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Effects of lower limb exoskeleton gait orthosis compared to mechanical gait orthosis on rehabilitation of patients with spinal cord injury: A systematic review and future perspectives. Gait Posture 2023; 102:64-71. [PMID: 36933346 DOI: 10.1016/j.gaitpost.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE We aimed to systematically evaluate the walking efficiency of lower limb exoskeleton gait orthosis and mechanical gait orthosis in patients with spinal cord injury. DATA SOURCES Databases searched included: Web of Science, MEDLINE, Cochrane Library and Google Scholar. STUDY SELECTION Articles published in English from 1970 to 2022 investigating the impact of lower limb exoskeleton gait orthosis versus mechanical gait orthosis on gait outcomes in patients with spinal cord injury were considered. DATA EXTRACTION Two researchers independently extracted data and filled out predesigned forms. Information including authors, year of study, methodological quality, participant characteristics, intervention and comparison details, outcomes and results. The primary outcomes were kinematic data; the secondary outcomes were clinical tests. DATA SYNTHESIS Data synthesis using meta-analysis was not possible due to the diversity of study designs, methodologies, and outcome measures. RESULTS A total of 11 trials and 14 types of orthotics were included. The information gathered generally supported the gait improving effects of lower limb exoskeleton gait orthosis and mechanical gait orthosis in both kinematic data and clinical tests among patients with spinal cord injury. CONCLUSIONS This systematic review compared walking efficiency of patients with spinal cord injury wearing powered exoskeleton gait orthosis and non-powered mechanical gait orthosis. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions. Future research should focus on improving trial quality and comprehensive parametric analysis of subjects with different physical conditions.
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Cui Y, Cheng S, Chen X, Xu G, Ma N, Li H, Zhang H, Li Z. Advances in the clinical application of orthotic devices for stroke and spinal cord injury since 2013. Front Neurol 2023; 14:1108320. [PMID: 36873455 PMCID: PMC9981677 DOI: 10.3389/fneur.2023.1108320] [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: 11/25/2022] [Accepted: 01/27/2023] [Indexed: 02/19/2023] Open
Abstract
Stroke and spinal cord injury are common neurological disorders that can cause various dysfunctions. Motor dysfunction is a common dysfunction that easily leads to complications such as joint stiffness and muscle contracture and markedly impairs the daily living activities and long-term prognosis of patients. Orthotic devices can prevent or compensate for motor dysfunctions. Using orthotic devices early can help prevent and correct deformities and treat muscle and joint problems. An orthotic device is also an effective rehabilitation tool for improving motor function and compensatory abilities. In this study, we reviewed the epidemiological characteristics of stroke and spinal cord injury, provided the therapeutic effect and recent advances in the application of conventional and new types of orthotic devices used in stroke and spinal cord injury in different joints of the upper and lower limbs, identified the shortcomings with these orthotics, and suggested directions for future research.
