Efficacy of Knee–Ankle–Foot Orthosis on Functional Mobility and Activities of Daily Living in Patients with Stroke: A Systematic Review of Case Reports

Kobayashi, Eiji; Hiratsuka, Kenta; Haruna, Hussein; Kojima, Nobue; Himuro, Nobuaki

doi:10.2340/jrm.v54.87

Cited by 9 publications

(4 citation statements)

References 37 publications

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“…For these patients, KAFOs enable assisted gait training by immobilizing the knee joint in extension during the stance phase and preventing knee buckling ( 7 , 8 , 10 , 19 ). However, the effect of gait training with a KAFO on improving gait ability has not been fully investigated ( 15 ). Therefore, in the present study, paretic lower extremity muscle activity during assisted walking with a KAFO was investigated in acute hemiplegic stroke patients with severe gait disturbances, as well as its association with the improvement of walking independence.…”

Section: Discussionmentioning

confidence: 99%

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Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance

Hayashi,

Yamazaki,

Komatsu

et al. 2024

Front. Neurol.

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IntroductionA knee-ankle-foot orthosis (KAFO) prevents knee buckling during walking and enables gait training for acute hemiplegic stroke patients with severe gait disturbances. Although the goal of gait training with a KAFO is to improve gait ability, that is, to acquire walking with an ankle-foot orthosis (AFO), it is not clear how gait training with a KAFO contributes to improving gait ability. Therefore, this study aimed to investigate the relationship between muscle activities during walking with a KAFO and the improvement of gait ability in hemiplegic stroke patients with severe gait disturbance.MethodsA prospective cohort study was conducted. Fifty acute hemiplegic stroke patients who could not walk with an AFO participated. Muscle activities of the paretic rectus femoris, biceps femoris, tibialis anterior, and soleus were assessed with surface electromyogram during walking with a KAFO. Electromyograms were assessed at the beginning of gait training and at the time the Ambulation Independence Measure score improved by 3 or higher, or discharge.ResultsEven in patients with complete hemiplegia, paretic rectus femoris, biceps femoris, and soleus showed periodic muscle activity during walking with a KAFO. Twenty-three patients improved to an Ambulation Independence Measure score of 3 or higher and were able to walk with an AFO (good recovery group). At the beginning of gait training, paretic rectus femoris muscle activity during the first double-limb support phase was significantly higher in the good recovery group than in the poor recovery group. The rectus femoris muscle activity significantly increased from before to after acute rehabilitation, which consisted mainly of gait training with a KAFO.DiscussionFor acute hemiplegic stroke patients with severe disturbance, the induction and enhancement of paretic quadriceps muscle activity during walking with a KAFO play an important role in acquiring walking with an AFO.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, the goal of gait training with a KAFO is to enable gait training with an AFO and eventually achieve independent walking with an AFO (7)(8)(9)(10)(11). However, the effectiveness of gait training with a KAFO on improving gait ability has not been fully investigated (15).…”

Section: Introductionmentioning

confidence: 99%

Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance

Hayashi,

Yamazaki,

Komatsu

et al. 2024

Front. Neurol.

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“…These can be in addition to knee collapse and backing of the knee due to gait posture in stroke patients [ 27 ]. Therefore, patients with stroke generally undergo gait training using knee-ankle-foot orthosis (KAFO) or ankle-foot orthosis (AFO) from the acute to sub-acute stages of stroke rehabilitation [ 28 , 29 , 30 ]. A previous study reported that the early wearing of KAFO was associated with higher recovery of ADL for stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Safety and Feasibility Study of the Medical Care Pit Walking Support System for Rehabilitation of Acute Stroke Patients

Watanabe,

Mathis,

Ueno

et al. 2023

JCM

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Stroke rehabilitation with mechanical assistance improves outcomes by facilitating repetition and relieving the care burden of therapy staff. Here, we tested the Medical Care Pit (MCP) walking assistance training device in the rehabilitation of eight acute stroke patients (median age 60.7 ± 16.3 years) who had recently suffered ischemic (three) or hemorrhagic (five) stroke (14.1 ± 6.5 days). Patients received standard rehabilitation approximately 5 days per week (weekdays only), plus MCP therapy twice a week, totaling four MCP sessions over 2 weeks. Fugl–Meyer Assessment-Lower Extremities (FMA-LE), Functional Ambulation Category (FAC), and other gait-associated parameters were measured. Over the 10.5 ± 1.6 days of therapy, MCP qualitatively assisted in gait analysis and real-time patient feedback while independent walking scores significantly improved (FAC 2.2 ± 0.8 to 3.1 ± 1.3, p = 0.020). FMA-LE scores also slightly improved but not to significance (p = 0.106). Objective burden on patients, as measured by modified Borg scale, was significantly improved (2.7 ± 1.6 to 2.0 ± 1.6, p = 0.014). In terms of questionnaires, anxiety scores for the physical therapist regarding gait training and falling with MCP significantly decreased (3.8 ± 2.3 to 1.0 ± 1.6; p = 0.027 and 3.1 ± 2.2 to 0.8 ± 1.3; p = 0.045) from the first to fourth sessions. Taken together, MCP, in addition to the usual rehabilitation program, was effective in gait rehabilitation for independent walking and relieved burdens on the patients. Such walking support systems may be an important part of acute stroke rehabilitation.

