Effectiveness of an ankle-foot orthosis on walking in patients with stroke: a systematic review and meta-analysis

A proposed evidence-guided algorithm for the adjustment and optimization of multi-function articulated ankle-foot orthoses in the clinical setting

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.

Functional and perceptive differences between conventional and advanced ankle foot orthoses in community ambulators post-limb trauma: the injuries managed with advanced bracing of the lower extremity (IM ABLE) study

Introduction

Many military service members and civilians suffer from lower extremity trauma. Despite recent advancements in lower limb bracing technology, it remains unclear whether these newer advanced braces offer improved comfort and functionality compared to conventional options. The IDEO (Intrepid Dynamic Exoskeletal Orthosis), a type of "advanced" orthosis was developed to assist in maintaining high functional performance in patients who have experienced high-energy lower extremity trauma and underwent limb salvage surgeries.

Methods

A cross-sector multi-site initiative was completed to study the efficacy of advanced ankle foot orthoses (AFO) for lower limb trauma and injury compared to a conventional AFO. Following fitting, training, and accommodation, the subjects were assessed in each AFO system for mobility, self-reported function, safety and pain, and preference.

Results

They preferred the advanced over the conventional AFO and the mobility and exertion perception improved with the advanced AFO with no difference in pain or overall health status scores.

Discussion

Thus, an advanced AFO is an option for trauma affecting the lower limb. Long-term studies are required to better understand the accommodation and learning process of using an advanced AFO.

Effect of insole on postural control and gait of stroke patients: a systematic review and meta-analysis

This systematic review aims to examine the evidence of adding postural insole to traditional physical therapy to improve weight distribution, gait, mobility, balance, and postural control in stroke survivors. Five databases were searched to retrieve all related randomized controlled trials examining the effect of insole on stroke patients. Two independent authors checked the potential articles against eligibility criteria according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A meta-analysis was conducted for available outcomes and the statistical heterogeneity was examined using the I2 test. Of 762 articles, only 15 with 448 patients were included after they met the inclusion criteria with most of them including participants exceeding 6 months of stroke incidence. When insole was used as compelled body weight shifting method, pooled statistical analysis revealed significant improvement in gait velocity [standardized mean difference (SMD) = 0.67; 95% confidence interval (CI): 0.31, 1.02; P = 0.0003], cadence (SMD = 0.67; 95% CI: 0.16, 1.18; P = 0.01] and stride length (SMD = 1.11; 95% CI: 0.57, 1.65; P < 0.0001), while no significant effect on step length (SMD = 0.48; 95% CI: -0.37, 1.33; P = 0.27). Pooled statistical analysis of balance outcomes revealed significant improvement in weight-bearing symmetry balance (SMD = 0.82; 95% CI: 0.25, 1.39; P = 0.005) and long-term improvement in Berg Balance Scale (SMD = 1.19; 95% CI: 0.19, 2.20; P = 0.02), while no difference was observed in balance confidence (SMD = 0.44; 95% CI: -0.15, 1.04; P = 0.14) and sensorimotor functions (SMD = 0.36; 95% CI -0.39, 1.11; P = 0.35). Insoles significantly improved spatiotemporal gait parameters, gait symmetry, and static balance compared with traditional physical therapy alone.

Articulated ankle-foot-orthosis improves inter-limb propulsion symmetry during walking adaptability task post-stroke

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.

Ankle stiffness asymmetry is associated with balance function in individuals with chronic stroke

Ankle joint is one of important contributors on balance in stroke survivors. This study aimed to investigate the relationships of ankle stiffness symmetry ratios along the talocrural and subtalar axes with clinical balance measures and weight distribution during quiet standing in ambulatory chronic post-stroke survivors. The clinical trials involved 15 ambulatory elderly with chronic post-stroke hemiparesis and 15 healthy controls. Ankle stiffness was evaluated during non-weight-bearing isokinetic passive biaxial ankle movements, and ankle stiffness symmetry ratios between paretic and non-paretic ankle stiffness (SR: Inversion/Eversion SRIE & Dorsi-/Plantarflexion SRDP) were measured. A certified physiotherapist evaluated the Berg Balance Scale (BBS) and weight-distribution ratio (WDR) on bilateral force plates during quiet standing. Correlation coefficients, the factor analysis, and Pearson linear multiple regression were assessed with measured parameters. Correlation coefficients showed significances in-betweens; BBS and SRDP (r = -0.543, p = 0.022), WDR and SRIE (r = -0.667, p = 0.004), SRIE and SRDP (r = -0.604, p = 0.011). The exploratory factor analysis suggested four extracted factors; (1) Balance & Gait, (2) Stroke, (3) Symmetry and (4) Dimension. The first and second factors include general and pathological characteristics in stoke participants respectively. The third factor is associated with symmetrical characteristics explaining up to 99.9% of the variance. Multiple regression analysis showed ankle stiffness ratios predict BBS up to 60% of variance. The biaxial ankle stiffness ratio is a useful clinical variable that assesses balance function, in ambulatory chronic stroke survivors.