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Affiliation(s)
- Yinxing Cui
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Shihuan Cheng
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Xiaowei Chen
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Guoxing Xu
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Ningyi Ma
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - He Li
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Hong Zhang
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
| | - Zhenlan Li
- Rehabilitation Medicine Department, First Hospital of Jilin University, Changchun, China
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Sinovas-Alonso I, Herrera-Valenzuela D, Cano-de-la-Cuerda R, Reyes-Guzmán ADL, del-Ama AJ, Gil-Agudo Á. Application of the Gait Deviation Index to Study Gait Impairment in Adult Population With Spinal Cord Injury: Comparison With the Walking Index for Spinal Cord Injury Levels. Front Hum Neurosci 2022; 16:826333. [PMID: 35444522 PMCID: PMC9013754 DOI: 10.3389/fnhum.2022.826333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
The Gait Deviation Index (GDI) is a multivariate measure of overall gait pathology based on 15 gait features derived from three-dimensional (3D) kinematic data. GDI aims at providing a comprehensive, easy to interpret, and clinically meaningful metric of overall gait function. It has been used as an outcome measure to study gait in several conditions: cerebral palsy (CP), post-stroke hemiparetic gait, Duchenne muscular dystrophy, and Parkinson’s disease, among others. Nevertheless, its use in population with Spinal Cord Injury (SCI) has not been studied yet. The aim of the present study was to investigate the applicability of the GDI to SCI through the assessment of the relationship of the GDI with the Walking Index for Spinal Cord Injury (WISCI) II. 3D gait kinematics of 34 patients with incomplete SCI (iSCI) was obtained. Besides, 3D gait kinematics of a sample of 50 healthy volunteers (HV) was also gathered with Codamotion motion capture system. A total of 302 (iSCI) and 446 (HV) strides were collected. GDI was calculated for each stride and grouped for each WISCI II level. HV data were analyzed as an additional set. Normal distribution for each group was assessed with Kolmogorov-Smirnov tests. Afterward, ANOVA tests were performed between each pair of WISCI II levels to identify differences among groups (p < 0.05). The results showed that the GDI was normally distributed across all WISCI II levels in both iSCI and HV groups. Furthermore, our results showed an increasing relationship between the GDI values and WISCI II levels in subjects with iSCI, but only discriminative in WISCI II levels 13, 19, and 20. The index successfully distinguished HV group from all the individuals with iSCI. Findings of this study indicated that the GDI is not an appropriate multivariate walking metric to represent the deviation of gait pattern in adult population with iSCI from a normal gait profile when it is compared with the levels of walking impairment described by the WISCI II. Future work should aim at defining and validating an overall gait index derived from 3D kinematic gait variables appropriate for SCI, additionally taking into account other walking ability outcome measures.
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Affiliation(s)
- Isabel Sinovas-Alonso
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
- *Correspondence: Isabel Sinovas-Alonso,
| | - Diana Herrera-Valenzuela
- International Doctoral School, Rey Juan Carlos University, Madrid, Spain
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
| | - Roberto Cano-de-la-Cuerda
- Faculty of Health Sciences, Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Rey Juan Carlos University, Alcorcón, Spain
- Roberto Cano-de-la-Cuerda,
| | | | - Antonio J. del-Ama
- School of Science and Technology, Department of Applied Mathematics, Materials Science, Engineering and Electronic Technology, Rey Juan Carlos University, Móstoles, Spain
| | - Ángel Gil-Agudo
- Biomechanics and Technical Aids Unit, National Hospital for Paraplegics, Toledo, Spain
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McGibbon C, Sexton A, Gryfe P, Dutta T, Jayaraman A, Deems-Dluhy S, Novak A, Fabara E, Adans-Dester C, Bonato P. Effect of using of a lower-extremity exoskeleton on disability of people with multiple sclerosis. Disabil Rehabil Assist Technol 2021:1-8. [DOI: 10.1080/17483107.2021.1874064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Chris McGibbon
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
- Faculty of Kinesiology, University of New Brunswick, Fredericton, Canada
| | - Andrew Sexton
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, Canada
| | - Pearl Gryfe
- Assistive Technology Clinic, Toronto, Canada
| | - Tilak Dutta
- Toronto Rehabilitation Institute, Toronto, Canada
| | - Arun Jayaraman
- Shirley Ryan AbilityLab/Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Susan Deems-Dluhy
- Shirley Ryan AbilityLab/Rehabilitation Institute of Chicago, Chicago, IL, USA
| | | | - Eric Fabara
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Catherine Adans-Dester
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Paolo Bonato
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
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Effects of Ankle Joint Motion on Pelvis-Hip Biomechanics and Muscle Activity Patterns of Healthy Individuals in Knee Immobilization Gait. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2019:3812407. [PMID: 31737239 PMCID: PMC6815642 DOI: 10.1155/2019/3812407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 08/15/2019] [Accepted: 09/07/2019] [Indexed: 11/18/2022]
