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Guo J, Yang J, Pu J, Ma F. Biomechanical investigation of a custom-made insole to decrease plantar pain of children with flatfoot: A technical note. Med Eng Phys 2023; 121:104070. [PMID: 37985027 DOI: 10.1016/j.medengphy.2023.104070] [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: 07/24/2023] [Revised: 10/09/2023] [Accepted: 11/05/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE The abnormal plantar pressure of flatfoot patients is a common condition. The main objective of the present study was to investigate the effect of custom-molded insole on the plantar pain of flatfoot METHODS: 105 patients (representing 174 feet) participated in evaluating a custom-made orthotic insole from June 2018 to March 2019. The height of the navicular tubercle (HNT) and the deflection angle of calcaneus (DAC) in flatfoot patients after using orthotic insoles for 6 months were recorded by X-ray imaging and scanning measurements. Plantar pressure on metatarsals 1-5 was measured by using an RSscan system RESULTS: Without the use of an orthotic insole, mean HNT was 0.99±0.34 cm and mean DAC was 20.0 ± 3.78 ° during the bearing weight. After using the insole, mean HNT and DAC values reduced to 0.87±0.30 cm and 14.3 ± 3.45 °, respectively (P < 0.05). Hindfoot plantar pressure did not change significantly (P > 0.05). Furthermore, pressure at metatarsals 1-3 decreased by 48.5 %, 45.6 %, and 14.3 %, respectively; that at metatarsals 4-5 increased by 33.3 % and 137.5 %, separately, when using the custom-made insole CONCLUSIONS: Visual analog scale score for plantar pain was significantly reduced. These findings indicate that metatarsal pain of flatfoot patients might be the cause of load imbalance in plantar foot.
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Affiliation(s)
- Junchao Guo
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China.
| | - Jiemeng Yang
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China
| | - Jingyu Pu
- The Second Center Kindergarten of Yinghai Town, Daxing District, Beijing, PR China
| | - Fengling Ma
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, 100176 Beijing, PR China
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Hwang S, Song CS. Assistive Technology Involving Postural Control and Gait Performance for Adults with Stroke: A Systematic Review and Meta-Analysis. Healthcare (Basel) 2023; 11:2225. [PMID: 37570466 PMCID: PMC10418390 DOI: 10.3390/healthcare11152225] [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: 06/29/2023] [Revised: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
This study aimed to comprehensively summarize assistive technology devices for postural control and gait performance in stroke patients. In the study, we searched for randomized controlled trials (RCTs) published until 31 December 2022 in four electrical databases. The most frequently applied assistive technology devices involving postural stability and gait function for stroke patients were robot-assistive technology devices. Out of 1065 initially retrieved citations that met the inclusion criteria, 30 RCTs (12 studies for subacute patients and 18 studies for chronic patients) were included in this review based on eligibility criteria. The meta-analysis included ten RCTs (five studies for subacute patients and five for chronic patients) based on the inclusion criteria of the data analysis. After analyzing, the variables, only two parameters, the Berg balance scale (BBS) and the functional ambulation category (FAC), which had relevant data from at least three studies measuring postural control and gait function, were selected for the meta-analysis. The meta-analysis revealed significant differences in the experimental group compared to the control group for BBS in both subacute and chronic stroke patients and for the FAC in chronic stroke patients. Robot-assistive training was found to be superior to regular therapy in improving postural stability for subacute and chronic stroke patients but not gait function. This review suggests that robot-assistive technology devices should be considered in rehabilitative approaches for postural stability and gait function for subacute and chronic stroke patients.