Immediate Effect of Ankle Exoskeleton on Spatiotemporal Parameters and Center of Pressure Trajectory After Stroke

Gait impairments is a common condition in post-stroke subjects. We recently presented a wearable ankle exoskeleton called G-Exos, which showed that the device assisted in the ankle's dorsiflexion and inversion/reversion movements. The aim of the current pilot study was to explore spatiotemporal gait parameters and center of pressure trajectories associated with the use of the G-Exos in stroke participants. Three post-stroke subjects (52-63 years, 2 female/1 male) walked 160-meter using the G-Exos on the affected limb, on a protocol divided into 4 blocks of 40-meters: (I) without the exoskeleton, (II) with systems hybrid system, (III) active only and (IV) passive only. The results showed that the use of the exoskeleton improved swing and stance phases on both limbs, reduced stride width on the paretic limb, increased stance COP distances, and made single support COP distances more similar between the paretic and non-paretic limb. This suggests that all G-Exos systems contributed to improving body weight bearing on the paretic limb and symmetry in the gait cycle.

Safety and Feasibility Study of the Medical Care Pit Walking Support System for Rehabilitation of Acute Stroke Patients

Stroke rehabilitation with mechanical assistance improves outcomes by facilitating repetition and relieving the care burden of therapy staff. Here, we tested the Medical Care Pit (MCP) walking assistance training device in the rehabilitation of eight acute stroke patients (median age 60.7 ± 16.3 years) who had recently suffered ischemic (three) or hemorrhagic (five) stroke (14.1 ± 6.5 days). Patients received standard rehabilitation approximately 5 days per week (weekdays only), plus MCP therapy twice a week, totaling four MCP sessions over 2 weeks. Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Functional Ambulation Category (FAC), and other gait-associated parameters were measured. Over the 10.5 ± 1.6 days of therapy, MCP qualitatively assisted in gait analysis and real-time patient feedback while independent walking scores significantly improved (FAC 2.2 ± 0.8 to 3.1 ± 1.3, p = 0.020). FMA-LE scores also slightly improved but not to significance (p = 0.106). Objective burden on patients, as measured by modified Borg scale, was significantly improved (2.7 ± 1.6 to 2.0 ± 1.6, p = 0.014). In terms of questionnaires, anxiety scores for the physical therapist regarding gait training and falling with MCP significantly decreased (3.8 ± 2.3 to 1.0 ± 1.6; p = 0.027 and 3.1 ± 2.2 to 0.8 ± 1.3; p = 0.045) from the first to fourth sessions. Taken together, MCP, in addition to the usual rehabilitation program, was effective in gait rehabilitation for independent walking and relieved burdens on the patients. Such walking support systems may be an important part of acute stroke rehabilitation.

Effects of community ambulation training with 3D-printed ankle-foot orthosis on gait and functional improvements: a case series of three stroke survivors

Introduction

Many of the patients using ankle-foot orthoses (AFOs) experience poor fit, pain, discomfort, dislike of the aesthetics of the device, and excessive range of motion restrictions, which diminish the use of AFOs. Although 3D-printed ankle-foot orthoses (3D-AFOs) affect patient satisfaction and overall gait functions such as ankle moment, joint range of motion (ROM), and temporal-spatial parameters, the material properties and manufacturing process of 3D-AFOs are still diverse; the clinical effects of community ambulation using 3D-AFOs and satisfaction in patients with stroke are poorly understood.

Case description

Case 1: A 30-year-old man, with a history of right basal ganglia hemorrhage, presented with marked foot drop and genu recurvatum. Case 2: A 58-year-old man, with a history of multifocal scattered infarction, presented with an asymmetrical gait pattern due to abnormal pelvic movement. Case 3: A 47-year-old man, with a history of right putamen hemorrhage, presented with recent poor balance and a prominent asymmetrical gait pattern due to increased ankle spasticity and tremor. All patients could walk independently with AFOs.

Interventions and outcomes

Gait was assessed under three walking (even, uneven, and stair ascent/descent) and four AFO (no shoes, only shoes, shoes with AFOs, and shoes with 3D-AFOs) conditions. After 4 weeks of community ambulation training with 3D-AFO or AFO, the patients were followed up. Spatiotemporal parameters; joint kinematics; muscle efficiency; clinical evaluations including impairments, limitations, and participation; and patient satisfaction with wearing 3D-AFO were evaluated.