Abstract
The purpose of the study was to investigate the pelvis-hip biomechanics and trunk and lower limb muscle activity patterns between healthy people walking in two gaits and evaluate the effects of ankle joint motion on these two gaits. The two gaits included walking with combined knee and ankle immobilization and with individual knee immobilization. Ten healthy participants were recruited and asked to walk along a 10 m walk away at their comfortable speeds in the two gaits. Kinematic data, ground reaction force, and electromyography waveforms of trunk and lower limb muscles on the right side were collected synchronously. Compared to individual knee immobilization gait, people walking in the combined knee and ankle immobilization gait increased the range and average angle of the anterior pelvic tilt during the first double support and the single support phase, respectively. The combined knee and ankle immobilization gait also increased the range of hip abduction during the second double support phase. These kinematic alternations caused changes in trunk and lower limb muscle activity patterns. The ankle immobilization increased the range of gluteus maximus activation in the first double support phase, the range of rectus abdominis activation, the average amplitude of rectus femoris activation in the single support phase, and the range of rectus femoris activation in swing phase and decreased the range of and tibialis anterior activation in the first double support phase. The ankle immobilization also increased the average values of proximodistal component in AKI gait during the single support phase. This study revealed significant differences in pelvis-hip biomechanics and trunk and lower limb muscle activity patterns between the two gaits.
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Arazpour M, Gholami M, Bahramizadeh M, Sharifi G, Bani MA. Influence of Reciprocating Link When Using an Isocentric Reciprocating Gait Orthosis (IRGO) on Walking in Patients with Spinal Cord Injury: A Pilot Study. Top Spinal Cord Inj Rehabil 2017; 23:256-262. [PMID: 29339901 DOI: 10.1310/sci16-00016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Studies collectively imply that the reciprocal link has no effect on walking when using reciprocating gait orthoses (RGOs). There may be differences between the 2 configurations of the RGO (eg, isocentric reciprocating gait orthosis [IRGO] and IRGO without reciprocating link), but the specific benefits and problems encountered in their use must be understood. Purpose: To highlight more evidence for the mechanical function of the reciprocal link in RGOs used for walking by individuals with spinal cord injury (SCI). Methods: Nine people with SCI participated in this study. Gait analysis was performed in 2 conditions (walking with IRGO and walking with IRGO without reciprocating link) in a random order. The Vicon digital capture system was used to obtain kinematic data. Results: There were significant differences between each orthotic configuration in terms of speed of walking (p = .029), step length (p = .048), hip joint range of motion (ROM) (p ≤ .001), and lateral and vertical compensatory motions (p ≤ .001). There was no significant difference between each orthotic configuration in cadence (p = .162). Conclusion: The reciprocating link in IRGO improved the walking parameters in SCI patients.
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Affiliation(s)
- Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Milad Gholami
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Mahmood Bahramizadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
| | - Guive Sharifi
- Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Department of Neurosurgery, Tehran, Iran
| | - Monireh Ahmadi Bani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Iran
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Paul S, Vijayakumar R, Mathew L, Sivarasu S. Finite element model-based evaluation of tissue stress variations to fabricate corrective orthosis in feet with neutral subtalar joint. Prosthet Orthot Int 2017; 41:157-163. [PMID: 26979816 DOI: 10.1177/0309364616631344] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The subtalar joint position during static stance is a crucial determinant of the peak plantar pressures and forms ideal reference point for any intervention in foot-related problems for leprosy-affected patients. OBJECTIVES The study pursued the hypothesis through a three-dimensional model that stress will be minimal in the distal joints of the foot when the subtalar joint is in neutral static stance position. STUDY DESIGN Finite element model. METHODS The computed tomography images of the feet for five patients suffering from Hansen's disease having no muscle weakness and joint restriction were acquired. The gray intensities corresponding to the bones of the foot from the computed tomography images were three-dimensionally reconstructed. The three-dimensional model of the human foot, incorporating the realistic geometry, and the material properties of the hard tissues were then analyzed using a finite element solver for the stress distribution on bones of the foot. RESULTS The results demonstrate that the position of the calcaneum in the static stance position does contribute to the varying stress in the foot. CONCLUSION The stresses in the bones of the foot are minimal while the subtalar is in neutral position; this position will be suitable for foot orthotic fabrication. Clinical relevance The clinicians, therapists, and podiatrists having less engineering skills can quickly assess the patient and get optimal results on the stress associated with the joints of the foot.
