Immediate synergistic effect of a trunk orthosis with joints providing resistive force and an ankle-foot orthosis on hemiplegic gait.

PURPOSE: The synergistic effects of a trunk orthosis and an ankle-foot orthosis (AFO) in stroke patients with a hemiplegic gait are unclear. We previously developed a trunk orthosis with joints providing resistive force (TORF) to modify malalignment of the trunk and pelvis and confirmed its positive effects in stroke patients during level walking without an AFO. The aim of the present study was to determine if this trunk orthosis and an AFO have synergistic effects during level walking in community-dwelling patients with chronic stroke. METHODS: Twenty-eight community-dwelling stroke patients performed level walking at a self-selected speed with an AFO and again while wearing a TORF (TORF group) or a corset (control group). Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. RESULTS: When compared with the control group, the TORF group showed significant increases in walking speed, number of steps on the paretic leg per minute, and peak ankle plantar flexion moment during the single stance phase. CONCLUSION: The TORF increased the ankle joint plantar flexion moment at the end of the single stance phase during level walking in stroke patients, leading to an increase in their gait speed because of the modified trunk and pelvis alignment.

Sit-to-walk Task in Hemiplegic Stroke Patients: Relationship between Movement Fluidity and the Motor Strategy in Initial Contact.

PURPOSE: Generally, stroke patients can walk and stand up fluidly but fulfill the sit-to-walk (STW) task with difficulty. The purpose of this study was to investigate the relationship between movement fluidity and motor strategy in the initial contact of the STW task. METHOD: Thirty stroke patients and ten healthy subjects performed the STW task from a sitting position, and their movement was measured by a motion analysis system. The differences in data between patients and healthy subjects were analyzed using the Mann-Whitney U test. The relationship between fluidity index (FI) and other indices (kinetic and kinematic data in STW, functional independence measure [FIM], and Fugl-Meyer Assessment [FMA]) were analyzed using Spearman's rank correlation coefficient. RESULTS: The stroke patients had lower FI values than the healthy subjects and exhibited shortened step length and prolonged duration from onset to the first stance leg off. FI values correlated with trunk flexure angle at initial contact, first step length, and maximum vertical floor reaction force. The independent level of the FIM of stair climbing and walking ability and the FMA of balance also correlated with FI. CONCLUSION: There is a possibility that poor balance is one of the reasons why stroke patients are unable to start walking fluently from the sitting position. To perform the STW fluidly, patients must start walking before the trunk extension is fully completed. The relationship between FI and indices of physical ability, namely stair climbing and balance, may have therapeutic benefits for coaching the STW task to stroke patients.

Immediate-term effects of use of an ankle-foot orthosis with an oil damper on the gait of stroke patients when walking without the device.

BACKGROUND: An ankle-foot orthosis using an oil damper is designed to enable natural movement of the ankle joint. Wearing an ankle-foot orthosis using an oil damper has been demonstrated to assist the first rocker in stroke patients, but its effect on their gait when not wearing it is unclear. OBJECTIVES: To determine the effect of use of ankle-foot orthosis using an oil damper on the gait of stroke patients with hemiparesis when not wearing the ankle-foot orthosis. STUDY DESIGN: Crossover study. METHODS: The gait of eight stroke patients in the chronic phase when not wearing an ankle-foot orthosis was measured, using a three-dimensional motion analysis system, before using the ankle-foot orthosis using an oil damper and then without and with using the ankle-foot orthosis using an oil damper after 3 weeks of use. Differences in gait were compared between the three measurement conditions. RESULTS: Use of ankle-foot orthosis using an oil damper significantly decreased preswing time and significantly increased the positive ankle joint power in stance when not wearing the ankle-foot orthosis using an oil damper. CONCLUSIONS: These changes indicate the promising therapeutic effects of ankle-foot orthosis using an oil damper use and suggest the ankle-foot orthosis using an oil damper's potential as a therapeutic device. CLINICAL RELEVANCE: After 3 weeks of use of an ankle-foot orthosis using an oil damper, which assists the first rocker, the gait of stroke patients in the chronic phase when not wearing the ankle-foot orthosis using an oil damper was improved. Preswing time was significantly decreased and positive ankle joint power was significantly increased. The ankle-foot orthosis using an oil damper, which assists the first rocker function with natural movement of the ankle joint during gait, has the potential to improve the gait of stroke patients after immediate-term use.

Change of rocker function in the gait of stroke patients using an ankle foot orthosis with an oil damper: immediate changes and the short-term effects.

BACKGROUND: An ankle foot orthosis (AFO) using an oil damper (AFO-OD) to assist the first rocker during gait was previously developed but the effect on the other rocker functions has not been clarified. OBJECTIVES: The immediate and short-term effects on the gait of stroke patients with the AFO-OD were investigated from the viewpoint of the rocker function. STUDY DESIGN: Crossover study. METHODS: The gait of eight stroke patients in chronic phase without an AFO, with the AFO-OD, and the gait with AFO-OD after three weeks of continuous use and gait training were measured by 3D motion analysis. RESULTS: Immediate changes observed on use of the AFO-OD were improvements in walking speed, the spatiotemporal parameters, and the angular change of dorsiflexion of the ankle joint. Three weeks of continuous AFO-OD use and gait training showed further improvements in walking speed and the spatiotemporal parameters as well as an increase in dorsiflexion angle and plantar flexor moment of the ankle joint of the paretic limb in stance. CONCLUSIONS: These changes produced improvement of the second rocker function, but improvement of the third rocker was insufficient. Results show the importance of gait training to take full advantage of an AFO.