Karen J Nolan1, Mathew Yarossi. 1. Kessler Foundation Research Center, Human Performance and Movement Analysis Laboratory & Traumatic Brain Injury Laboratory, West Orange, New Jersey 07052, USA. knolan@kesslerfoundation.org
Abstract
BACKGROUND: Identifying and understanding the changes in transfer of momentum that are directly affected by orthotic intervention are significant factors related to the improvement of mobility in individuals with hemiplegia. OBJECTIVES: The purpose of this investigation was to use a novel analysis technique to objectively measure weight transfer during double support (DS) in healthy individuals and individuals with hemiplegia secondary to stroke with and without an ankle foot orthosis. STUDY DESIGN: Prospective, Repeated measures, case-controlled trial. METHODS: Participants included 25 adults with stroke-related hemiplegia >6 months using a prescribed ankle foot orthosis and 12 age-matched healthy controls. Main outcome measures included the weight transfer point timing (WTP, %DS), maximum total force timing (MTF, %DS), timing difference between WTP and MTF (MTF-WTP, %DS) and the linearity of loading (LOL, R(2)) during the DS phase of the gait cycle. RESULTS: The WTP and LOL were significantly different between conditions with and without the ankle foot orthosis for the affected and unaffected limb in post-stroke individuals, p ≤ 0.01. The MTF and difference in timing between MTF-WTP were significantly different during affected limb loading with and without the ankle foot orthosis in the stroke group, p ≤ 0.0001 and p = 0.03, respectively. MTF, MTF-WTP and LOL were significantly different between individuals with stroke (during affected limb loading) and healthy controls (during right limb loading). CONCLUSIONS: This research established a systematic method for analysing weight transfer during walking to evaluate the effect of an ankle foot orthosis on loading during double support in hemiplegic gait. This novel method can be used to elucidate biomechanical mechanisms behind orthosis-mediated changes in gait patterns and quantify functional mobility outcomes in rehabilitation. CLINICAL RELEVANCE: This novel approach to orthotic assessment will provide the clinician with needed objective evidence to select the most effective orthotic intervention to maximize functional recovery for individuals with hemiplegia secondary to stroke.
BACKGROUND: Identifying and understanding the changes in transfer of momentum that are directly affected by orthotic intervention are significant factors related to the improvement of mobility in individuals with hemiplegia. OBJECTIVES: The purpose of this investigation was to use a novel analysis technique to objectively measure weight transfer during double support (DS) in healthy individuals and individuals with hemiplegia secondary to stroke with and without an ankle foot orthosis. STUDY DESIGN: Prospective, Repeated measures, case-controlled trial. METHODS:Participants included 25 adults with stroke-related hemiplegia >6 months using a prescribed ankle foot orthosis and 12 age-matched healthy controls. Main outcome measures included the weight transfer point timing (WTP, %DS), maximum total force timing (MTF, %DS), timing difference between WTP and MTF (MTF-WTP, %DS) and the linearity of loading (LOL, R(2)) during the DS phase of the gait cycle. RESULTS: The WTP and LOL were significantly different between conditions with and without the ankle foot orthosis for the affected and unaffected limb in post-stroke individuals, p ≤ 0.01. The MTF and difference in timing between MTF-WTP were significantly different during affected limb loading with and without the ankle foot orthosis in the stroke group, p ≤ 0.0001 and p = 0.03, respectively. MTF, MTF-WTP and LOL were significantly different between individuals with stroke (during affected limb loading) and healthy controls (during right limb loading). CONCLUSIONS: This research established a systematic method for analysing weight transfer during walking to evaluate the effect of an ankle foot orthosis on loading during double support in hemiplegic gait. This novel method can be used to elucidate biomechanical mechanisms behind orthosis-mediated changes in gait patterns and quantify functional mobility outcomes in rehabilitation. CLINICAL RELEVANCE: This novel approach to orthotic assessment will provide the clinician with needed objective evidence to select the most effective orthotic intervention to maximize functional recovery for individuals with hemiplegia secondary to stroke.