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Affiliation(s)
| | | | - Lazar Mathew
- 3 PSG Institute of Advanced Studies, Coimbatore, India
| | - Sudesh Sivarasu
- 4 Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Arazpour M, Samadian M, Bahramizadeh M, Ahmadi Bani M, Gharib M, Hosseini SA, Hutchins SW, Mardani MA. The effect of trunk extension on physiological cost index in spinal cord injury patients when using the advanced reciprocating gait orthosis: A pilot study. Prosthet Orthot Int 2016. [PMID: 26209422 DOI: 10.1177/0309364615592700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND People with spinal cord injury walk with a flexed trunk when using reciprocating gait orthoses for walking. Reduction in trunk flexion during ambulation has been shown to improve gait parameters for reciprocating gait orthosis users. OBJECTIVE The aim of this study was to investigate the effect on energy expenditure when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. STUDY DESIGN Quasi experimental study. METHODS Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis after completing a specific gait training program. Patients walked along a flat walkway using the advanced reciprocating gait orthosis as a control condition and also while additionally wearing a thoracolumbosacral orthosis at their self-selected walking speed. A stopwatch and a polar heart rate monitor were used to measure walking speed and heart rate. RESULTS Walking speed, the distance walked, and the physiological cost index all improved when walking with the advanced reciprocating gait orthosis/thoracolumbosacral orthosis test condition compared to walking with no thoracolumbosacral orthosis in situ. CONCLUSION Spinal cord injury patients can improve their walking speed, walking distance, and physiological cost index when wearing a thoracolumbosacral orthosis in conjunction with an advanced reciprocating gait orthosis, which may be attributed to the trunk extension provided by the thoracolumbosacral orthosis. CLINICAL RELEVANCE It is concluded that wearing thoracolumbosacral orthosis in association with an advanced reciprocating gait orthosis could be an effective alternative in rehabilitation for thoracic level of paraplegic patients to promote their health and well-being.
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Affiliation(s)
- Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran.,Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Samadian
- Loghman Hakim hospital, Shahid Beheshti University of Medical Sciences, Department of Neurosurgery, Tehran, Iran
| | - Mahmood Bahramizadeh
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Monireh Ahmadi Bani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Masoud Gharib
- Department of Occupational Therapy, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | - Seyyed Ali Hosseini
- Department of Occupational therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Stephen W Hutchins
- IHSCR, Faculty of Health & Social Care, University of Salford, Manchester, Salford, UK
| | - Mohammad A Mardani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
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The influence of orthosis options on walking parameters in spinal cord-injured patients: a literature review. Spinal Cord 2016; 54:412-22. [PMID: 26857271 DOI: 10.1038/sc.2015.238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 11/26/2015] [Accepted: 12/08/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Orthoses for various joints sections are considered to greatly influence the gait function and energy expenditure in spinal cord-injured (SCI) patients. The aim of this review was to determine the influence of orthoses characteristics and options on the improvement of walking in patients with SCI. METHODS A search was performed using the Population Intervention Comparison Outcome (PICO) method, based on selected keywords; studies were identified electronically in the Science Direct, Google Scholar, Scopus, Web of Knowledge and PubMed databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was used to report the results. Assessment of the quality of all articles was performed based on the Physiotherapy Evidence Database (PEDro scale). RESULTS Twelve studies evaluated the effects of different hip joint options on walking parameters and energy expenditure. Five studies investigated the role of knee joint options on gait parameters and compensatory trunk motion. Only five studies analyzed modified ankle joints on gait parameters in SCI patients. Nine studies analyzed gait parameters in SCI patients as powered orthoses and exoskeleton. These studies had a low level of evidence according to the PEDro score (2/10). CONCLUSION The various joint types of orthoses appear to be critical in the improvement of walking in patients with SCI. In particular, 'user friendly' orthoses that support the related structure such as the hip joint with a reciprocating mechanism, activated knee joint and movable ankle joint with dorsiflexion assist enable SCI patients to optimize their walking pattern when wearing an orthoses system.