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“…Clinically meaningful improvement in functional mobility promoted active rehabilitation and facilitated quick recovery in patients with stroke by KAFO were reported. 15 , 16 , 17 , 18 , 19 , 20 , 21 KAFO allowed patients to gain stability in paralyzed foot and walked with better dynamic balance. 21 ASAP employed a set of KAFO (Gait Innovation (Dial Lock) + GS Double Klenzak) which was designed to be shared in the hospital with quickly and easily adjustable circumference of thigh cuff, heights of lower leg cuff, knee joint and thigh cuff by the lever and slides.…”

Section: Methodsmentioning

confidence: 99%

Proactive outcome monitoring and standardisation of physiotherapy stroke rehabilitation — A retrospective functional outcomes analysis of Accelerated Stroke Ambulation Programme (ASAP)

Chung

Lau

2023

Hong Kong Physiother. J.

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Background: A clinical quality improvement programme named Accelerated Stroke Ambulation Programme (ASAP) was piloted in Physiotherapy Department of Tai Po Hospital from 1st October 2019 to 30th September 2020 and executed as a standard practice afterwards. The goal of ASAP was to facilitate early maximal walking ability of stroke patients in early rehabilitation phase. ASAP featured (1) proactive outcome monitoring and standardised process compliance monitoring by a patient database — Stroke Registry; (2) standardised mobility prediction by Reference Modified Rivermead Mobility Index (MRMI) Gain and (3) standardised intervention database — Stroke Treatment Library. Objective: To investigate the effectiveness of ASAP in an inpatient rehabilitation setting for stroke patients in terms of functional outcomes. Methods: The design was a retrospective comparative study to analyse the difference in functional outcomes of Pre-ASAP Group (1st October 2018 - 30th September 2019) and Post-ASAP Group (1st October 2020–30th September 2021). The primary outcome measures were MRMI, Berg’s Balance Scale (BBS), Modified Barthel Index (MBI), MRMI Gain, BBS Gain, MBI Gain, MRMI Efficiency, BBS Efficiency and MBI Efficiency. Results: There 348 subjects in Pre-ASAP Group and 281 subjects in Post-ASAP Group. Both groups had highly significant within-group improvement in MRMI, BBS and MBI ([Formula: see text]). The MRMI Gain of Pre-ASAP Group and Post-ASAP Group was 6.32 and 7.42, respectively; and the difference was significant ([Formula: see text]). The BBS Gain of Pre-ASAP Group and Post-ASAP Group was 8.17 and 9.70, respectively; and the difference was in margin of significance ([Formula: see text]). The MBI Gain of Pre-ASAP Group and Post-ASAP Group was 10.69 and 11.96, respectively; but the difference was non-significant ([Formula: see text]). The MRMI Efficiency, BBS Efficiency and MBI Efficiency of Post-ASAP Group were higher than Pre-ASAP Group but the difference was non-significant. The results of this study reflected that stroke rehabilitation programme with proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database was practical in real clinical practice with better functional outcomes than traditional physiotherapy practice which were dominated by personal preference and experience of therapists. Conclusion: Proactive outcome monitoring, standardised process compliance monitoring, standardised mobility prediction and standardised intervention database may enhance the effectiveness in terms of functional outcomes of stroke rehabilitation programme.

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Efficacy of Knee–Ankle–Foot Orthosis on Functional Mobility and Activities of Daily Living in Patients with Stroke: A Systematic Review of Case Reports

Cited by 9 publications

References 37 publications

Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance

Quadriceps muscle activity during walking with a knee ankle foot orthosis is associated with improved gait ability in acute hemiplegic stroke patients with severe gait disturbance

Safety and Feasibility Study of the Medical Care Pit Walking Support System for Rehabilitation of Acute Stroke Patients

Proactive outcome monitoring and standardisation of physiotherapy stroke rehabilitation — A retrospective functional outcomes analysis of Accelerated Stroke Ambulation Programme (ASAP)

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