ankle assistive devices.
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Affiliation(s)
- Farahnaz Fallahtafti
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA.
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, 984375 Nebraska Medical Center, Omaha, NE 68198-4375, USA
| | - Zahra Salamifar
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA
| | - Jason Johanning
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Iraklis Pipinos
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE 68105, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska at Omaha, 6160 University Drive South, Omaha, NE 68182, USA; Department of Surgery and VA Research Service, VA Nebraska-Western Iowa Health Care System, Omaha, NE 68105, USA.
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Chujo Y, Mori K, Wakida M, Mano N, Kuwabara T, Tanaka H, Kubo T, Hase K. Diverse Plantarflexor Module Characteristics Influence Immediate Effects of Plastic Ankle-Foot Orthosis on Gait Performance in Patients With Stroke: A Cross-sectional Study. Arch Phys Med Rehabil 2024; 105:1322-1329. [PMID: 38458374 DOI: 10.1016/j.apmr.2024.02.734] [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: 10/13/2023] [Revised: 12/21/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVE To investigate the immediate effects of plastic ankle-foot orthosis (AFO) on locomotor performance in patients with stroke and determine how such effects might undergo alteration when distinct plantarflexor (PF) module subtypes are considered. DESIGN Cross-sectional study. SETTING Two university hospitals. PARTICIPANTS Fifty-two patients with stroke and 21 of those without stroke (N=73). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Motor modules were identified through non-negative matrix factorization, and participants were classified into 3 groups: independent-normal-timing, independent-altered-timing, and merged PF modules. To assess the effects of the AFO, gait measurements reflecting locomotor performance were obtained with and without the presence of the plastic AFO for each group. RESULTS The independent-altered-timing group had increased paretic propulsion, greater non-paretic step length, and faster walking speed after the administration of the plastic AFO; however, these significant changes were not observed in the independent-normal-timing and merged PF module groups. Notably, patients in the independent-normal-timing and merged PF module groups exhibited longer paretic stance times. CONCLUSION This study suggests that the immediate effects of plastic AFO depend on the PF module subtype. These findings can potentially guide clinical decision-making regarding AFO selection for stroke rehabilitation in patients with diverse gait control characteristics.
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Affiliation(s)
- Yuta Chujo
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan; Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan.
| | - Kimihiko Mori
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masanori Wakida
- Faculty of Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
| | - Naoto Mano
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan; Department of Physical Medicine and Rehabilitation, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Takayuki Kuwabara
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan; Department of Physical Medicine and Rehabilitation, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Hiroaki Tanaka
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan; Department of Physical Medicine and Rehabilitation, Kansai Medical University Hospital, Hirakata, Osaka, Japan
| | - Takanari Kubo
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan; Department of Rehabilitation, Osaka Kawasaki Rehabilitation University, Kaizuka, Osaka, Japan
| | - Kimitaka Hase
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, Hirakata, Osaka, Japan
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Hovorka CF, Kogler GF, Chang YH, Gregor RJ. Selective orthotic constraint of lower limb movement during walking reveals new insights into neuromuscular adaptation. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1354115. [PMID: 38994331 PMCID: PMC11236798 DOI: 10.3389/fresc.2024.1354115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 06/11/2024] [Indexed: 07/13/2024]
Abstract
Introduction A concern expressed by the clinical community is that the constraint of motion provided by an ankle foot orthosis (AFO) may lead the user to become dependent on its stiffness, leading to learned non-use. To examine this, we hypothesized that using an experimental AFO-footwear combination (exAFO-FC) that constrains ankle motion during walking would result in reduced soleus and tibialis anterior EMG compared to free (exAFO-FC) and control (no AFO, footwear only) conditions. Method A total of 14 healthy subjects walked at their preferred speed (1.34 ± 0.09 m·s-1) for 15 min, in three conditions, namely, control, free, and stop. Results During the stance phase of walking in the stop condition, ipsilateral soleus integrated EMG (iEMG) declined linearly, culminating in a 32.1% reduction compared to the control condition in the final 5 min interval of the protocol. In contrast, ipsilateral tibialis anterior iEMG declined in a variable fashion culminating in an 11.2% reduction compared to control in the final 5 min interval. During the swing phase, the tibialis anterior iEMG increased by 6.6% compared to the control condition during the final 5 min interval. The contralateral soleus and tibialis anterior exhibited increased iEMG in the stop condition. Discussion An AFO-FC functions as a biomechanical motion control device that influences the neural control system and alters the output of muscles experiencing constraints of motion.
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Affiliation(s)
- Christopher F. Hovorka
- Department of Rehabilitation Medicine, Center for the Intrepid, Brooke Army Medical Center, San Antonio, TX, United States
- Defense Health Agency, Falls Church, VA, United States
- Oak Ridge Institute for Science and Education, Oak Ridge, TN, United States
| | - Géza F. Kogler
- Clinical Biomechanics Laboratory, Kennesaw State University, Kennesaw, GA, United States
| | - Young-Hui Chang
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Robert J. Gregor
- School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, United States
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Vistamehr A, Neptune RR, Conroy CL, Freeborn PA, Brunetti GM, Fox EJ. Articulated ankle-foot-orthosis improves inter-limb propulsion symmetry during walking adaptability task post-stroke. Clin Biomech (Bristol, Avon) 2024; 116:106268. [PMID: 38795609 DOI: 10.1016/j.clinbiomech.2024.106268] [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: 10/12/2023] [Revised: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Community ambulation involves complex walking adaptability tasks such as stepping over obstacles or taking long steps, which require adequate propulsion generation by the trailing leg. Individuals post-stroke often have an increased reliance on their trailing nonparetic leg and favor leading with their paretic leg, which can limit mobility. Ankle-foot-orthoses are prescribed to address common deficits post-stroke such as foot drop and ankle instability. However, it is not clear if walking with an ankle-foot-orthosis improves inter-limb propulsion symmetry during adaptability tasks. This study sought to examine this hypothesis. METHODS Individuals post-stroke (n = 9) that were previously prescribed a custom fabricated plantarflexion-stop articulated ankle-foot-orthosis participated. Participants performed steady-state walking and adaptability tasks overground with and without their orthosis. The adaptability tasks included obstacle crossing and long-step tasks, leading with both their paretic and nonparetic leg. Inter-limb propulsion symmetry was calculated using trailing limb ground-reaction-forces. FINDINGS During the obstacle crossing task, ankle-foot-orthosis use resulted in a significant improvement in inter-limb propulsion symmetry. The orthosis also improved ankle dorsiflexion during stance, reduced knee hyperextension, increased gastrocnemius muscle activity, and increased peak paretic leg ankle plantarflexor moment. In contrast, there were no differences in propulsion symmetry during steady-state walking and taking a long-step when using the orthosis. INTERPRETATION Plantarflexion-stop articulated ankle-foot-orthoses can improve propulsion symmetry during obstacle crossing tasks in individuals post-stroke, promoting paretic leg use and reduced reliance on the nonparetic leg.
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Affiliation(s)
- Arian Vistamehr
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA.
| | - Richard R Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Christy L Conroy
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Paul A Freeborn
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Gina M Brunetti
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA
| | - Emily J Fox
- Motion Analysis Center & Clinical Research Center, Brooks Rehabilitation, Jacksonville, FL, USA; Department of Physical Therapy, University of Florida, Gainesville, FL, USA
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Hayashi Y, Yamazaki K, Komatsu S, Yamamoto N, Ueda S, Sato K, Yamaguchi T, Hatori K, Honaga K, Takakura T, Wada F, Tanuma A, Fujiwara T. Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance. Front Neurol 2024; 15:1387607. [PMID: 38774057 PMCID: PMC11107341 DOI: 10.3389/fneur.2024.1387607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/19/2024] [Indexed: 05/24/2024] Open
Abstract
Introduction A knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance. Methods A prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge. Results Even in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO. Discussion For acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.
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Affiliation(s)
- Yusuke Hayashi
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kota Yamazaki
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shinya Komatsu
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Naoaki Yamamoto
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shujiro Ueda
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazunori Sato
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Tomofumi Yamaguchi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Kozo Hatori
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Rehabilitation Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomokazu Takakura
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Futoshi Wada
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
| | - Akira Tanuma
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
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Camuncoli F, Malerba G, Biffi E, Diella E, Di Stanislao E, Rosellini G, Panzeri D, Piccinini L, Galli M. The Effect of a New Generation of Ankle Foot Orthoses on Sloped Walking in Children with Hemiplegia Using the Gait Real Time Analysis Interactive Lab (GRAIL). Bioengineering (Basel) 2024; 11:280. [PMID: 38534554 DOI: 10.3390/bioengineering11030280] [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: 02/01/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
Cerebral palsy poses challenges in walking, necessitating ankle foot orthoses (AFOs) for stability. Gait analysis, particularly on slopes, is crucial for effective AFO assessment. The study aimed to compare the performance of commercially available AFOs with a new sports-specific AFO in children with hemiplegic cerebral palsy and to assess the effects of varying slopes on gait. Eighteen participants, aged 6-11, with hemiplegia, underwent gait analysis using GRAIL technology. Two AFO types were tested on slopes (uphill +10 deg, downhill -5 deg, level-ground). Kinematic, kinetic, and spatiotemporal parameters were analyzed. The new AFO contributed to significant changes in ankle dorsi-plantar-flexion, foot progression, and trunk and hip rotation during downhill walking. Additionally, the new AFO had varied effects on spatiotemporal gait parameters, with an increased stride length during downhill walking. Slope variations significantly influenced the kinematics and kinetics. This study provides valuable insights into AFO effectiveness and the impact of slopes on gait in hemiplegic cerebral palsy. The findings underscore the need for personalized interventions, considering environmental factors, and enhancing clinical and research approaches for improving mobility in cerebral palsy.