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The effect of ankle joint mobility when using an isocentric reciprocating gait orthosis (IRGO) on energy consumption in people with spinal cord injury: preliminary results. Spinal Cord Ser Cases 2015; 1:15017. [PMID: 28053720 DOI: 10.1038/scsandc.2015.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/07/2015] [Accepted: 07/14/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of walking with isocentric reciprocating gait orthoses (IRGOs) utilizing two designs of ankle foot orthoses (AFOs) on specific outcome measures in people with spinal cord injury (SCI). METHODS Four volunteer SCI subjects participated in this study, and were fitted with an IRGO equipped with either solid or dorsiflexion-assisted AFOs in a randomized order. Subjects walked at their self-selected speed along a flat walkway to enable a comparison of walking speed, endurance and the resulting physiological cost index (PCI) to be performed. RESULTS Increased walking speed, increased distance walked and less PCI were demonstrated in walking with the IRGO incorporating dorsiflexion-assisted AFOs as compared to walking with an IRGO plus solid AFO as a control condition. CONCLUSION This study demonstrated that people with SCI could walk at relatively higher speeds and with greater endurance and a reduced PCI when utilizing an IRGO with dorsiflexion-assisted AFO components compared to solid ones. It is therefore concluded that the IRGO incorporating dorsiflexion-assisted AFOs may be an effective alternative in helping to reduce the energy consumption experienced by people with SCI.
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Arazpour M, Gharib M, Hutchins SW, Bani MA, Curran S, Mousavi ME, Saberi H. The influence of trunk extension in using advanced reciprocating gait orthosis on walking in spinal cord injury patients: A pilot study. Prosthet Orthot Int 2015; 39:286-92. [PMID: 24821714 DOI: 10.1177/0309364614531010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 03/14/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND Spinal cord injury patients walk with a flexed trunk when using reciprocating gait orthoses. Reduction of trunk flexion during ambulation may produce an improvement in gait parameters for reciprocating gait orthosis users. OBJECTIVES To investigate the effect on kinematics and temporal-spatial parameters when spinal cord injury patients ambulate with an advanced reciprocating gait orthosis while wearing a thoracolumbosacral orthosis to provide trunk extension. STUDY DESIGN Comparative study between before and after use o thoracolumbosacral orthosis with the advanced reciprocating gait orthoses. METHODS Four patients with spinal cord injury were fitted with an advanced reciprocating gait orthosis and also wore a thoracolumbosacral orthosis. Patients walked along a flat walkway either with or without the thoracolumbosacral orthosis at their self-selected walking speed. Temporal-spatial parameters and lower limb kinematics were analyzed. RESULTS Mean walking speed, step length, and cadence all improved when walking with the thoracolumbosacral orthosis donned compared to the trunk support offered by the advanced reciprocating gait orthosis. Hip and ankle joint ranges of motion were significantly increased when wearing the thoracolumbosacral orthosis during ambulation. CONCLUSION Using an advanced reciprocating gait orthosis when wearing a thoracolumbosacral orthosis can improve walking speed and the step length of walking as compared with walking with an advanced reciprocating gait orthosis, probably due to the extended position of the trunk. CLINICAL RELEVANCE Donning the thoracolumbosacral orthosis produced a relatively extended trunk position in the advanced reciprocating gait orthosis for all the patients included in the study, which resulted in improved gait parameters.
