Corien D M Nikamp1, Job van der Palen2, Hermie J Hermens3, Johan S Rietman4, Jaap H Buurke3. 1. Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands; Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. Electronic address: c.nikamp@rrd.nl. 2. Medisch Spectrum Twente, Medical School Twente, P.O. Box 50 000, 7500 KA, Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. 3. Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands; Department of Biomedical Signals and Systems, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. 4. Roessingh Research and Development, P.O. Box 310, 7500 AH, Enschede, The Netherlands; Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands; Department of Amputation and Orthopedics, Roessingh Center for Rehabilitation, P.O. Box 310, 7500 AE, Enschede, The Netherlands.
Abstract
BACKGROUND: Compensatory pelvis, hip- and knee movements are reported after stroke to overcome insufficient foot-clearance. Ankle-foot orthoses (AFOs) are often used to improve foot-clearance, but the optimal timing of AFO-provision post-stroke is unknown. Early AFO-provision to prevent foot-drop might decrease the development of compensatory movements, but it is unknown whether timing of AFO-provision affects post-stroke kinematics. RESEARCH QUESTIONS: 1) To compare the effect of AFO-provision at two different points in time (early versus delayed) on frontal pelvis and hip, and sagittal hip and knee kinematics in patients with sub-acute stroke. Effects were assessed after 26 weeks; 2) To study whether possible changes in kinematics or walking speed during the 26-weeks follow-up period differed between both groups. METHOD: An explorative randomized controlled trial was performed, including unilateral hemiparetic patients maximal six weeks post-stroke with indication for AFO-use. Subjects were randomly assigned to AFO-provision early (at inclusion) or delayed (eight weeks later). 3D gait-analysis with and without AFO was performed in randomized order. Measurements were performed in study-week 1, 9, 17 and 26. RESULTS:Twenty-six subjects (15 early, 11 delayed) were analyzed. After 26 weeks, no differences in kinematics were found between both groups for any of the joint angles, both for the without and with AFO-condition. Changes in kinematics during the 26-weeks follow-up period did not differ between both groups for any of the joint angles during walking without AFO. Significant differences in changes in walking speed during the 26-weeks follow-up were found (p = 0.034), corresponding to the first eight weeks after AFO-provision. SIGNIFICANCE: Results indicate that early or delayed AFO-use post-stroke does not influence pelvis, hip and knee movements after 26 weeks, despite that AFO-use properly corrected drop-foot. AFOs should be provided to improve drop-foot post-stroke, but not with the intention to influence development of compensatory patterns around pelvis and hip.
RCT Entities:
BACKGROUND: Compensatory pelvis, hip- and knee movements are reported after stroke to overcome insufficient foot-clearance. Ankle-foot orthoses (AFOs) are often used to improve foot-clearance, but the optimal timing of AFO-provision post-stroke is unknown. Early AFO-provision to prevent foot-drop might decrease the development of compensatory movements, but it is unknown whether timing of AFO-provision affects post-stroke kinematics. RESEARCH QUESTIONS: 1) To compare the effect of AFO-provision at two different points in time (early versus delayed) on frontal pelvis and hip, and sagittal hip and knee kinematics in patients with sub-acute stroke. Effects were assessed after 26 weeks; 2) To study whether possible changes in kinematics or walking speed during the 26-weeks follow-up period differed between both groups. METHOD: An explorative randomized controlled trial was performed, including unilateral hemipareticpatients maximal six weeks post-stroke with indication for AFO-use. Subjects were randomly assigned to AFO-provision early (at inclusion) or delayed (eight weeks later). 3D gait-analysis with and without AFO was performed in randomized order. Measurements were performed in study-week 1, 9, 17 and 26. RESULTS: Twenty-six subjects (15 early, 11 delayed) were analyzed. After 26 weeks, no differences in kinematics were found between both groups for any of the joint angles, both for the without and with AFO-condition. Changes in kinematics during the 26-weeks follow-up period did not differ between both groups for any of the joint angles during walking without AFO. Significant differences in changes in walking speed during the 26-weeks follow-up were found (p = 0.034), corresponding to the first eight weeks after AFO-provision. SIGNIFICANCE: Results indicate that early or delayed AFO-use post-stroke does not influence pelvis, hip and knee movements after 26 weeks, despite that AFO-use properly corrected drop-foot. AFOs should be provided to improve drop-foot post-stroke, but not with the intention to influence development of compensatory patterns around pelvis and hip.
Authors: Corien D M Nikamp; Marte S H Hobbelink; Job van der Palen; Hermie J Hermens; Johan S Rietman; Jaap H Buurke Journal: PLoS One Date: 2019-03-12 Impact factor: 3.240
Authors: Agnes Sturma; Othmar Schuhfried; Timothy Hasenoehrl; Clemens Ambrozy; Stefan Salminger; Laura A Hruby; Johannes A Mayer; Kirsten Götz-Neumann; Richard Crevenna; Michaela M Pinter; Oskar C Aszmann Journal: PLoS One Date: 2019-04-17 Impact factor: 3.240
Authors: Ling-Fung Yeung; Cathy C Y Lau; Charles W K Lai; Yannie O Y Soo; Man-Lok Chan; Raymond K Y Tong Journal: J Neuroeng Rehabil Date: 2021-01-29 Impact factor: 4.262