Effect of different designs of ankle-foot orthoses on gait in patients with stroke: A systematic review

Daryabor, Aliyeh; Arazpour, Mokhtar; Aminian, Gholamreza

doi:10.1016/j.gaitpost.2018.03.026

Cited by 87 publications

(82 citation statements)

References 43 publications

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“…Our ndings showed chronic stroke subjects had signi cant improvement in gait independency and enhanced gait con dence at heel strike after 20-session gait training wearing this robot for stair and over-ground gait training [18]. Similar ankle rehabilitation robotics have also shown their potential to be an alternative gait rehabilitation for stroke [19][20][21][22][23], examples are Anklebot [8] and ReStore (ReWalk Robotics, USA) [24]. Nevertheless, few existing researches investigated into the potential of ankle robotics in facilitating stair training.…”

Section: Introductionmentioning

confidence: 72%

“…The ankle robot in SCAR acted as a swing-controlled orthosis, which switched between locked and unlocked ankle joint based on the gait phases [13]. Whenever the robot detected terminal stance as the foot was lifted up from the ground, the ankle joint was locked by the servomotor in the neutral position to prevent foot drop condition during swing phase for foot clearance [20]. When heel strike and foot contact with the ground were detected, the servomotor released the ankle joint to allow unimpeded forward ankle rocker during stance phase.…”

Section: Interventionmentioning

confidence: 99%

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Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

Yeung

Lau

Lai

et al. 2020

Preprint

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Background: Wearable ankle robotics could potentially facilitate intensive repetitive task-specific gait training on stair environment for stroke rehabilitation. A lightweight (0.5kg) and portable exoskeleton ankle robot was designed to facilitate over-ground and stair training either providing active assistance to move paretic ankle augmenting residual motor function (power-assisted ankle robot, PAAR), or passively support dropped foot by lock/release ankle joint for foot clearance in swing phase (swing-controlled ankle robot, SCAR).In this two-center randomized controlled trial, we hypothesized that robot-assisted gait training using either PAAR or SCAR in stair environment are more effective to enhance gait recovery and promote independency in early stroke, than conventional training.Methods: Sub-acute stroke survivors (within two months after stroke onset) received hospital usual care plus 20-session robot-assisted training (at least twice weekly, 30-minute per session) on over-ground and stair environments, wearing PAAR (n=14) or SCAR (n=16), as compared to control group receiving conventional training only (CT, n=17). PAAR provided 2.5Nm-4.2Nm torque which was calibratedin each training session to adjust for any progression of functional changes throughout the intervention. Clinical assessments were performed before and after the 20-session intervention, including functional ambulatory categoryas primary outcome measure, along with Berg balance scale and timed 10-metre walk test.Results: After the 20-session interventions, all three groups showed statistically significant and clinically meaningful within-group functional improvement in all outcome measures (p<0.005). Between-group comparison showed SCAR had greater improvement in functional ambulatory category(mean difference +0.6, medium effect size 0.610) with more than 56% independent walkers after training, as compared to only 29% for CT. Analysis of covariance results showed PAAR had greater improvement in walking speed than SCAR (mean difference +0.15m/s, large effect size 0.752), which was in line with the higher cadence and speed when wearing the robot during the 20-session robot-assisted training over-ground and on stairs.Conclusions: Robot-assisted stair training would lead to greater functional improvement in gait independency and walking speed than conventional training in usual care. The active powered ankle assistance might facilitate users to walk more and faster with their paretic leg during stair and over-ground walking.Trial Registration:ClinicalTrials.gov NCT03184259. Registered on 12 June 2017.

