ABSTRACT
BACKGROUND: Ankle-foot orthoses (AFO) have been used to improve the gait of individuals post stroke, but their use has come into question secondary to increased understanding of motor re-learning. OBJECTIVES: The purpose of this study was to determine if there is a change in tibialis anterior muscle electromyography, ankle angle, or gait velocity when individuals post stroke walk with a posterior leaf-spring AFO (PLAFO) or a dynamic ankle orthosis (DAO). STUDY DESIGN: Repeated measures. METHODS: Fifteen participants post stroke walked without an orthosis, with a PLAFO, and with a DAO. Data were gathered using electromyography, force plates, and three-dimensional motion analysis cameras. A repeated measures ANOVA was used to test for statistical significance (p ≤ 0.05). RESULTS: Participants exhibited significantly less tibialis anterior muscle electromyography during the swing phase of gait with use of a DAO (p < 0.001). No change in velocity or ankle angle was exhibited with use of either orthosis. CONCLUSIONS: The results support therapists' notions that bracing can lead to a decline in tibialis anterior muscle activity during the swing phase of gait. The results also showed no improvement in gait velocity when either orthosis was used by participants who could walk without an orthosis.
Subject(s)
Ankle Joint/physiology , Gait/physiology , Muscle, Skeletal/physiology , Orthotic Devices , Range of Motion, Articular/physiology , Stroke/physiopathology , Walking/physiology , Adult , Aged , Ankle , Biomechanical Phenomena , Electromyography , Female , Foot , Humans , Male , Middle Aged , Motor Activity/physiology , Reproducibility of Results , Video RecordingABSTRACT
The purpose of this study was to determine the effects of prolonged standing on gait characteristics in children with spastic cerebral palsy. Six children with spastic cerebral palsy participated in this study with an average age of 6.5 years (SD = 2.5, range = 4.0-9.8 years). A reverse baseline design (A-B-A) was used over a 9-week period. During phase A, the children received their usual physical therapy treatment. During phase B, children received the prolonged standing program three times per week, in addition to their usual physical therapy treatment. During phase A2, children received their usual physical therapy treatment. Gait analysis and clinical assessment of spasticity were performed before and after each phase. Analysis of variance (ANOVA) for repeated measurements was used to test for changes in gait measures across the four measurement sessions. Friedman's was used to test for changes in muscle tone (Modified Ashworth Scale) across the four measurement sessions. Stride length (p <.001), gait speed (p <.001), stride time (p <.001), stance phase time (p <.001), double support time (p <.003), muscle tone (p <.02), and peak dorsiflexion angle during midstance (p <.004) improved significantly following the intervention phase. The results of this study demonstrate that the gait pattern of children with cerebral palsy classified as level II or III on the Gross Motor Functional Classification System (GMFCS) improved by a prolonged standing program. However, these improvements were not maintained at 3 weeks. Further research is necessary with larger sample sizes to replicate these findings and determine specific "dosing" for standing programs to create long-lasting functional effects on gait.