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Affiliation(s)
- Federica Camuncoli
- Department of Electronics Information Technology and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Giorgia Malerba
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy
| | - Emilia Biffi
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy
| | - Eleonora Diella
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy
| | | | | | - Daniele Panzeri
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy
| | - Luigi Piccinini
- Scientific Institute IRCCS Eugenio Medea, 23842 Bosisio Parini, Italy
| | - Manuela Galli
- Department of Electronics Information Technology and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
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10
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Lee SJ, Kim TY, Kim KM, Cho SR. Comparison between prefabricated ankle-foot orthoses, Dyna Ankle and UD Flex, in patients with hemiplegia. J Int Med Res 2024; 52:3000605241233514. [PMID: 38501996 PMCID: PMC10952991 DOI: 10.1177/03000605241233514] [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: 08/21/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVE To compare the kinematic effects of two widely-used prefabricated ankle-foot orthoses (AFOs), the Dyna Ankle (DA) and UD Flex (UD), on the gait cycle of patients with hemiplegia due to cerebral palsy or acquired brain injury. METHODS This was a retrospective cohort study involving 29 patients. Gait analysis results were assessed under three conditions: barefoot, with the DA, and with the UD. Friedman tests and post hoc analysis with Bonferroni correction were performed to assess differences between the three conditions. RESULTS The DA significantly improved ankle dorsiflexion during the mid-swing phase, making it more effective in correcting foot drop compared with the UD (DA: 2.28°, UD: 0.44°). Conversely, the UD was more effective in preventing knee flexion during the loading response (DA: 28.11°, UD: 26.72°). CONCLUSIONS The DA improved ankle dorsiflexion during the swing phase significantly more than that with the UD in patients with hemiplegia. Compared with the DA, the UD more effectively prevented increased knee flexion during the loading response. The choice to prescribe these orthoses should consider individual patient characteristics.
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Affiliation(s)
- Su Ji Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Yong Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung Min Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Rae Cho
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
- Graduate Program of Biomedical Engineering, Yonsei University College of Medicine, Seoul, Korea
- Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, Korea
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11
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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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12
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Rong H, Ramezani S, Ambro A, Lei CH, Choi H. Design and characterization of a variable-stiffness ankle-foot orthosis. Prosthet Orthot Int 2024:00006479-990000000-00213. [PMID: 38180143 DOI: 10.1097/pxr.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Ankle-foot orthoses (AFOs) are a type of assistive device that can improve the walking ability of individuals with neurological disorders. Adjusting stiffness is a common way to customize settings according to individuals' impairment. OBJECTIVE This study aims to design a variable-stiffness AFO by stiffness module and characterize the AFO stiffness range to provide subject-specific settings for the users. METHODS We modeled AFO using bending beams with varying fulcrum positions to adjust the stiffness. To characterize the stiffness range and profile, we used the superposition method to generate the theoretical model to analyze the AFO numerically. The intrinsic deformation of the bending beam in the AFO is considered a combination of 2 bending deformations to replicate actual bending conditions. The corresponding experiments in different fulcrum positions were performed to compare with and optimize the theoretical model. The curve fitting method was applied to tune the theoretical model by adding a fulcrum position-related coefficient. RESULTS The AFO stiffness increased as the fulcrum moved to the proximal position. The maximum stiffness obtained was 1.77 Nm/° at a 6-cm fulcrum position, and the minimum stiffness was 0.82 Nm/° at a 0.5-cm fulcrum position with a 0.43-cm thick fiberglass beam. The corresponding theoretical model had maximum and minimum stiffness of 1.71 and 0.80 Nm/°, respectively. The theoretical model had a 4.08% difference compared with experimental values. CONCLUSIONS The stiffness module can provide adjustable stiffness with the fulcrum position and different kinds of fiberglass bars, especially the thickness and material of the beam. The theoretical model with different fulcrum positions can be used to profile the real-time stiffness of the AFO in a dynamic motion and to determine the appropriate dimensions of the bending beam.
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Affiliation(s)
- Haochen Rong
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Sepehr Ramezani
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, Orlando, FL
| | - Alex Ambro
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Chi Hou Lei
- Department of Aerospace and Mechanical Engineering, Saint Louis University, St. Louis, MO
| | - Hwan Choi
- Department of Mechanical and Aerospace Engineering, Biionix Cluster, University of Central Florida, Orlando, FL
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13
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Thitithunwarat N, Krityakiarana W, Kheowsri S, Jongkamonwiwat N, Richards J. The effect of a modified elastic band orthosis on gait and balance in stroke survivors. Prosthet Orthot Int 2023; 47:466-472. [PMID: 36752760 DOI: 10.1097/pxr.0000000000000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/21/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Gait is crucial for independent living for stroke survivors and assistive devices have been developed to support gait performance. Ankle foot orthosis (AFOs) are commonly provided to stroke survivors to prevent foot drop during walking. However, previous studies have reported limitations of AFOs including them being too heavy, creating skin irritation, and being a stigma of disability. OBJECTIVE The purpose was to compare the gait and balance improvement between elastic band orthosis (EBOs) and AFOs. STUDY DESIGN Experimental study design. METHODS The AFOs and EBOs were provided to 17 stroke survivors, and changes in gait and balance were assessed compared to barefoot (control). Gait spatiotemporal parameters were measured using the zebris-FDM-Rehawalk® system, and balance ability was evaluated using the time up and go test (TUG). Satisfaction with the EBOs was determined using the Quebec user evaluation of satisfaction with assistive technology (QUEST2.0) questionnaire. RESULTS The EBO showed significant differences in; gait speed, cadence, stride length, stride time, step length unaffected side, stance phase and swing phase on the affected side, and pre-swing on the unaffected side, and balance performance (TUG) (p<0.05) when compared to the AFO and control conditions. The participants were quite satisfied with the EBOs with QUEST2.0 scores greater than 4 out of 5. CONCLUSIONS EBOs could be provided to stroke survivors given their acceptability and properties to improve gait and balance. The EBO used in this study offered clinically important improvements in gait and balance when compare to AFO and control conditions, and could mitigate against some of the limitations reported in the use of AFOs in stroke survivors.
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Affiliation(s)
- Nutkritta Thitithunwarat
- Assistive Technology for Persons with Disabilities, Ratchasuda College, Mahidol University, Nakhon Pathom, Thailand
| | - Warin Krityakiarana
- Assistive Technology for Persons with Disabilities, Ratchasuda College, Mahidol University, Nakhon Pathom, Thailand
- Biomechanics and Sports (BaS) Laboratory, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Suchittra Kheowsri
- Assistive Technology for Persons with Disabilities, Ratchasuda College, Mahidol University, Nakhon Pathom, Thailand
| | - Nopporn Jongkamonwiwat
- Center for Neuroscience Research, Faculty of Science, Mahidol University, Nakhon Pathom, Thailand
- Department of Anatomy, Faculty of Science, Mahidol University, Nakhon Pathom, Thailand
| | - Jim Richards
- Allied Health Research Unit, Faculty of Allied Health and Well-being, University of Central Lancashire, Preston, UK
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14
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Grunst MM, Wiederien RC, Wilken JM. Carbon fiber ankle-foot orthoses in impaired populations: A systematic review. Prosthet Orthot Int 2023; 47:457-465. [PMID: 36779973 DOI: 10.1097/pxr.0000000000000217] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 01/14/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Carbon fiber is increasingly being used in ankle-foot orthoses (AFOs). Orthotic devices and carbon fiber-containing devices have been shown to reduce pain and improve function in multiple patient populations. Although the number of publications and interest in carbon fiber AFOs is growing, a systematic evaluation of their effects is lacking. OBJECTIVES To characterize the effects of carbon fiber AFOs in impaired individuals. STUDY DESIGN Qualitative systematic review. METHODS Systematic searches in PubMed, Embase, CINAHL, and Cochrane Library were completed in July 2020. The results were deduplicated, screened, and assessed for quality by independent reviewers. Articles were excluded if they had nonhuman subjects, only healthy subjects, or included active control systems, motors, or other power sources. RESULTS Seventy-eight articles were included in the qualitative synthesis. Most articles were of low to moderate methodological quality. Five commonly used devices were identified: the Intrepid Dynamic Exoskeletal Orthosis, ToeOff, WalkOn, Neuro Swing, and Chignon. The devices have unique designs and are associated with specific populations. The Intrepid Dynamic Exoskeletal Orthosis was used in individuals with lower-limb trauma, the Neuro Swing and ToeOff in individuals with neurological disorders, the Chignon in individuals with hemiplegia and stroke, and the WalkOn in people with hemiplegia and cerebral palsy. Each device produced favorable outcomes in their respective populations of interest, such as increased walking speed, reduced pain, or improved balance. CONCLUSIONS The mechanical characteristics and designs of carbon fiber AFOs improve outcomes in the populations in which they are most studied. Future literature should diligently report patient population, device used, and fitting procedures.