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Affiliation(s)
- Sujin Hwang
- Department of Physical Therapy, Division of Health Science, Baekseok University, Cheonan 31065, Republic of Korea;
- The Graduate School of Health Welfare, Baekseok University, Seoul 06695, Republic of Korea
| | - Chiang-Soon Song
- Department of Occupational Therapy, College of Natural Science and Public Health and Safety, Chosun University, Gwangju 61452, Republic of Korea
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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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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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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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Ramstrand N, Stevens PM. Clinical outcome measures to evaluate the effects of orthotic management post-stroke: a systematic review. Disabil Rehabil 2021; 44:3019-3038. [PMID: 33438496 DOI: 10.1080/09638288.2020.1859630] [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: 10/22/2022]
Abstract
PURPOSE To identify, and classify, according to International Classification of Functioning, Disability and Health (ICF), clinically applicable outcome measures that have been used to evaluate lower limb orthotic management post-stroke and to investigate which outcome measures recorded the largest effect sizes. MATERIALS AND METHODS Electronic searches were performed in Pubmed, Cochrane, Web of Science, Cinahl, Scopus and Embase databases from inception to May 2020. Articles were included if they investigated clinical outcomes in people post-stroke who had received a lower-limb orthotic intervention. RESULTS 88 articles underwent full-text review and 54 were included in the review, which was performed in accordance with the Preferred Reporting Items for Systematic Review (PRISMA) principles. 48 different outcome measures were identified; effect sizes were able to be calculated from 39 studies. The most frequently applied outcome measures were the 10-metre Walk Test and the timed-up-and-go test. Outcome measures that recorded large effect sizes in two or more studies were the 10-metre Walk Test, Functional Reach Test, and Physiological Cost Index. When coded according to the ICF, the most frequently represented codes were d450 (Walking) and d455 (moving around). CONCLUSIONS Results suggest that outcome measures related to mobility (ICF chapter d4) are most often applied to evaluate orthotic management post-stroke. Effect sizes appear to be greatest in outcome measures related to velocity, balance, and energy expenditure.IMPLICATIONS FOR REHABILITATIONThe 10-meter Walk Test appears to have the greatest effect size when evaluating orthotic management post-stroke.While outcome measures related to mobility are commonly applied when evaluating orthotic management post-stroke, rehabilitation professionals should consider complementing these with measures representing the participation domain of the ICF.
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Affiliation(s)
- Nerrolyn Ramstrand
- CHILD Research Group, Department of Rehabilitation, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Phillip M Stevens
- Department of Clinical and Scientific Affairs, Hanger Clinic, Salt Lake City, UT, USA.,Department of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, USA
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Nikamp CDM, Hobbelink MSH, van der Palen J, Hermens HJ, Rietman JS, Buurke JH. The effect of ankle-foot orthoses on fall/near fall incidence in patients with (sub-)acute stroke: A randomized controlled trial. PLoS One 2019; 14:e0213538. [PMID: 30861038 PMCID: PMC6414023 DOI: 10.1371/journal.pone.0213538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/19/2019] [Indexed: 11/29/2022] Open
Abstract
Falls are commonly reported post-stroke. Ankle-foot orthoses (AFOs) are often provided to improve safety and walking, but the effect of their use in the reduction of falls after stroke is unknown. A randomized controlled trial (RCT) on the effects of AFO-provision after stroke was performed. Effects on clinical scales, 3D-gait kinematics and muscle-activity were previously reported. This paper aims to study the effects of AFO-provision on occurrence and circumstances of falls/near falls. The RCT included unilateral hemiparetic stroke patients. AFOs were provided either early (study week 1) or delayed (study week 9). Both groups were compared in the first eight weeks of the study and diaries were used to register falls/near falls and their circumstances. Follow-up measurements were performed in week 9–52, in which both groups were provided with AFOs. Functional Ambulation Categories and Berg Balance Scale were assessed to determine walking independence and balance, respectively. Last known scores were noted in case of an incident. Thirty-three subjects were included (16 early, 17 delayed). In week 1–8, the early group, who were provided with AFOs, fell significantly more frequently compared with the delayed group, 11 versus 4 times, respectively (Incidence Rate Ratio = 2.9, p = 0.039). Out of the falls recorded in the early group, 63.6% occurred without wearing AFOs. Most of these falls occurred during transfers (36.4%) and standing (27.3%), and notably it were the subjects who did not have independent walking ability. No differences were found for near falls in week 1–8, or for falls/near falls in week 9–52. Six severe consequences (including fractures) were reported from a fall. To conclude, the subjects provided with AFOs early after stroke reported a higher number of falls, compared to the subjects that had not yet been provided with AFOs. However, in the subjects provided with AFOs, 63.6% of the falls occurred whilst without wearing the AFO. Furthermore, the majority of these incidents took place whilst subjects had no independent walking ability. This raises an interesting question of the importance of careful instructions to patients and their relatives, and the influence of potential cognitive impairments on the ability of the subjects to take on these instructions.