Results and conclusion

3D-AFOs were suitable for community ambulation of patients with chronic stroke and effective on step length, stride width, symmetry, ankle range of motion, and muscle efficiency during even surface walking and stair ascent in patients with chronic stroke. The 4-week community ambulation training with 3D-AFOs did not promote patient participation; however, it increased ankle muscle strength, balance, gait symmetry, and gait endurance and reduced depression among patients with a history of stroke. The participants were satisfied with 3D-AFO's thinness, lightweight, comfortable feeling with wearing shoes, and gait adjustability.

Comparison between a novel helical and a posterior ankle-foot orthosis on gait in people with unilateral foot drop: a randomised crossover trial

BACKGROUND

Neuromuscular disease and peripheral neuropathy may cause drop foot with or without evertor weakness. We developed a helical-shaped, non-articulated ankle-foot orthosis (AFO) to provide medial-lateral stability while allowing mobility, to improve gait capacity. Our aim was to evaluate the effect of the helical AFO (hAFO) on functional gait capacity (6-min walk test) in people with peripheral neuropathy or neuromuscular disease (NMD) causing unilateral drop foot and compare with a posterior leaf spring AFO (plsAFO). Secondary aims were to compare functional mobility, 3D kinematic and kinetic gait variables and satisfaction between the AFOs.

METHODS

Single centre, randomised crossover trial from January to July 2017 in 20 individuals (14 with peripheral neuropathy and 6 with NMD, 12 females, mean age 55.6 years, SD 15.3); 10 wore the hAFO for the first week and 10 wore the plsAFO before switching for the second week. The 6-min walk test (6MWT), Timed Up and Go (TUG) test and 3D gait analysis were evaluated with the hAFO, the plsAFO and shoes only (noAFO) at inclusion and 1 week after wearing each orthosis. Satisfaction was evaluated with the Quebec user evaluation of satisfaction with assistive technology (QUEST).

RESULTS

Median [interquartile range] 6MWT distance was greater with the hAFO (444 m [79]) than the plsAFO (389 m [135], P < 0.001, Hedge's g = 0.6) and noAFO (337 m [91], P < 0.001, g = 0.88). TUG time was shorter with the hAFO (8.1 s [2.8]) than the plsAFO (9.5 s [2.6], P < 0.001, g = - 0.5) and noAFO (10.0 s [2.6]), P < 0.001, g = - 0.6). The plsAFO limited plantarflexion during the loading response (plsAFO - 7.5 deg [6.0] vs. noAFO -13.0 deg [10.0], P = 0.0007, g = - 1.0) but the hAFO did not (- 11.0 deg [5.1] vs. noAFO, P = 0.05, g = - 0.5). Quasi-stiffness was lower for the hAFO than plsAFO (P = 0.009, g = - 0.7). The dimensionless eversion moment was higher (though not significantly) with the hAFO than noAFO. Neither orthosis reduced ankle power (P = 0.34). Median total QUEST score was higher for the hAFO (4.7 [0.7]) than the plsAFO (3.6 [0.8]) (P < 0.001, g = 1.9).

CONCLUSIONS

The helical orthosis significantly and considerably improved functional gait performance, did not limit ankle mobility, increased lateral stability, though not significantly, and was associated with greater patient satisfaction than the posterior leaf spring orthosis. Trial registration The trial began before registration was mandatory.

The quality of systematic reviews/meta-analyses assessing the effects of ankle-foot orthosis on clinical outcomes in stroke patients: A methodological systematic review

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.

The impact of ankle-foot orthosis's plantarflexion resistance on knee adduction moment in people with chronic stroke

BACKGROUND

An ankle-foot orthosis (AFO) is used to assist gait of people with chronic stroke. It is widely accepted that AFO's plantarflexion resistance affects sagittal knee moments during their gait. However, its effect on the coronal knee moment remains unclear. This study aimed to examine the effects of varying articulated AFO's plantarflexion resistance on knee adduction moment in people with chronic stroke.

METHODS

Ten people with chronic stroke participated in this study. Gait performance was measured using a Vicon 3-dimensional motion capture system and a Bertec split-belt instrumented treadmill. The participants walked on the treadmill wearing an articulated AFO whose plantarflexion resistance could be systematically adjusted. The ankle joints were set to four distinct levels of plantarflexion resistance (S1 < S2 < S3 < S4). The coronal ankle and knee joint moment, center of pressure, and ground reaction force were analyzed using Visual3D.

RESULTS

The external knee adduction moment increased significantly ( P < .001) and the position of the center of pressure trajectory shifted significantly ( P = .003) in the medial direction as the plantarflexion resistance of the AFO was increased from the least resistive condition (S1) to the most resistive condition (S4). The maximum knee adduction moment (median [interquartile range]) was S1: 0.097 (-0.012 to 0.265) Nm/kg; S2: 0.136 (0.040 to 0.287) Nm/kg; S3: 0.160 (0.465 to 0.289) Nm/kg; and S4: 0.192 (0.080 to 0.288) Nm/kg.