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Affiliation(s)
- Megan M Grunst
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA
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15
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Goyal V, Dragunas A, Askew RL, Sukal-Moulton T, López-Rosado R. Altered biomechanical strategies of the paretic hip and knee joints during a step-up task. Top Stroke Rehabil 2023; 30:137-145. [PMID: 36744516 PMCID: PMC9902751 DOI: 10.1080/10749357.2021.2008596] [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: 06/09/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stroke often leads to chronic motor impairments in the paretic lower limb that can constrain lower extremity movement and negatively impact the ability to navigate stairs or curbs. This cross-sectional study investigated the differences in hip and knee biomechanical strategies during a step-up task between five adults with hemiparetic stroke and five age-matched adults without stroke. METHODS Participants were instructed to step up onto a 10.2 cm platform, where joint biomechanics were quantified for the hip in the frontal plane and the hip and knee in the sagittal plane. Peak joint kinematics were identified during the leading limb swing phase, and peak joint moments and power were identified during the leading limb pull-up phase of stance. Mixed effects regression models estimated fixed effects of limb (three levels: control dominant, stroke non-paretic, and stroke paretic) on biomechanical outcomes, while a random effect of participant controlled for within-participant correlations. RESULTS Repeated assessments within participants (approximately 60 trials per lower limb) increased the effective sample size to between 12.0 and 19.6. Altered biomechanical strategies of the paretic lower limb included reduced flexion angles and increased pelvic obliquity angles during swing, decreased power generation in the hip frontal plane during stance, and decreased moment and power generation in the knee sagittal plane during stance. A strategy of substantial interest was the elevated hip sagittal plane moment and power generation in both stroke limbs. CONCLUSIONS Our findings suggest that chronic motor impairments following stroke can lead to inefficient biomechanical strategies when stepping up.
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Affiliation(s)
- Vatsala Goyal
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Ave., Chicago, Illinois, USA, 60611
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, E310, Evanston, Illinois, USA 60208
| | - Andrew Dragunas
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Ave., Chicago, Illinois, USA, 60611
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Road, E310, Evanston, Illinois, USA 60208
| | - Robert L. Askew
- Department of Psychology, Stetson University, 421 N. Woodland Blvd., Unit 8281, DeLand, Florida, USA, 32723
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Ave., Chicago, Illinois, USA, 60611
- Department of Pediatrics, Northwestern University, 255 E. Chicago Avenue, Box 86, Chicago, Illinois, USA 60611
| | - Roberto López-Rosado
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, 645 N. Michigan Ave., Chicago, Illinois, USA, 60611
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16
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Shahabi S, Mojgani P, Lankarani KB, Jalali M. The quality of systematic reviews/meta-analyses assessing the effects of ankle-foot orthosis on clinical outcomes in stroke patients: A methodological systematic review. Health Sci Rep 2023; 6:e1130. [PMID: 36875933 PMCID: PMC9978320 DOI: 10.1002/hsr2.1130] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Background and Aims Given the importance of systematic reviews (SRs) for practitioners, researchers, and policymakers, it is essential to assess them to ensure robust methodology and reliable results before applying them. The purpose of this methodological study was to assess the methodological and reporting quality of recently published SRs and/or meta-analyses (MAs) evaluating the effects of ankle-foot orthoses (AFOs) on clinical outcomes in stroke survivors. Methods PubMed, Scopus, Web of Science, Embase, ProQuest, CENTRAL, REHABDATA, and PEDro were searched. The research team applied A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) tool and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist for evaluating the reporting and methodological quality, respectively, and the ROBIS tool was used to evaluate the risk of bias (RoB) in the included reviews. The quality of the evidence was also judged using the (Grades of Recommendation, Assessment, Development and Evaluation) GRADE method. Results In final, 14 SRs/MAs met inclusion criteria. Evaluation of methodological quality using the AMSTAR-2 tool demonstrated that the overall quality of included reviews was mostly "critically low" or "low," except for two studies that were "high." In addition, the findings showed that the mean score of the reporting quality of the included reviews based on the PRISMA criteria was 24.9, down from 42. In accordance with the overall evaluation applying the ROBIS tool, 14.3% of the review studies were evaluated as high RoB, 64.3% were evaluated as unclear RoB, and 21.4% were evaluated as low RoB. Regarding the level of evidence quality, the GRADE results indicated that the evidence quality of the included reviews was unsatisfactory. Conclusion This study showed that although the reporting quality of recently published SR/MAs evaluating the clinical effects of AFOs in stroke survivors was moderate, the methodological quality of almost all reviews was suboptimal. Therefore, reviewers must consider a number of criteria in designing, conducting, and reporting their studies to move toward transparent and conclusive results.
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Affiliation(s)
- Saeed Shahabi
- Health Policy Research Center, Institute of Health Shiraz University of Medical Sciences Shiraz Iran
| | - Parviz Mojgani
- Iran-Helal Institute of Applied Science and Technology Tehran Iran.,Research Center for Emergency and Disaster Resilience Red Crescent Society of The Islamic Republic of Iran Tehran Iran
| | - Kamran Bagheri Lankarani
- Health Policy Research Center, Institute of Health Shiraz University of Medical Sciences Shiraz Iran
| | - Maryam Jalali
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences Iran University of Medical Sciences Tehran Iran
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17
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Ling H, Guo H, Zhou H, Chang XQ, Guo ZY, Yamamoto S, Cai LF, Zhao J. Effect of a rigid ankle foot orthosis and an ankle foot orthosis with an oil damper plantar flexion resistance on pelvic and thoracic movements of patients with stroke during gait. Biomed Eng Online 2023; 22:9. [PMID: 36747170 PMCID: PMC9901085 DOI: 10.1186/s12938-023-01068-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/16/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Impairments of trunk movements in gait of stroke are often reported. Ankle foot orthosis (AFO) is commonly used to improve gait of stroke; however, the effect of different types of AFOs on the pelvic and thoracic movements during gait in stroke has not been clarified. METHODS Thirty-four patients with stroke were randomly allocated to undergo 2 weeks of gait training by physiotherapists while wearing a rigid AFO (RAFO) with a fixed ankle or an AFO with an oil damper (AFO-OD) that provides plantarflexion resistance and free dorsiflexion. A motion capture system was used for measurements of shod gait without AFO at baseline and with and without AFO after gait training. Two-way repeated ANOVA, Wilcoxon signed-rank test, and Mann-Whitney U test were performed for the data after the gait training to know the effect of different kinds of AFOs. RESULTS Twenty-nine patients completed the study (AFO-OD group: 14, RAFO group: 15). Interactions were found in pelvic rotation angle, change of shank-to-vertical angle (SVA) in the stance, and paretic to non-paretic step length, which increased in AFO-OD group with AFOs (p < 0.05), while the SVA decreased in RAFO group with AFOs (p < 0.05). The main effects were found in pelvic rotation at the contralateral foot off, and thoracic tilt at foot off when an AFO was worn. The change of SVA in stance was positively correlated with the pelvic rotation in the AFO-OD group (r = 0.558). At initial contact, pelvic rotation was positively correlated with thoracic rotation in both groups. CONCLUSIONS The findings in 29 patients with stroke showed that pelvic and thoracic movements especially the rotation were affected by the type of AFOs. Pelvic rotation and lower limb kinematics exhibited significant improvements with AFO-OD, reflecting more desirable gait performance. On the other hand, the increase in thoracic in-phase rotation might expose the effect of insufficient trunk control and dissociation movement. Trial registration UMIN000038694, Registered 21 November 2019, https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_his_list.cgi?recptno=R000044048 .
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Affiliation(s)
- Hua Ling
- Rehabilitation Engineering Institute, China Rehabilitation Science Institute, No.18, Jiaomen Beilu, Beijing, 100068, China
| | - Hui Guo
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, No.10, Jiaomen Beilu, Beijing, 100068, China
| | - Hao Zhou
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, No.10, Jiaomen Beilu, Beijing, 100068, China
| | - Xiao-Qian Chang
- Rehabilitation Engineering Institute, China Rehabilitation Science Institute, No.18, Jiaomen Beilu, Beijing, 100068, China
| | - Zi-Yang Guo
- Rehabilitation Engineering Institute, China Rehabilitation Science Institute, No.18, Jiaomen Beilu, Beijing, 100068, China
| | - Sumiko Yamamoto
- Graduate School, International University of Health & Welfare, 4‑1‑26 Akasaka, Minato‑ku, Tokyo, 107‑8402, Japan
| | - Li-Fei Cai
- Rehabilitation Engineering Institute, China Rehabilitation Science Institute, No.18, Jiaomen Beilu, Beijing, 100068, China.
| | - Jun Zhao
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, No.10, Jiaomen Beilu, Beijing, 100068, China.
