Previous studies have suggested that the use of an ankle-foot orthosis may cause disuse atrophy of the tibialis anterior muscle. The objective of this study was to explore gait and muscle activity changes in patients in the recovery phase of stroke with 2-month use of an ankle-foot orthosis that provided plantarflexion resistance. Methods: The participants were 19 patients in the recovery phase of stroke who were prescribed an ankle-foot orthosis that provided plantarflexion resistance. We measured ankle and shank tilt angles as well as electromyography activity of the tibialis anterior and the soleus during 10-m walk tests. Measurements were taken on three occasions. The first was 2 weeks after delivery of the orthosis, 1 and 2 months after the initial measurement, and the third 2 months later. Changes in gait parameters were analyzed between the first and second measurements and between the second and third measurements. Results: Between the second and third measurements, significant increases were observed in plantarflexion and shank forward tilt angles and the activity ratio of the tibialis anterior during loading response compared with other phases. Conclusions: Plantarflexion movement induced by an ankle-foot orthosis with plantarflexion resistance could increase the activity ratio of the tibialis anterior during loading response.

We aimed to evaluate knee joint movement and muscle activity ratio changes in stroke hemiplegic patients in recovery phase after using a knee-ankle-foot orthosis with an adjustable knee joint for 1 month; we also aimed to discuss the practical implications of our findings. [Participants and Methods] The participants were 8 hemiplegic patients in the recovery phase of stroke who were prescribed knee-ankle-foot orthosis with adjustable knee joint. We measured knee joint angles and electromyographic activity of the vastus medialis and biceps femoris during walking in two conditions: the knee-ankle-foot orthosis knee joint fixed in the extended position and the knee joint moved from 0° to 30° in the flexion direction. Measurements were taken 2 weeks after completion to account for habituation of the orthosis and repeated 1 month later. [Results] When the knee joint was moving from 0° to 30° in the flexion direction, the knee joint angle at initial contact and the minimum flexion angle of the gait cycle decreased significantly between the first and second measurements. When knee joint flexion was 30°, the muscle activity ratio of the vastus medialis increased significantly in the loading response and mid-stance compared to when it was fixed. [Conclusion] Setting the knee joint of a knee-ankle-foot orthosis in accordance with the knee joint movement may increase the muscle activity ratio of the vastus medialis from loading response to mid-stance.

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Objective：This study aimed to clarify the actual functions and issues associated with the work of a full-time prosthetist and orthotist while treating patients and users at a rehabilitation hospital.Methods：Using a database that recorded the work performed by the full-time prosthetist and orthotist, the details of the work performed over the course of a year were classified into eight categories and tabulated by stage and item.Results：A total of 1,300 responses were collected for the one-year study period, of which participation in replacement of consumables and damage repair, adjustment of conformity, and brace clinic conferences accounted for 54.0%. Ankle-foot orthosis was the most common response(59.2%) , and was more frequently associated with the living phase (76.3%)than the recovery phase(46.5%) . The response numbers for all items per prescription in the recovery phase were as follows：prosthetic legs, 11.1 times；ankle-foot orthoses, 3.7 times；and knee ankle-foot orthoses, 2.2 times. Thus, the responses for knee ankle-foot orthoses were less frequent than those for the other two.Conclusion：The maintenance of ankle-foot orthoses in the living phase and prosthetic legs in the recovery phase was well supported by a full-time prosthetist and orthotist. On the other hand, users of knee ankle-foot orthoses may have received less support.