The effect of a modified elastic band orthosis on gait and balance in stroke survivors

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.

Lower-Limb Exosuits for Rehabilitation or Assistance of Human Movement: A Systematic Review

Background: The aim of this review is to provide a comprehensive overview of the technological state-of-the-art of exosuits and the clinical results obtained when applied to users with mobility impairment. Methods: Searches are carried out in the COCHRANE, PubMed, IEEE Xplore and MEDLINE databases. Titles, abstracts and full texts are screened for inclusion criteria. Technological and clinical data are extracted. The quality of the studies is evaluated via a study quality assessment tool. Results: 19 studies are identified as relevant. Active (47%) and passive exosuits (53%) are used. Most are used untethered (84%), accommodating the demand of mobility. No study reports power consumption, which is important for dimensioning power systems. Fields of applications are post-stroke (79%), osteoarthritis (16%) and post-trauma (5%). Mostly the ankle joint is addressed (57%), while less studies address multiple joints (21%). The outcomes of clinical evaluations of lower-limb exosuits with patients suffering from mobility impairments are positive in the correction of gait pattern and reducing metabolic energy consumption during hemiparetic walking. Conclusions: Lower-limb exosuits for clinical applications are still facing technological challenges. Fields of application are limited to stroke, osteoarthritis and trauma. While clinical outcomes are overall positive, improvements in the study protocols are suggested.

Effects of elastic neutral ankle-foot orthoses on 3 dimensional parameters during gait training in patients with stroke: A pilot study

BACKGROUND

General ankle-foot orthosis (AFO) cannot be flexibly adjusted to volumetric change in the lower leg because the molding is custom-fit. Thus, we developed a flexible assistive device called elastic neutral AFO (EN-AFO) to help stroke patients hold a neutral ankle position. The purpose of this study was to investigate the effects of EN-AFO and improve gait patterns in stroke patients with rearfoot varus deformity.

METHODS

Fifteen stroke patients with a varus deformity of the foot performed a walking test with and without the use of EN-AFO. Kinematic data were measured with a 3D motion analysis system with inertial measurement unit (IMU) sensors.

RESULTS

In the stance phase, maximal pelvic tilt and maximal ankle dorsiflexion in the affected side changed, and maximal and minimal pelvic tilts and maximal hip abduction in the less-affected limb effectively changed, as well. During the swing phase, minimal pelvic tilt and minimal ankle abduction in the affective limb greatly changed; particularly, the reduction of maximal ankle inversion was significantly cleared.

CONCLUSIONS

The EN-AFO was effective in controlling the tendency of foot inversion in patients with varus deformities. This is suitable for gait training, as it can adjust the orthosis stiffness according to the foot condition.

Immediate Effects of Ankle-Foot Orthosis Using Wire on Static Balance of Patients with Stroke with Foot Drop: A Cross-Over Study

The aim of this study was to investigate the immediate static balance effects of bare foot, UD-Flex ankle–foot orthosis (AFO), and AFO using wire (AOW) of patients with stroke with foot drop. Seventeen patients with stroke with foot drop (8 men and 9 women) were randomized to three conditions (bare foot, UD-Flex AFO, or AOW made with a flexible material). Static balance was assessed using the Zebris (Zebris GmbH, Isny, Germany) and BioRescue (RM Ingenierie, Rodez, France) pressure platform by a single examiner, who did not design the AOW. The order of testing with the equipment was random. The center of pressure path length (mm) measured using Zebris showed significant differences among the three conditions (bare foot, 484.47 ± 208.42; UD-Flex AFO, 414.59 ± 144.43; AOW, 318.29 ± 157.60) (p < 0.05). The bare-foot condition was not significantly different from the UD-Flex AFO condition (p > 0.05), but was significantly different from the AOW condition (p < 0.05). The surface area ellipse (mm²) measured using BioRescue showed significant differences among the three conditions (bare foot, 241.35 ± 153.76; UD-Flex AFO, 277.41 ± 381.83; AOW, 68.06 ± 48.98) (p < 0.05). The bare-foot condition was not significantly different from the UD-Flex AFO condition (p > 0.05), but the AOW condition was significantly different from the bare-foot (p < 0.05) and from the UD-Flex AFO conditions (p < 0.05). We suggest using the AOW made of flexible materials and wire instead of the UD-Flex AFO to improve immediate static balance of patients with stroke with foot drop after stroke. Further studies on the effects of dynamic balance and gait are required.

Wearable tubing assistive walking device immediately enhances gait parameters in subjects with stroke: A randomized controlled study

BACKGROUND

Stroke patients develop compensatory movements due to limitations of ankle dorsiflexion and knee flexion. To solve the limitations, there are many adjustable walking assistive devices such as robotic devices, ankle-foot orthoses, and functional electric stimulation in rehabilitation session. However, these assistive devices have some disadvantages, including expense and discomforts. Therefore, the development of a new assistive device for stroke patients is needed to assist ankle dorsiflexion and knee flexion.

OBJECTIVE

This study investigated the effects of a wearable tubing assistive walking device (WTAWD) on gait parameters (gait speed, cadence, and step length and stride length on affected and less affected sides) in patients with stroke.

METHODS

Gait parameters were measured using the GAITRite system. One-way repeated measures analysis of variance was used to determine gait differences under three conditions (WTAWD, barefoot, and conventional elastic band orthosis).

RESULTS

Gait speed, cadence, and step length and stride length on both affected and less affected sides were significantly greater with WTAWD, compared to barefoot and conventional elastic band orthosis conditions.

CONCLUSION

WTAWD could be effective for patients with stroke.