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18
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DiBello SA, Wurdeman SR, Gorniak SL. Orthotic Research Initiative for Outcomes aNalysis (ORION I): predictors of PROMIS PF for stroke survivors seeking orthotic intervention. Disabil Rehabil 2022; 44:6878-6883. [PMID: 34473570 DOI: 10.1080/09638288.2021.1971306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Ankle-foot orthoses (AFOs) are used to improve physical performance measures of physical function (PF) post-stroke; however, the perception of improved PF of this population has not been described. The purpose of this study was to identify the predictors of self-reported PF of individuals seeking orthotic intervention post-stroke. MATERIALS AND METHODS A retrospective analysis of 237 patients at a nationwide orthotic services provider in the United States was conducted to characterize PF using the Patient-Reported Outcome Measures Information System®. A backward stepwise multiple regression was conducted to identify demographic characteristics predictive of self-reported PF. RESULTS The mean T-score of PF of the sample was 30.8 (±6.5), two standard deviations below the US general population mean, indicating significant impairment. The regression model explained approximately 15% (R = 0.411) of the variance in PF of the sample. Self-reported PF was worse for individuals requiring more supportive assistive devices (β = 0.270, p = 0.001), those with more recent ankle problems (β = -0.167, p = 0.035), and those with greater living assistance (β = -0.139, p = 0.089). CONCLUSIONS These results improve understanding of the factors that contribute to impaired self-reported PF of stroke survivors in need of AFO intervention.Implications for rehabilitationAnkle-foot orthoses (AFOs) are often used to improve physical performance measures of physical performance (PF) during stroke rehabilitation.Our data indicate that the self-reported PF of AFO users is severely impaired.Level of assistance, time since ankle and foot problems began, and living assistance status are important clinical characteristics to consider when planning AFO intervention for this population.
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Affiliation(s)
- Sally A DiBello
- Health and Human Performance, University of Houston, Houston, TX, USA.,School of Health Professions, Baylor College of Medicine, Houston, TX, USA
| | - Shane R Wurdeman
- Clinical and Scientific Affairs, Hanger Clinic, Austin, TX, USA.,Department of Biomechanics, University of Nebraska, Omaha, NE, USA
| | - Stacey L Gorniak
- Health and Human Performance, University of Houston, Houston, TX, USA
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19
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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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20
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Nakagawa K, Higashi K, Ikeda A, Kadono N, Tanaka E, Yuge L. Robotic ankle control can provide appropriate assistance throughout the gait cycle in healthy adults. Front Neurorobot 2022; 16:993939. [PMID: 36238427 PMCID: PMC9551652 DOI: 10.3389/fnbot.2022.993939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022] Open
Abstract
Ankle foot orthoses are mainly applied to provide stability in the stance phase and adequate foot clearance in the swing phase; however, they do not sufficiently assist during the entire gait cycle. On the other hand, robotic-controlled orthoses can provide mechanical assistance throughout the phases of the gait cycle. This study investigated the effect of ankle control throughout the gait cycle using an ankle joint walking assistive device under five different robotic assistance conditions: uncontrolled, dorsiflexion, and plantar flexion controlled at high and low speeds in the initial loading phase. Compared with the no-control condition, the plantar flexion condition enhanced knee extension and delayed the timing of ankle dorsiflexion in the stance phase; however, the opposite effect occurred under the dorsiflexion condition. Significant differences in the trailing limb angle and minimum toe clearance were also observed, although the same assistance was applied from the mid-stance phase to the initial swing phase. Ankle assistance in the initial loading phase affected the knee extension and ankle dorsiflexion angle during the stance phase. The smooth weight shift obtained might have a positive effect on lifting the limb during the swing phase. Robotic ankle control may provide appropriate assistance throughout the gait cycle according to individual gait ability.
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Affiliation(s)
- Kei Nakagawa
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Keita Higashi
- Department of Rehabilitation, Innoshima Medical Association Hospital, Onomichi, Japan
| | - Akari Ikeda
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoto Kadono
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Eiichiro Tanaka
- Graduate School of Information, Production and Systems, Faculty of Science and Engineering, Waseda University, Kita-Kyushu, Japan
| | - Louis Yuge
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- *Correspondence: Louis Yuge
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21
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Sumihira W, Otani T, Kobayashi Y, Tanaka M. Computational modelling of ankle-foot orthosis to evaluate spatially asymmetric structural stiffness: Importance of geometric nonlinearity. Proc Inst Mech Eng H 2022; 236:1357-1364. [PMID: 35875899 DOI: 10.1177/09544119221114199] [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: 11/16/2022]
Abstract
An ankle-foot orthosis (AFO) constructed as a single piece of isotropic elastic material is a commonly used assistive device that provides stability to the ankle joint of patients with spastic diplegic cerebral palsy. The AFO has asymmetric stiffness that restricts plantarflexion during the swing phase while it is flexible to allow dorsiflexion during the stance phase with a large deflection, including buckling originating from geometric nonlinearity. However, its mechanical implications have not been sufficiently investigated. This study aims to develop a computational model of an AFO considering geometric nonlinearity and examine AFO stiffness asymmetry during plantarflexion and dorsiflexion using physical experiments. Three-dimensional AFO mechanics with geometric nonlinearities were expressed using corotational triangle-element formulations that obeyed Kirchhoff-Love plate theory. Computational load tests for plantarflexion and dorsiflexion, using idealised AFOs with two different ankle-region designs (covering or not covering the apexes of the malleoli), showed that plantarflexion moment-ankle angle relationships were linear and dorsiflexion moment-ankle angle relationships were nonlinear; increases in dorsiflexion led to negative apparent stiffness of the AFO. Both ankle-region designs resisted both plantarflexion and dorsiflexion, and out-of-plane elastic energy was locally concentrated on the lateral side, resulting in large deflections during dorsiflexion. These findings give insight into appropriate AFO design from a mechanical viewpoint by characterising three-dimensional structural asymmetry and geometric nonlinearity.
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Affiliation(s)
- Wataru Sumihira
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Tomohiro Otani
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Yo Kobayashi
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Masao Tanaka
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
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Zhou C, Yang Z, Li K, Ye X. Research and Development of Ankle-Foot Orthoses: A Review. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22176596. [PMID: 36081055 PMCID: PMC9460335 DOI: 10.3390/s22176596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 05/14/2023]
Abstract
The ankle joint is one of the important joints of the human body to maintain the ability to walk. Diseases such as stroke and ankle osteoarthritis could weaken the body's ability to control joints, causing people's gait to be out of balance. Ankle-foot orthoses can assist users with neuro/muscular or ankle injuries to restore their natural gait. Currently, passive ankle-foot orthoses are mostly designed to fix the ankle joint and provide support for walking. With the development of materials, sensing, and control science, semi-active orthoses that release mechanical energy to assist walking when needed and can store the energy generated by body movement in elastic units, as well as active ankle-foot orthoses that use external energy to transmit enhanced torque to the ankle, have received increasing attention. This article reviews the development process of ankle-foot orthoses and proposes that the integration of new ankle-foot orthoses with rehabilitation technologies such as monitoring or myoelectric stimulation will play an important role in reducing the walking energy consumption of patients in the study of human-in-the-loop models and promoting neuro/muscular rehabilitation.
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Affiliation(s)
- Congcong Zhou
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qingchun Road, Hangzhou 310016, China
- Key Laboratory for Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Zhao Yang
- Key Laboratory for Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Kaitai Li
- Key Laboratory for Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Xuesong Ye
- Key Laboratory for Biomedical Engineering of Education Ministry, Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
- Correspondence:
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23
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Kirker S. Orthoses for neurological ankles. Pract Neurol 2022; 22:311-316. [PMID: 35332078 DOI: 10.1136/practneurol-2022-003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2022] [Indexed: 11/04/2022]
Abstract
Patients with weakness or abnormal posture of their lower leg may benefit greatly from appropriate orthoses. This paper describes the sorts of problems that can be helped in neurological practice and the range of devices commonly used, and also highlights some of the factors influencing selection. With greater understanding of their use, clinicians will feel more confident about referring patients for early orthotic assessment.