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Affiliation(s)
- Corien D. M. Nikamp
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- * E-mail:
| | | | - Job van der Palen
- Medisch Spectrum Twente, Medical School Twente, Enschede, the Netherlands
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, the Netherlands
| | - Hermie J. Hermens
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Johan S. Rietman
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomechanical Engineering, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Roessingh Center for Rehabilitation, Enschede, the Netherlands
| | - Jaap H. Buurke
- Roessingh Research and Development, Enschede, the Netherlands
- Department of Biomedical Signals and Systems, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Kobayashi T, Orendurff MS, Hunt G, Gao F, LeCursi N, Lincoln LS, Foreman KB. The effects of alignment of an articulated ankle-foot orthosis on lower limb joint kinematics and kinetics during gait in individuals post-stroke. J Biomech 2018; 83:57-64. [PMID: 30503257 DOI: 10.1016/j.jbiomech.2018.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 11/27/2022]
Abstract
Mechanical tuning of an ankle-foot orthosis (AFO) is important in improving gait in individuals post-stroke. Alignment and resistance are two factors that are tunable in articulated AFOs. The aim of this study was to investigate the effects of changing AFO ankle alignment on lower limb joint kinematics and kinetics with constant dorsiflexion and plantarflexion resistance in individuals post-stroke. Gait analysis was performed on 10 individuals post-stroke under four distinct alignment conditions using an articulated AFO with an ankle joint whose alignment is adjustable in the sagittal plane. Kinematic and kinetic data of lower limb joints were recorded using a Vicon 3-dimensional motion capture system and Bertec split-belt instrumented treadmill. The incremental changes in the alignment of the articulated AFO toward dorsiflexion angles significantly affected ankle and knee joint angles and knee joint moments while walking in individuals post-stroke. No significant differences were found in the hip joint parameters. The alignment of the articulated AFO was suggested to play an important role in improving knee joint kinematics and kinetics in stance through improvement of ankle joint kinematics while walking in individuals post-stroke. Future studies should investigate long-term effects of AFO alignment on gait in the community in individuals post-stroke.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Prosthetics and Orthotics, Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Hokkaido, Japan; Orthocare Innovations, Edmonds, WA, USA.
| | - Michael S Orendurff
- Orthocare Innovations, Edmonds, WA, USA; Motion & Sports Performance Laboratory, Department of Pediatric Orthopedics, Lucille Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Grace Hunt
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Fan Gao
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | | | | | - K Bo Foreman
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, USA
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Kobayashi T, Orendurff MS, Hunt G, Gao F, LeCursi N, Lincoln LS, Foreman KB. The effects of an articulated ankle-foot orthosis with resistance-adjustable joints on lower limb joint kinematics and kinetics during gait in individuals post-stroke. Clin Biomech (Bristol, Avon) 2018; 59:47-55. [PMID: 30145413 PMCID: PMC6234099 DOI: 10.1016/j.clinbiomech.2018.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 07/12/2018] [Accepted: 08/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Resistance is a key mechanical property of an ankle-foot orthosis that affects gait in individuals post-stroke. Triple Action® joints allow independent adjustment of plantarflexion resistance and dorsiflexion resistance of an ankle-foot orthosis. Therefore, the aim of this study was to investigate the effects of incremental changes in dorsiflexion and plantarflexion resistance of an articulated ankle-foot orthosis with the Triple Action joints on lower limb joint kinematics and kinetics in individuals post-stroke during gait. METHODS Gait analysis was performed on 10 individuals who were post-stroke under eight resistance settings (four plantarflexion and four dorsiflexion resistances) using the articulated ankle-foot orthosis. Kinematic and kinetic data of the lower limb joints were recorded while walking using a three-dimensional Vicon motion capture system and a Bertec split-belt instrumented treadmill. FINDINGS Repeated measures analysis of variance revealed that adjustment of plantarflexion resistance had significant main effects on the ankle (P < 0.001) and knee (P < 0.05) angles at initial contact, while dorsiflexion resistance had significant (P < 0.01) main effects on the peak dorsiflexion angle in stance. Plantarflexion and dorsiflexion resistance adjustments appeared to affect the peak knee flexor moment in stance, but no significant main effects were revealed (P = 0.10). Adjustment of plantarflexion resistance also demonstrated significant (P < 0.05) main effects in the peak ankle positive power in stance. INTERPRETATION This study demonstrated that the adjustments of resistance in the ankle-foot orthosis with the Triple Action joints influenced ankle and knee kinematics in individuals post-stroke. Further work is necessary to investigate the long-term effects of the articulated ankle-foot orthoses on their gait.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Prosthetics and Orthotics, Faculty of Health Sciences, Hokkaido University of Science, Sapporo, Hokkaido, Japan; Orthocare Innovations, Edmonds, WA, USA.
| | - Michael S Orendurff
- Orthocare Innovations, Edmonds, WA, USA; Lucille Packard Children's Hospital, Stanford University, Motion & Sports Performance Laboratory, Palo Alto, CA, USA
| | - Grace Hunt
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, USA
| | - Fan Gao
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
| | | | | | - K Bo Foreman
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, USA
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