CONCLUSIONS

This study demonstrated that varying AFO's plantarflexion resistance altered the knee adduction moment, likely by altering the center of pressure trajectory while walking, in people with chronic stroke.

The effects of anterior and posterior ankle-foot orthoses on sit-to-stand transfer performance in stroke patients

BACKGROUND

Nonarticulated and low-temperature thermoplastic ankle-foot orthoses (AFOs) have a semirigid design and are effective in improving the postural control mechanism (PCM) in individuals with poststroke hemiparesis. AFOs with an anterior leaf (AAFOs) are more often prescribed than are AFOs with a posterior leaf (PAFOs); however, the effects of AAFOs on the PCM during sit-to-stand transfer (STST) have not been explored.

RESEARCH QUESTIONS

Do AAFOs and PAFOs change the PCM differently during STST?

METHODS

A cross-sectional quasi-experimental design was adopted in this study. Fourteen individuals with poststroke hemiparesis (10 men and 4 women, aged between 38 and 71 years, stroke onset between 1 and 17 months) performed STST with shoes only, an AAFO with shoes, or a PAFO with shoes. Vertical ground reaction force (VGRF) and center-of-pressure (CoP) coordinates were collected using a pressure mat to calculate PCM parameters. A single-factor repeated measures analysis of variance was performed to answer the research question.

RESULTS

(1) The weight-bearing percentage of the paretic leg was significantly lower when the participants wore a PAFO (p = 0.018) than when they wore an AAFO (p = 0.019) during the first 5 and 5-10 s after rising. (2) A small rate of change of the VGRF increment (dF/dT) was detected when participants wore AFOs, particularly AAFO. (3) The maximum mediolateral displacement of the CoP when standing up was significantly different among the three conditions (p = 0.012).

SIGNIFICANCE

For patients with poststroke hemiparesis, AAFO and PAFOs change the PCM during STST performance. Only AAFO improved the PCM possibly because of the rigidity and clearance of the heel region, which provide somatic sensory feedback. Therefore, rehabilitation professionals should educate hemiplegic patients who use AAFOs or PAFOs to perform dynamic daily tasks slowly for their safety.

Anterior or Posterior Ankle Foot Orthoses for Ankle Spasticity: Which One Is Better?

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.

Does Gait with an Ankle Foot Orthosis Improve or Compromise Minimum Foot Clearance?

The purpose of this study was to investigate if the use of an ankle foot orthosis in passive mode (without actuation) could modify minimum foot clearance, and if there are any compensatory mechanisms to enable these changes during treadmill gait at a constant speed. Eight participants walked on an instrumented treadmill without and with an ankle foot orthosis on the dominant limb at speeds of 0.8, 1.2, and 1.6 km/h. For each gait cycle, the minimum foot clearance and some gait linear kinematic parameters were calculated by an inertial motion capture system. Additionally, maximum hip and knee flexion and maximum ankle plantar flexion were calculated. There were no significant differences in the minimum foot clearance between gait conditions and lower limbs. However, differences were found in the swing, stance and step times between gait conditions, as well as between limbs during gait with orthosis (p < 0.05). An increase in hip flexion during gait with orthosis was observed for all speeds, and different ankle ranges of motion were observed according to speed (p < 0.05). Thus, the use of an ankle foot orthosis in passive mode does not significantly hinder minimum foot clearance, but can change gait linear and angular parameters in non-pathological individuals.

Analysis of Gait Characteristics Using Hip-Knee Cyclograms in Patients with Hemiplegic Stroke

Gait disturbance is a common sequela of stroke. Conventional gait analysis has limitations in simultaneously assessing multiple joints. Therefore, we investigated the gait characteristics in stroke patients using hip-knee cyclograms, which have the advantage of simultaneously visualizing the gait kinematics of multiple joints. Stroke patients (n = 47) were categorized into two groups according to stroke severity, and healthy controls (n = 32) were recruited. An inertial measurement unit sensor-based gait analysis system, which requires placing seven sensors on the dorsum of both feet, the shafts of both tibias, the middle of both femurs, and the lower abdomen, was used for the gait analysis. Then, the hip-knee cyclogram parameters (range of motion, perimeter, and area) were obtained from the collected data. The coefficient of variance of the cyclogram parameters was obtained to evaluate gait variability. The cyclogram parameters differed between the stroke patients and healthy controls, and differences according to stroke severity were also observed. The gait variability parameters mainly differed in patients with more severe stroke, and specific visualized gait patterns of stroke patients were obtained through cyclograms. In conclusion, the hip-knee cyclograms, which show inter-joint coordination and visualized gait cycle in stroke patients, are clinically significant.

Classification of Ankle Joint Stiffness during Walking to Determine the Use of Ankle Foot Orthosis after Stroke

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.