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Affiliation(s)
- Stephen Kirker
- Rehab Medicine Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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24
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de Miguel-Fernandez J, Pescatore C, Mesa-Garrido A, Rikhof C, Prinsen E, Font-Llagunes JM, Lobo-Prat J. Immediate Biomechanical Effects of Providing Adaptive Assistance With an Ankle Exoskeleton in Individuals After Stroke. IEEE Robot Autom Lett 2022. [DOI: 10.1109/lra.2022.3183799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jesus de Miguel-Fernandez
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Camille Pescatore
- ABLE Human Motion, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Alba Mesa-Garrido
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Cindy Rikhof
- Roessingh Research and Development, Enschede, AH, Netherlands
| | - Erik Prinsen
- Roessingh Research and Development, Enschede, AH, Netherlands
| | - Josep M. Font-Llagunes
- Biomechanical Engineering Lab, Department of Mechanical Engineering and Research Centre for Biomedical Engineering, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Joan Lobo-Prat
- ABLE Human Motion, Universitat Politècnica de Catalunya, Barcelona, Spain
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25
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Bashir AZ, Dinkel DM, Pipinos II, Johanning JM, Myers SA. Patient Compliance With Wearing Lower Limb Assistive Devices: A Scoping Review. J Manipulative Physiol Ther 2022; 45:114-126. [PMID: 35753880 DOI: 10.1016/j.jmpt.2022.04.003] [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: 05/28/2021] [Revised: 03/24/2022] [Accepted: 04/14/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The aim of this scoping review was to identify information on compliance with wearing orthoses and other supportive devices, to discuss the barriers to adherence, and to suggest strategies for improvement based on these findings. METHODS Online databases of PubMed, Web of Science, and the Cochrane Library were searched for articles about patients' compliance with regard to lower limb assistive devices. In addition, a methodological quality control process was conducted. Studies were included if in the English language and related to compliance and adherence to the lower limb assistive device. Exclusion was based on first reading the abstract and then the full manuscript confirming content was not related to orthotic devices and compliance. RESULTS Twelve studies were included. The data revealed between 6% and 80% of patients were not using a prescribed device. Barriers to the use of the orthotic device included medical, functional, device properties and lack of proper fit. Strategies for improved compliance included better communication between patient and clinician, patient education, and improved comfort and device esthetics. CONCLUSIONS Individualized orthotic adjustments, rehabilitation, and patient education were promising for increasing adherence. Despite positive aspects of improvements in gait, balance in elderly, and a sense of security produced by using assistive devices, compliance remains less than ideal due to barriers. As compliance in recent studies has not improved, continued work in this area is essential to realize the benefits of technological advances in orthotic and assistive devices.
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Affiliation(s)
- Ayisha Z Bashir
- Department of Biomechanics, University of Nebraska, Omaha, Nebraska; Department of Health and Kinesiology, University of Nebraska, Omaha, Nebraska.
| | - Danae M Dinkel
- Department of Health and Kinesiology, University of Nebraska, Omaha, Nebraska
| | - Iraklis I Pipinos
- Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska; Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jason M Johanning
- Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska; Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sara A Myers
- Department of Biomechanics, University of Nebraska, Omaha, Nebraska; Department of Surgery and Research Service, Omaha VA Medical Center, Omaha, Nebraska
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Daryabor A, Yamamoto S, Motojima N, Tanaka S. Therapeutic effect of gait training with two types of ankle-foot orthoses on the gait of the stroke patients in the recovery phase. Turk J Phys Med Rehabil 2022; 68:175-183. [PMID: 35989954 PMCID: PMC9366476 DOI: 10.5606/tftrd.2022.7866] [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: 12/01/2020] [Accepted: 05/05/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives This study aimed to demonstrate the therapeutic effect of gait training using ankle-foot orthoses (AFOs) on the gait of stroke patients when not wearing AFOs with two different types of AFO, an AFO with an oil damper (AFO-OD) that resists plantarflexion and an AFO with a plantarflexion stop (AFO-PS), and to display the possible differences between the AFO types. Patients and methods Forty-two patients (38 males, 4 males, mean age: 59.7±10.9; range, 38 to 81 years) with subacute stroke were randomized to either an AFO-PS or an AFO-OD group. Participants were given gait training in a two-week period by physiotherapists wearing their allocated AFO. Nineteen patients were assigned to the AFO-PS group and 20 to the AFO-OD group. Patients' gait without an AFO before gait training and then after two weeks of training wearing allocated AFOs was recorded through a three-dimensional movement capture system. Results A therapeutic effect through two weeks of continuous use of AFOs and gait training was found in both AFO groups (main effect of time) in the spatiotemporal factors, ankle joint moments, ankle power generation, shank-to-vertical angle, and center of gravity velocity throughout the stance phase, pre-swing knee angular velocity, and hip flexion moment in pre-swing. The results did not show a large interaction between two AFOs group. Conclusion These findings reveal that both AFOs had significant therapeutic effects on stroke gait. There was no significant difference between the two AFO groups. Further studies with a control group representing the effects of gait training without wearing an AFO are needed.
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Affiliation(s)
- Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- International University of Health & Welfare, Tokyo, Japan
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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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Fang Y, Lerner ZF. Bilateral vs. Paretic-Limb-Only Ankle Exoskeleton Assistance for Improving Hemiparetic Gait: A Case Series. IEEE Robot Autom Lett 2022; 7:1246-1253. [PMID: 35873136 PMCID: PMC9307082 DOI: 10.1109/lra.2021.3139540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
People with lower-limb hemiparesis have impaired function on one side of the body that affects their walking ability. Wearable robotic assistance has been investigated to treat hemiparetic gait by applying assistance to the paretic limb. In this exploratory case series, we sought to compare the effects of bilateral vs. paretic-limb-only ankle exoskeleton assistance on walking performance in a case series of three heterogeneous presentations of lower-limb hemiparesis. A secondary goal was to validate the use of a real-time ankle-moment-adaptive exoskeleton control system for effectively assisting hemiparetic gait; the ankle moment controller accuracy ranged from 72 - 90% across all conditions and participants. Compared to walking without the device, both paretic-limb-only and bilateral assistance resulted in greater average total ankle power (up to 72%), improved treadmill walking efficiency (up to 28%), and increased over-ground walking distance (up to 41%). All participants achieved a more symmetrical, efficient gait pattern with bilateral assistance, indicating that assisting both limbs may be more beneficial than assisting only the paretic side in people with hemiparetic gait. The results of this case series are intended to inform future clinical studies and exoskeleton designs in a wide range of patient populations.
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Affiliation(s)
- Ying Fang
- Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ 86011 USA
| | - Zachary F. Lerner
- Mechanical Engineering Department, Northern Arizona University, Flagstaff, AZ 86011 USA, and also with the Department of Orthopedics, The University of Arizona College of Medicine-Phoenix, Phoenix, AZ 85004 USA
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The effect of an ankle-foot orthosis on tibiofemoral motion during step-up and step-down in healthy adults. Prosthet Orthot Int 2022; 46:148-154. [PMID: 35412522 DOI: 10.1097/pxr.0000000000000073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/09/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Solid ankle-foot orthoses (SAFOs) are frequently prescribed in conditions such as cerebral palsy and stroke. Although gait is improved in the short term, long-term effects of limiting ankle and foot motion during functional activities on joints such as the knee have not been investigated. Our study purpose was to compare tibiofemoral (TF) motion in shoe and SAFO conditions in healthy adults to inform future studies in clinical populations. METHODS A custom-made device using electromagnetic sensors was used to collect three-dimensional TF rotation data while 29 healthy adult participants (female participants = 19, age = 24.4 ± 4.5 years) performed step-up/step-down in shoe and SAFO conditions. RESULTS In the SAFO condition during step-up, extent of motion was greater in frontal and transverse planes and less in the sagittal plane. Discrete values at 0%-10% of the cycle in sagittal, 50%-100% in frontal, and 40%-100% in transverse planes were statistically different, producing more abduction and external rotation. In the SAFO condition during step-down, extent of motion was significantly greater in the frontal and transverse planes. Discrete values were statistically different in 40%-60% of the cycle in sagittal, 0%-30% and 70%-90% in frontal, and 0%-30% and 70%-90% in transverse planes, producing more abduction and external rotation in the first half of the cycle and more adduction and internal rotation in the second half of the cycle. CONCLUSIONS An SAFO affects triplanar TF kinematics in healthy adults during step-up/step-down. Future investigations into ankle-foot orthosis prescription and TF motion in clinical populations will facilitate optimal ankle-foot orthosis prescription and knee function in the long term.
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Chen CPC, Suputtitada A, Chatkungwanson W, Seehaboot K. Anterior or Posterior Ankle Foot Orthoses for Ankle Spasticity: Which One Is Better? Brain Sci 2022; 12:brainsci12040454. [PMID: 35447984 PMCID: PMC9027033 DOI: 10.3390/brainsci12040454] [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: 02/24/2022] [Revised: 03/14/2022] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives: Ankle foot orthoses (AFOs) are commonly used by stroke patients to walk safely and efficiently. Both posterior AFOs (PAFOs) and anterior AFOs (AAFOs) are available. The objective of this study was to compare the efficacy of AAFOs and PAFOs in the treatment of ankle spasticity. Materials and Methods: A crossover design with randomization for the interventions and blinded assessors was used. Twenty patients with chronic stroke, a Modified Ashworth Scale (MAS) score of the ankle joint of 2, and a Tardieu angle ≥20 degrees were recruited. The patients were assigned to wear either an AAFO or PAFO at random and subsequently crossover to the other AFO. Results: Twenty stroke patients with ankle spasticity were recruited. The mean age was 46.60 (38−60) years. The mean time since stroke onset was 9.35 (6−15) months. It was discovered that the AAFO improved walking speed as well as the stretch reflex dynamic electromyography (dEMG) and walking dEMG amplitudes of the medial gastrocnemius muscles more significantly than the PAFO (p < 0.05). Conclusions: The AAFO had greater efficacy in reducing both static and dynamic ankle spasticity, and allowed for faster walking than the PAFO. The stretch reflex and walking dEMG amplitudes could be used for quantitative spasticity assessment.