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Affiliation(s)
- Mokhtar Arazpour
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Islamic Republic of Iran
| | - Masoud Gharib
- Department of Occupational Therapy, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran
| | | | - Monireh Ahmadi Bani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Islamic Republic of Iran
| | - Sarah Curran
- Cardiff School of Health Sciences, Cardiff Metropolitan University Cardiff, UK
| | - Mohammad Ebrahim Mousavi
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science, Tehran, Islamic Republic of Iran
| | - Hooshang Saberi
- Brain and Spinal Injuries Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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Kim MJ, Choi YD, Lee JH. Effects of orthosis on balance and gait in healthy adults. J Phys Ther Sci 2015; 27:1993-6. [PMID: 26180365 PMCID: PMC4500028 DOI: 10.1589/jpts.27.1993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 03/14/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study evaluated the effects of an oral orthosis that can change body
alignment on the balance ability and gait of healthy adults. [Subjects and Methods] The
subjects of this study were 21 University students. A gait analyzer was used to analyze
the subjects’ balance ability and gait quality. Two walking speeds were used: 2 km/h, a
comfortable speed, and 4 km/h, a slightly faster walking speed. [Results] The step length,
and base of gait at 2 km/h differed significantly after the intervention. The total step
time and step length increased significantly after the intervention. Furthermore, the
total base of gait decreased significantly after the intervention. The step times of the
left lower limb at 4 km/h differed significantly after the intervention. [Conclusion] The
oral orthosis tested positively affects the balance ability and gait of healthy
adults.
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Affiliation(s)
- Myung-Joon Kim
- Department of Physical Therapy, Kyungdong University, Republic of Korea
| | - Yeong-Deok Choi
- Department of Physical Therapy, Kyungdong University, Republic of Korea
| | - Jung-Ho Lee
- Department of Physical Therapy, Kyungdong University, Republic of Korea
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Arazpour M, Bani MA, Hutchins SW, Curran S, Javanshir MA, Mousavi ME. Influence of orthotic gait training with powered hip orthosis on walking in paraplegic patients. Disabil Rehabil Assist Technol 2014; 9:226-30. [PMID: 24749556 DOI: 10.3109/17483107.2013.807442] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Gait training has been shown to improve the walking performance of spinal cord-injured (SCI) patients. The use of powered hip orthoses (PHO) during gait training is one approach which could potentially improve rehabilitative outcomes for such subjects. The aim of this study was therefore to evaluate the influence of a PHO on the kinematics and temporal-spatial parameters of walking by SCI patients. METHODS Four SCI patients participated in this study. Gait evaluation was performed at baseline and at 10 weeks following intervention with the use of a PHO and gait re-training. Walking speed, step length, vertical and horizontal compensatory motions and hip joint kinematics were analysed prior to and following the training regime. RESULTS Significant increases in walking speed and step length were demonstrated by the SCI patients when walking with the PHO following orthotic gait training. Sagittal plane hip range of motion also increased, but not significantly. However, vertical and horizontal compensatory motions decreased significantly. CONCLUSIONS Positive effects on the kinematics and temporal-spatial parameters of gait by SCI subjects were demonstrated following a period of gait training with a PHO. Further studies are therefore warranted to confirm their long term effects on the rehabilitation of SCI subjects. IMPLICATIONS FOR REHABILITATION Powered hip orthosis could be used by spinal cord injury patients. A major advantage of the orthotic gait training with powered hip orthosis was regeneration of hip movement closer to that of normal human walking. The orthotic gait training with the powered hip orthosis improved the kinematics and temporalspatial parameters in a spinal cord injury patient which also produced near-normal hip joint angle patterns during gait.