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Section: Introductionmentioning

confidence: 72%

Section: Interventionmentioning

confidence: 99%

Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

Yeung

Lau

Lai

et al. 2020

Preprint

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“…TA works in dorsiflexion, where it keeps ω during P1 [44], and ensures toe clearance during P4 [37]. Meanwhile, G is responsible for plantarflexion, where it maintains the forward force during P2 to avoid over-extending [45]. In this case, the reduction of TA and G muscle activity is expected when assisted by the MR brake with appropriate stiffness because it has the same working principle, which restricts the foot movement.…”

Section: B Data Processing and Analysismentioning

confidence: 99%

Improving Passive Ankle Foot Orthosis System Using Estimated Ankle Velocity Reference

Adiputra¹,

Rahman

Ubaidillah

et al. 2020

IEEE Access

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This study aims to investigate an appropriate ankle velocity reference (ωref), which is the average ankle velocity of a certain healthy subject when walking with a certain walking speed. The goal is to improve a Passive Controllable Ankle Foot Orthosis (PICAFO) by implementing the ankle velocity reference. Firstly, the function to estimate ωref, based on walking speed and body mass index (BMI), is obtained from 16 able-bodied subjects walking gait data. The effect of controlled stiffness (based on ωref) to the user's ankle kinematics and muscle activity was evaluated by comparing it to other settings, such as walking barefooted and various constant damping stiffness (0%, 30%, 60%, and 100% of the maximum damping stiffness). Two able-bodied subjects (normal and overweight) participated in the evaluation, where they had to walk at two different walking speeds (1 and 2 km/h). The result showed that ankle kinematics and muscle activity were improved when ω was controlled during walking speed of 1 km/h for both subjects. In terms of ankle kinematics, the toe clearance occurred, and walking stability increased. In terms of muscle activity, the average muscle activity had reduced by ~29% for the normal subject and by ~57% for an overweight subject, which shows that PICAFO provides necessary damping stiffness to replace the muscle works partially. In the future, by using the ωref based on walking speed and BMI, the therapists can skip the trial and error process of finding an appropriate PICAFO prescription for a post-stroke patient.

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“…Although, the flexible rigid AFO has no effect on the power output of the limb in the horizontal axis [25], it affects the power output in the vertical axis because of unnecessary restrictions on the plantar flexion, which is comparable to the rigid AFO [15,26]. Meanwhile, the articulated AFO is equipped with an actuator for controlling the mechanical properties according to the gait control strategy, and thus, it is more useful compared to the flexible rigid and rigid AFOs [27].…”

Section: Types Of Afo Structuresmentioning

confidence: 99%

A Review on the Control of the Mechanical Properties of Ankle Foot Orthosis for Gait Assistance

et al. 2019

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In the past decade, advanced technologies in robotics have been explored to enhance the rehabilitation of post-stroke patients. Previous works have shown that gait assistance for post-stroke patients can be provided through the use of robotics technology in ancillary equipment, such as Ankle Foot Orthosis (AFO). An AFO is usually used to assist patients with spasticity or foot drop problems. There are several types of AFOs, depending on the flexibility of the joint, such as rigid, flexible rigid, and articulated AFOs. A rigid AFO has a fixed joint, and a flexible rigid AFO has a more flexible joint, while the articulated AFO has a freely rotating ankle joint, where the mechanical properties of the AFO are more controllable compared to the other two types of AFOs. This paper reviews the control of the mechanical properties of existing AFOs for gait assistance in post-stroke patients. Several aspects that affect the control of the mechanical properties of an AFO, such as the controller input, number of gait phases, controller output reference, and controller performance evaluation are discussed and compared. Thus, this paper will be of interest to AFO researchers or developers who would like to design their own AFOs with the most suitable mechanical properties based on their application. The controller input and the number of gait phases are discussed first. Then, the discussion moves forward to the methods of estimating the controller output reference, which is the main focus of this study. Based on the estimation method, the gait control strategies can be classified into subject-oriented estimations and phase-oriented estimations. Finally, suggestions for future studies are addressed, one of which is the application of the adaptive controller output reference to maximize the benefits of the AFO to users.

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Effect of different designs of ankle-foot orthoses on gait in patients with stroke: A systematic review

Cited by 87 publications

References 43 publications

Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

Effects of Wearable Ankle Robotics for Stair and Over-ground Training on Sub-acute Stroke: A Randomized Controlled Trial

Improving Passive Ankle Foot Orthosis System Using Estimated Ankle Velocity Reference

A Review on the Control of the Mechanical Properties of Ankle Foot Orthosis for Gait Assistance

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