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Affiliation(s)
- Carl P. C. Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Guishan District, Taoyuan City 33343, Taiwan;
| | - Areerat Suputtitada
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
- Division of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
- Excellent Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
- Correspondence: or
| | - Watchara Chatkungwanson
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Kittikorn Seehaboot
- Division of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand;
- Excellent Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
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Cui W, Huang L, Tian Y, Luo H, Chen S, Yang Y, Li Y, Fu J, Yu Q, Xu L. Effect and mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke: A fMRI study. NeuroRehabilitation 2022; 51:65-77. [PMID: 35311718 DOI: 10.3233/nre-210307] [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: 11/15/2022]
Abstract
BACKGROUND Mirror therapy has been gradually adopted for lower limb rehabilitation, but its efficacy and neural mechanism are not well understood. OBJECTIVE This study aims to investigate the effect and neural mechanism of mirror therapy on lower limb rehabilitation after ischemic stroke by using resting state functional magnetic resonance imaging (rs-fMRI). METHODS A single-blind and randomized controlled pilot study was conducted. 32 patients with ischemic stroke were included in this study and randomly divided into two groups - the control group (CT, n = 16) and the mirror therapy group (MT, n = 16). Both the CT and MT groups received medication and routine rehabilitation training. In addition, mirror therapy was added to the MT group 5 times a week for 30 minutes each time over a period of 3 weeks. Patients' motor functions, functional connectivity (FC), regional homogeneity (ReHo), and fractional amplitude of low-frequency fluctuations (fALFF) were analyzed both before and immediately after the treatment. RESULTS Patients' motor functions showed significant improvement in both groups compared to those before treatment (p < 0.01). Moreover, the MT group showed significantly better improvement than the CT group after the treatment (p < 0.05). FC, ReHo and fALFF indicated enhanced neuronal activities in motor function-related brain regions in the MT group compared to the CT group. CONCLUSION Mirror therapy promotes the recovery of lower limb motor functions in patients with ischemic stroke. Through the comparative rs-fMRI analysis, it is found that the mirror therapy promotes the functional reorganization of the injured brain.
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Affiliation(s)
- Wei Cui
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Lin Huang
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yang Tian
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Hong Luo
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Shuang Chen
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yan Yang
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Yamei Li
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Jing Fu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Qian Yu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
| | - Li Xu
- Department of Rehabilitation Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Sichuan, China
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Classification of Ankle Joint Stiffness during Walking to Determine the Use of Ankle Foot Orthosis after Stroke. Brain Sci 2021; 11:brainsci11111512. [PMID: 34827512 PMCID: PMC8615379 DOI: 10.3390/brainsci11111512] [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: 09/13/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 11/16/2022] Open
Abstract
Categorization based on quasi-joint stiffness (QJS) may help clinicians select appropriate ankle foot orthoses (AFOs). The objectives of the present study were to classify the gait pattern based on ankle joint stiffness, also called QJS, of the gait in patients after stroke and to clarify differences in the type of AFO among 72 patients after stroke. Hierarchical cluster analysis was used to classify gait patterns based on QJS at least one month before the study, which revealed three distinct subgroups (SGs 1, 2, and 3). The proportion of use of AFOs, articulated AFOs, and non-articulated AFOs were significantly different among SGs 1-3. In SG1, with a higher QJS in the early and middle stance, the proportion of the patients using articulated AFOs was higher, whereas in SG3, with a lower QJS in both stances, the proportion of patients using non-articulated AFOs was higher. In SG2, with a lower QJS in the early stance and higher QJS in the middle stance, the proportion of patients using AFOs was lower. These findings indicate that classification of gait patterns based on QJS in patients after stroke may be helpful in selecting AFO. However, large sample sizes are required to confirm these results.
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Effects of Ankle Foot Orthoses on the Gait Patterns in Children with Spastic Bilateral Cerebral Palsy: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8100903. [PMID: 34682168 PMCID: PMC8534539 DOI: 10.3390/children8100903] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is the most common cause of motor disability in children and can cause severe gait deviations. The sagittal gait patterns classification for children with bilateral CP is an important guideline for the planning of the rehabilitation process. Ankle foot orthoses should improve the biomechanical parameters of pathological gait in the sagittal plane. METHODS A systematic search of the literature was conducted to identify randomized controlled trials (RCT) and controlled clinical trials (CCT) which measured the effect of ankle foot orthoses (AFO) on the gait of children with spastic bilateral CP, with kinetic, kinematic, and functional outcomes. Five databases (Pubmed, Scopus, ISI Web of SCIENCE, SciELO, and Cochrane Library) were searched before February 2020. The PEDro Score was used to assess the methodological quality of the selected studies and alignment with the Cochrane approach was also reviewed. Prospero registration number: CRD42018102670. RESULTS We included 10 studies considering a total of 285 children with spastic bilateral CP. None of the studies had a PEDro score below 4/10, including five RCTs. We identified five different types of AFO (solid; dynamic; hinged; ground reaction; posterior leaf spring) used across all studies. Only two studies referred to a classification for gait patterns. Across the different outcomes, significant differences were found in walking speed, stride length and cadence, range of motion, ground force reaction and joint moments, as well as functional scores, while wearing AFO. CONCLUSIONS Overall, the use of AFO in children with spastic bilateral CP minimizes the impact of pathological gait, consistently improving some kinematic, kinetic, and spatial-temporal parameters, and making their gait closer to that of typically developing children. Creating a standardized protocol for future studies involving AFO would facilitate the reporting of new scientific data and help clinicians use their clinical reasoning skills to recommend the best AFO for their patients.
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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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Bardelli R, Harlaar J, Morone G, Tomba P, Esquenazi A, Benedetti MG. The Codivilla Spring: from then to now and beyond. Eur J Phys Rehabil Med 2021; 57:1012-1019. [PMID: 33861038 DOI: 10.23736/s1973-9087.21.06822-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ankle-foot-orthosis (AFO), originally called Codivilla Spring, is an orthotic device prescribed to the patients with foot drop due to neurological diseases in order to control the range of motion of the ankle joint, to compensate for the muscle weakness/spasticity thus optimizing the gait function. In this paper, a historical revision of the most known and used AFO worldwide from the origin of its name and the first applications at the Rizzoli Orthopedic Institute to the most advanced solutions in use today is covered. Through the critical analysis of historical documents available, the paper reports on the controversy about the true inventor of the Codivilla Spring during the first decades of the twentieth century. Main current adult and child AFOs, in terms of their design and indications are presented. Finally, possible approaches for the selection of the correct orthosis and the individual prescription are discussed in order to manage specific mechanical neuromuscular deficiencies of the subject's ankle-foot complex optimizing walking efficiency.
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Affiliation(s)
- Roberta Bardelli
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jaap Harlaar
- Clinical Technology & Technical Medicine, Delft University of Technology, Rotterdam Erasmus MC & Leiden UMC, Rotterdam, the Nederlands
| | | | - Patrizia Tomba
- Scientific Library, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Esquenazi
- Department of PM&R, MossRehab and Einstein Healthcare Network, Elkins Park, PA, USA
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy -
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Murayama M. Knee joint movement and muscle activity changes in stroke hemiplegic patients on continuous use of knee-ankle-foot orthosis with adjustable knee joint. J Phys Ther Sci 2021; 33:322-328. [PMID: 33935355 PMCID: PMC8079889 DOI: 10.1589/jpts.33.322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/06/2021] [Indexed: 11/25/2022] Open
Abstract
[Purpose] We aimed to evaluate knee joint movement and muscle activity ratio changes in
stroke hemiplegic patients in recovery phase after using a knee-ankle-foot orthosis with
an adjustable knee joint for 1 month; we also aimed to discuss the practical implications
of our findings. [Participants and Methods] The participants were 8 hemiplegic patients in
the recovery phase of stroke who were prescribed knee-ankle-foot orthosis with adjustable
knee joint. We measured knee joint angles and electromyographic activity of the vastus
medialis and biceps femoris during walking in two conditions: the knee-ankle-foot orthosis
knee joint fixed in the extended position and the knee joint moved from 0° to 30° in the
flexion direction. Measurements were taken 2 weeks after completion to account for
habituation of the orthosis and repeated 1 month later. [Results] When the knee joint was
moving from 0° to 30° in the flexion direction, the knee joint angle at initial contact
and the minimum flexion angle of the gait cycle decreased significantly between the first
and second measurements. When knee joint flexion was 30°, the muscle activity ratio of the
vastus medialis increased significantly in the loading response and mid-stance compared to
when it was fixed. [Conclusion] Setting the knee joint of a knee-ankle-foot orthosis in
accordance with the knee joint movement may increase the muscle activity ratio of the
vastus medialis from loading response to mid-stance.