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Affiliation(s)
- Mokhtar Arazpour
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Science , Tehran , Iran
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Ahmadi Bani M, Arazpour M, Farahmand F, Mousavi ME, Hutchins SW. The efficiency of mechanical orthoses in affecting parameters associated with daily living in spinal cord injury patients: a literature review. Disabil Rehabil Assist Technol 2014; 10:183-90. [PMID: 24383891 DOI: 10.3109/17483107.2013.875067] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The most simple and common approach in providing standing and walking by subjects with spinal cord injury (SCI) is the use of mechanical orthoses. These include traditional orthoses, medial linkage orthoses (MLOs) and reciprocating gait orthoses (RGOs). Independence, energy expenditure, gait parameters, system reliability and cosmesis are important factors in orthotic design. The aim of this review was to compare the evidence of existing mechanical orthoses to that of other types regarding these factors. METHODS The preferred reporting items for systematic reviews and meta-analyses (PRISMA) method was used by an experience researcher based on selected keywords and their composition and an electronic search was performed in well-known databases. RESULTS Twenty articles were selected for final evaluation. Many were case studies, and also had limited and heterogeneous sample sizes with different instruments used for evaluation. The results of the analysis demonstrated that independence and cosmesis are improved when using MLOs, but gait parameters, energy expenditure and stability are all improved when using RGOs. CONCLUSION Those mechanical orthoses which have reciprocal motion and congruency between the anatomical and orthotic joints have been shown to provide positive effects on patient lifestyles. However, further improvement is needed to more effectively meet the needs of SCI patients. IMPLICATIONS FOR REHABILITATION The most simple and traditional approach to enable standing and walking by people with SCI is use of purely mechanical orthoses. The most important factors that increase rejection rates of orthoses in paraplegia patients are excessive energy expenditure and increased applied force on upper limb joints. Improvement of the structure of mechanical orthoses is needed to improve independence, energy expenditure, and gait parameters, and is an important approach to improve ambulatory function in subjects with paraplegia.
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Affiliation(s)
- Monireh Ahmadi Bani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Science , Tehran , Iran
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Arazpour M, Hutchins SW, Ahmadi Bani M, Curran S, Bahramizadeh M, Saberi H, Mardani MA. The influence of a rocker sole adaptation on gait parameters in spinal cord injury patients ambulating with the advanced reciprocating gait orthosis – a pilot study. Disabil Rehabil Assist Technol 2013; 10:89-92. [DOI: 10.3109/17483107.2013.838805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Arazpour M, Bani MA, Hutchins SW, Curran S, Javanshir MA. The influence of ankle joint mobility when using an orthosis on stability in patients with spinal cord injury: a pilot study. Spinal Cord 2013; 51:750-4. [PMID: 23896671 DOI: 10.1038/sc.2013.78] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/22/2013] [Accepted: 06/25/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Perceived risk of falling is an important factor for people with spinal cord injury (SCI). This study investigated the influence of ankle joint motion on postural stability and walking in people with SCI when using an orthosis. METHODS Volunteer subjects with SCI (n=5) participated in this study. Each subject was fitted with an advanced reciprocating gait orthosis (ARGO) equipped with either solid or dorsiflexion-assist type ankle-foot orthosis (AFOs) and walked at their self-selected speed along a flat walkway to enable the comparison of walking speed, cadence and endurance. A force plate system and a modified Falls Efficacy Scale (MFES) were utilized to measure postural sway and the perceived fear of falling, respectively. RESULTS There were significant differences in the mean MFES scores between two types of orthosis (P=0.023). When using two crutches, there was no significant difference in static standing postural sway in the medio-lateral (M/L) direction (P=0.799), but significant difference in the antero-posterior (A/P) direction (P=0.014). However, during single crutch support, there was a significant difference in both M/L (P=0.019) and A/P (P=0.022) directions. Walking speed (7%) and endurance (5%) significantly increased when using the ARGO with dorsi flexion assisted AFOs. There was no significant deference between two types of orthoses in cadence (P=0.54). CONCLUSIONS Using an ARGO with dorsiflexion-assisted AFOs increased the fear of falling, but improved static postural stability and increased walking speed and endurance, and should therefore be considered as an effective orthosis during the rehabilitation of people with SCI.
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Affiliation(s)
- M Arazpour
- Orthotics and Prosthetics Department, University of Social Welfare and Rehabilitation Science, Tehran, Iran
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