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Affiliation(s)
- Minoru Murayama
- Funabashi Municipal Rehabilitation Hospital: 4-26-1 Natsumidai, Funabashi, Chiba 273-0866, Japan
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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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Yeung LF, Lau CCY, Lai CWK, Soo YOY, Chan ML, Tong RKY. Effects of wearable ankle robotics for stair and over-ground training on sub-acute stroke: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:19. [PMID: 33514393 PMCID: PMC7847008 DOI: 10.1186/s12984-021-00814-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 01/12/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Wearable ankle robotics could potentially facilitate intensive repetitive task-specific gait training on stair environment for stroke rehabilitation. A lightweight (0.5 kg) and portable exoskeleton ankle robot was designed to facilitate over-ground and stair training either providing active assistance to move paretic ankle augmenting residual motor function (power-assisted ankle robot, PAAR), or passively support dropped foot by lock/release ankle joint for foot clearance in swing phase (swing-controlled ankle robot, SCAR). In this two-center randomized controlled trial, we hypothesized that conventional training integrated with robot-assisted gait training using either PAAR or SCAR in stair environment are more effective to enhance gait recovery and promote independency in early stroke, than conventional training alone. METHODS Sub-acute stroke survivors (within 2 months after stroke onset) received conventional training integrated with 20-session robot-assisted training (at least twice weekly, 30-min per session) on over-ground and stair environments, wearing PAAR (n = 14) or SCAR (n = 16), as compared to control group receiving conventional training only (CT, n = 17). Clinical assessments were performed before and after the 20-session intervention, including functional ambulatory category as primary outcome measure, along with Berg balance scale and timed 10-m walk test. RESULTS After the 20-session interventions, all three groups showed statistically significant and clinically meaningful within-group functional improvement in all outcome measures (p < 0.005). Between-group comparison showed SCAR had greater improvement in functional ambulatory category (mean difference + 0.6, medium effect size 0.610) with more than 56% independent walkers after training, as compared to only 29% for CT. Analysis of covariance results showed PAAR had greater improvement in walking speed than SCAR (mean difference + 0.15 m/s, large effect size 0.752), which was in line with the higher cadence and speed when wearing the robot during the 20-session robot-assisted training over-ground and on stairs. CONCLUSIONS Robot-assisted stair training would lead to greater functional improvement in gait independency and walking speed than conventional training in usual care. The active powered ankle assistance might facilitate users to walk more and faster with their paretic leg during stair and over-ground walking. TRIAL REGISTRATION ClinicalTrials.gov NCT03184259. Registered on 12 June 2017.
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Affiliation(s)
- Ling-Fung Yeung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cathy C Y Lau
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Charles W K Lai
- Physiotherapy Department, Shatin Hospital, Ma On Shan, Hong Kong
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, Hong Kong
| | - Man-Lok Chan
- Physiotherapy Department, Tung Wah Hospital, Sheung Wan, Hong Kong
| | - Raymond K Y Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Investigating the effect of innovative storing-restoring hybrid passive ankle-foot orthosis on braking and propulsion impulse of walking in drop-foot patients: a prospective cohort study. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Effect of Functional Electrical Stimulation of the Gluteus Medius during Gait in Patients following a Stroke. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8659845. [PMID: 35721669 PMCID: PMC9201370 DOI: 10.1155/2020/8659845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/12/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022]
Abstract
Many stroke patients rely on cane or ankle-foot orthosis during gait rehabilitation. The purpose of this study was to investigate the immediate effect of functional electrical stimulation (FES) to the gluteus medius (GMed) and tibialis anterior (TA) on gait performance in stroke patients, including those who needed assistive devices. Fourteen stroke patients were enrolled in this study (mean poststroke duration: 194.9 ± 189.6 d; mean age: 72.8 ± 10.7 y). Participants walked 14 m at a comfortable velocity with and without FES to the GMed and TA. After an adaptation period, lower-limb motion was measured using magnetic inertial measurement units attached to the pelvis and the lower limb of the affected side. Motion range of angle of the affected thigh and shank segments in the sagittal plane, motion range of the affected hip and knee extension-flexion angle, step time, and stride time were calculated from inertial measurement units during the middle ten walking strides. Gait velocity, cadence, and stride length were also calculated. These gait indicators, both with and without FES, were compared. Gait velocity was significantly faster with FES (p = 0.035). Similarly, stride length and motion range of the shank of the affected side were significantly greater with FES (stride length: p = 0.018; motion range of the shank: p = 0.026). Meanwhile, cadence showed no significant difference (p = 0.238) in gait with or without FES. Similarly, range of motion of the affected hip joint, knee joint, and thigh did not differ significantly depending on FES condition (p = 0.115‐0.529). FES to the GMed and TA during gait produced an improvement in gait velocity, stride length, and motion range of the shank. Our results will allow therapists to use FES on stroke patients with varying conditions.
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Murayama M, Yamamoto S. Gait and Muscle Activity Changes in Patients in the Recovery Phase of Stroke with Continuous Use of Ankle-Foot Orthosis with Plantarflexion Resistance. Prog Rehabil Med 2020; 5:20200021. [PMID: 32923737 PMCID: PMC7481650 DOI: 10.2490/prm.20200021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/26/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: Previous studies have suggested that the use of an ankle–foot orthosis may cause disuse
atrophy of the tibialis anterior muscle. The objective of this study was to explore gait
and muscle activity changes in patients in the recovery phase of stroke with 2-month use
of an ankle–foot orthosis that provided plantarflexion resistance. Methods: The participants were 19 patients in the recovery phase of stroke who were prescribed
an ankle–foot orthosis that provided plantarflexion resistance. We measured ankle and
shank tilt angles as well as electromyography activity of the tibialis anterior and the
soleus during 10-m walk tests. Measurements were taken on three occasions. The first was
2 weeks after delivery of the orthosis, 1 and 2 months after the initial measurement,
and the third 2 months later. Changes in gait parameters were analyzed between the first
and second measurements and between the second and third measurements. Results: Between the second and third measurements, significant increases were observed in
plantarflexion and shank forward tilt angles and the activity ratio of the tibialis
anterior during loading response compared with other phases. Conclusions: Plantarflexion movement induced by an ankle–foot orthosis with plantarflexion
resistance could increase the activity ratio of the tibialis anterior during loading
response.
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Affiliation(s)
- Minoru Murayama
- Funabashi Municipal Rehabilitation Hospital, Funabashi, Japan.,International University of Health and Welfare Graduate School, Tokyo, Japan
| | - Sumiko Yamamoto
- International University of Health and Welfare Graduate School, Tokyo, Japan
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Sekiguchi Y, Owaki D, Honda K, Fukushi K, Hiroi N, Nozaki T, Izumi SI. Ankle-foot orthosis with dorsiflexion resistance using spring-cam mechanism increases knee flexion in the swing phase during walking in stroke patients with hemiplegia. Gait Posture 2020; 81:27-32. [PMID: 32652487 DOI: 10.1016/j.gaitpost.2020.06.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/10/2020] [Accepted: 06/25/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Ankle-foot orthoses with plantarflexion resistance (AFO-Ps) improve knee flexion in the stance phase on the paretic side in patients with hemiparesis. However, AFO-Ps decrease ankle power generation in the late stance phase and do not improve the knee flexion in the swing phase based on insufficient push-off at the late stance, resulting in lower toe clearance. RESEARCH QUESTION This study sought to investigate the effect of an AFO with dorsiflexion resistance, which was implemented by our developed device with spring-cam mechanism attached to the AFO-P (Gait Solution; Pacific Supply Co., Ltd., Japan), on kinetics and kinematics in the lower limb during gait in patients with hemiparesis. METHODS Eleven patients with hemiparesis due to stroke walked on a 7-m walkway at a self-selected comfortable pace in the following conditions: (a) walking using the AFO-P with the proposed device with a spring-cam mechanism (AFO-PCAM), (b) walking using the AFO-P without our device (AFO-P), and (c) walking using no device (barefoot condition). Gait kinematics and kinetics were collected using a three-dimensional motion analysis system and four ground-reaction force plates. Changes in all parameters from the barefoot to AFO-PCAM and AFO-P conditions were compared using the Wilcoxon signed-rank test. RESULTS In the AFO-PCAM condition, decrease in the maximum ankle power generation in the late-stance phase was significantly smaller than that in the AFO-P condition (p = 0.041). We noted a significant higher change in knee flexion in the paretic swing phase in the AFO-PCAM condition relative to that in the AFO-P condition (p = 0.016). The effect size for the comparisons of change was large (r ≧ 0.5). SIGNIFICANCE Our device facilitated the realization of the ankle plantarflexion power in the late-stance phase because of dorsiflexion resistance, increasing the knee flexion angle during the swing phase.
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Affiliation(s)
- Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575, Japan.
| | - Dai Owaki
- Department of Robotics, Graduate School of Engineering, Tohoku University, 6-6-01 Aoba, Aramaki, Aoba-ku, Sendai, 980-8579, Japan
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575, Japan
| | | | | | - Takeo Nozaki
- NEC Corporation, 34, Miyukigaoka, Tukuba, 305-8501, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575, Japan; Graduate School of Biomedical Engineering, Tohoku University, 2-1, Seiryo-machi, Sendai, 980-8575, Japan
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Karakkattil PS, Trudelle-Jackson E, Medley A, Swank C. Effects of two different types of ankle-foot orthoses on gait outcomes in patients with subacute stroke: a randomized crossover trial. Clin Rehabil 2020; 34:1094-1102. [PMID: 32573271 DOI: 10.1177/0269215520927738] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify whether patients in the subacute stage of stroke, with foot drop, would have better gait outcomes when using a double-adjustable AFO (DA AFO) or a posterior leaf spring AFO (PLS AFO) at baseline without practice and to determine whether one week of practice would significantly change gait outcomes with either of the AFOs. DESIGN Within-subject 2 × 2 repeated measures design. SETTING Postacute and outpatient rehabilitation center. PARTICIPANTS Twenty individuals with mean age of 57 years (SD: 12.0 years) with subacute stroke. INTERVENTIONS Participants were measured using DA AFO and PLS AFO at baseline. Follow-up measurements were taken after one week of practice with each type of AFO in randomly assigned order. OUTCOME MEASURES Gait endurance (6-Minute Walk Test (6MWT)), gait symmetry, and gait velocity at self-selected and fast-paced velocity measured using GAITRite gait analysis system and patient report of AFO preference. RESULTS At baseline, no significant differences were found between the 2 AFOs (P > 0.05). There was no significant interaction (P > 0.05) of AFO and practice for gait endurance, symmetry, and velocity. Main effect of practice was significant for gait endurance (P < 0.001), self-selected velocity (P = 0.001), and fast-paced velocity (P < 0.001). In all, 16 participants preferred using DA AFO for walking. CONCLUSIONS No difference between DA AFO and PLS AFO was found on measures of gait endurance, symmetry, and velocity at baseline or after practice. With practice over time, participants improved in gait endurance and velocity regardless of AFO type.
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Affiliation(s)
| | - Elaine Trudelle-Jackson
- School of Physical Therapy, Texas Woman's University Institute of Health Sciences, Dallas, TX, USA
| | - Ann Medley
- School of Physical Therapy, Texas Woman's University Institute of Health Sciences, Dallas, TX, USA
| | - Chad Swank
- Baylor Scott & White Institute for Rehabilitation, Dallas, TX, USA
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Daryabor A, Yamamoto S, Orendurff M, Kobayashi T. Effect of types of ankle-foot orthoses on energy expenditure metrics during walking in individuals with stroke: a systematic review. Disabil Rehabil 2020; 44:166-176. [DOI: 10.1080/09638288.2020.1762767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Aliyeh Daryabor
- Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- International University of Health and Welfare, Tokyo, Japan
| | - Sumiko Yamamoto
- International University of Health and Welfare, Tokyo, Japan
| | | | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, Hong Kong Polytechnic University, Hong Kong, China
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A D, M A, G A, M B, S Y. Design and Evaluation of an Articulated Ankle Foot Orthosis with Plantarflexion Resistance on the Gait: a Case Series of 2 Patients with Hemiplegia. J Biomed Phys Eng 2020; 10:119-128. [PMID: 32158719 PMCID: PMC7036417 DOI: 10.31661/jbpe.v0i0.1159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 03/15/2019] [Indexed: 06/10/2023]
Abstract
Ankle-foot orthoses (AFOs) have been described to have positive effects on the gait biomechanics in stroke patients. The plantarflexion resistance of an AFO is considered important for hemiplegic patients, but the evidence is still limited. The purpose of this case series was to design and evaluate the immediate effect of an articulated AFO on kinematics and kinetics of lower-limb joints in stroke patients. The articulated AFO with the adjustment of plantarflexion resistance was designed. The spring generates a plantarflexion resistance of the ankle joint at initial stance phase. The efficacy of orthosis was evaluated on two stroke patients in 2 conditions: without an AFO and with the AFO. Results showed the immediate improvements for walking speed, stride length and angular changes of dorsiflexion of the paretic ankle joint during a gait cycle of both subjects using the AFO compared with barefoot walking. The AFO also was able to reduce the paretic knee extension in the single-support phase of the stance and increase the vertical COM displacement during stance phase on the affected leg. In conclusion, the designed AFO affect not only the movement of the ankle joint but also the movements of the knee joint and the vertical COM height. These changes indicate improvement of the first and the second rockers and swing phase gait but not third rocker function. Further investigation is recently underway to compare its effect compared with other AFOs on the gait parameters of hemiplegic patients.
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Affiliation(s)
- Daryabor A
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- PhD, Researcher in International University of Health and Welfare, Japan, Tokyo
| | - Arazpour M
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Aminian G
- PhD, Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Baniasad M
- PhD, Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Yamamoto S
- PhD, International University of Health and Welfare, Tokyo, Japan
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Shahabi S, Shabaninejad H, Kamali M, Jalali M, Ahmadi Teymourlouy A. The effects of ankle-foot orthoses on walking speed in patients with stroke: a systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2019; 34:145-159. [DOI: 10.1177/0269215519887784] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: The aim of this study was to evaluate the effects of ankle-foot orthoses on speed walking in patients with stroke. Data sources: PubMed, Embase, Web of Science, Scopus, CENTRAL, PEDro, RehabData, RECAL, and ProQuest were searched from inception until 30 September 2019. Review methods: This study was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline statement. Risk of bias assessment was performed using the Cochrane Risk of Bias Tool. Begg’s test and Egger’s regression method were used to assess the publication bias. Trim and fill analysis was also used to adjust any potential publication bias. Sensitivity analysis was performed to evaluate the effect of individual studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. Results: Overall, 14 studies were included with a total of 1186 participants. A small-to-moderate and non-significant improvement in favor of the ankle-foot orthosis versus without ankle-foot orthosis (standardized mean difference (SMD) = 0.41, 95% confidence interval = −0.15 to 0.96), similar effects of ankle-foot orthosis and functional electrical stimulation (SMD = 0.00, 95% confidence interval = −0.16 to 0.16), and a small and non-significant improvement in favor of ankle-foot orthosis versus another type of ankle-foot orthosis (SMD = 0.22, 95% confidence interval = −0.05 to 0.49) in walking speed were found. However, the quality of evidence for all comparisons was low or very low. Conclusion: Despite reported positive effects in some studies, there is no firm evidence of any benefit of ankle-foot orthoses on walking speed.
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Affiliation(s)
- Saeed Shahabi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hosein Shabaninejad
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
- Population Health Sciences Institute, Newcastle University, UK
| | - Mohammad Kamali
- Rehabilitation Research Center, Department of Rehabilitation Management, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Jalali
- Rehabilitation Research Center, Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ahmadi Teymourlouy
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Young J, Moss C. Orthotic care needs in a cohort of neurological rehabilitation inpatients. Disabil Rehabil Assist Technol 2019; 16:609-613. [PMID: 31746242 DOI: 10.1080/17483107.2019.1685018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM Orthotic management is frequently part of the rehabilitation of various neurological conditions in adults such as stroke, peripheral neuropathies, spinal cord injuries and multiple sclerosis. Despite this, there are limited data available on the implementation of orthotic care in practice. The primary aim of this study is to establish the proportion of inpatients in a mixed neurorehabilitation cohort which receive orthotic assessment and treatment. The secondary aim was to document the overall care pathway. METHODS Existing data were reviewed retrospectively. Data gathered included patient demographics such as age, gender and diagnosis, type of orthoses prescribed, number of orthotic treatment sessions required and outcome measures used. The paper was prepared in accordance with the STROBE statement for observational studies. RESULTS During a 6 month period, 54 patients were admitted as inpatients. Of these, 25 (46%) were referred to the orthotic service for assessment, with 23 (43%) receiving a lower limb orthosis and 19 (35%) subsequently being discharged using either an ankle-foot orthosis or knee-ankle-foot orthosis. The conditions most commonly seen were stroke (40%), incomplete spinal cord injuries (28%) and peripheral neuropathies (16%). Significant improvements were recorded at discharge using the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM). Various aspects of the orthotic care process are described. CONCLUSIONS This study suggests that orthotic treatment is needed with high frequency in a mixed inpatient neurorehabilitation cohort. In terms of service planning, these data support existing the recommendation that neurological rehabilitation centres should have good access to orthotic services.Implications for rehabilitationCustom orthoses such as AFOs and KAFOs are frequently needed by neurological rehabilitation inpatients.Orthoses may facilitate standing and walking at an earlier stage during rehabilitation.Those responsible for neurological rehabilitation services should ensure appropriate access to orthotic services.
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Affiliation(s)
- Joshua Young
- Orthotic Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Cameron Moss
- Wolfson Neurorehabilitation Centre, St George's University Hospitals NHS Foundation Trust, London, UK
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Yamamoto M, Shimatani K, Hasegawa M, Murata T, Kurita Y. Effects of altering plantar flexion resistance of an ankle-foot orthosis on muscle force and kinematics during gait training. J Electromyogr Kinesiol 2019; 46:63-69. [DOI: 10.1016/j.jelekin.2019.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 11/25/2022] Open
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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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