Gait and Muscle Activity Changes in Patients in the Recovery Phase of Stroke with Continuous Use of Ankle–Foot Orthosis with Plantarflexion Resistance

Murayama, Minoru; Yamamoto, Sumiko

doi:10.2490/prm.20200021

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…In this study, gait was measured continuously after stroke onset until approximately 2 to 3 months later and included the recovery phase of gait ability, as in Lee et al and Branco et al In contrast, there was no significant change in the %EMG of each muscle. Murayama et al showed that using an AFO that provided plantarflexion resistance without limiting plantarflexion in loading response for 2 months resulted in an increase in the activity ratio of tibialis anterior in loading response 5) . In the present study, no change was observed after 1 month of use, so a longer period of time may be required to realize a change in muscle activity.…”

Section: Resultsmentioning

confidence: 99%

“…However, the effect of KAFOs on knee extensor muscle activity and joint motion in stroke patients during the recovery phase has not been reported. In addition, Murayama et al showed that long-term use of AFOs providing plantarflexion resistance without limiting plantarflexion in loading response resulted in an increase in the activity ratio of the tibialis anterior in loading response 5) . Therefore, using a KAFO with an adjustable knee joint that does not fix the knee joint during extension may increase the muscle activity ratio during the stance phase…”

Section: Introductionmentioning

confidence: 99%

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Knee joint movement and muscle activity changes in stroke hemiplegic patients on continuous use of knee-ankle-foot orthosis with adjustable knee joint

Murayama

2021

J Phys Ther Sci

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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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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Knee joint movement and muscle activity changes in stroke hemiplegic patients on continuous use of knee-ankle-foot orthosis with adjustable knee joint

Murayama

2021

J Phys Ther Sci

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“…During the swing phase, the activity of the tibialis anterior lifts the foot and toe to obtain foot clearance 23 . In general, AFO can improve foot clearance during the swing and stance phases 24 .…”

Section: Discussionmentioning

confidence: 99%

Machine learning analysis to predict the need for ankle foot orthosis in patients with stroke

Choo

Kim

et al. 2021

Sci Rep

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We investigated the potential of machine learning techniques, at an early stage after stroke, to predict the need for ankle–foot orthosis (AFO) in stroke patients. We retrospectively recruited 474 consecutive stroke patients. The need for AFO during ambulation (output variable) was classified according to the Medical Research Council (MRC) score for the ankle dorsiflexor of the affected limb. Patients with an MRC score of < 3 for the ankle dorsiflexor of the affected side were considered to require AFO, while those with scores ≥ 3 were considered not to require AFO. The following demographic and clinical data collected when patients were transferred to the rehabilitation unit (16.20 ± 6.02 days) and 6 months after stroke onset were used as input data: age, sex, type of stroke (ischemic/hemorrhagic), motor evoked potential data on the tibialis anterior muscle of the affected side, modified Brunnstrom classification, functional ambulation category, MRC score for muscle strength for shoulder abduction, elbow flexion, finger flexion, finger extension, hip flexion, knee extension, and ankle dorsiflexion of the affected side. For the deep neural network model, the area under the curve (AUC) was 0.887. For the random forest and logistic regression models, the AUC was 0.855 and 0.845, respectively. Our findings demonstrate that machine learning algorithms, particularly the deep neural network, are useful for predicting the need for AFO in stroke patients during the recovery phase.

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“…We also hypothesized that participants would present with increased soleus activity relative to baseline when the exosuit resistance was removed as short-term retention, and that this increased activity would result in increased peak plantarflexion angle [ 63 , 64 ]. Although we did not find significant retention in soleus activity for any force level, the applied plantarflexion resistance led to significant short-term after-effects in peak plantarflexion angle at the HIGH condition.…”

Section: Discussionmentioning

confidence: 99%

Ankle resistance with a unilateral soft exosuit increases plantarflexor effort during pushoff in unimpaired individuals

Swaminathan

Park

Raza

et al. 2021

J NeuroEngineering Rehabil

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Background Ankle-targeting resistance training for improving plantarflexion function during walking increases rehabilitation intensity, an important factor for motor recovery after stroke. However, understanding of the effects of resisting plantarflexion during stance on joint kinetics and muscle activity—key outcomes in evaluating its potential value in rehabilitation—remains limited. This initial study uses a unilateral exosuit that resists plantarflexion during mid-late stance in unimpaired individuals to test the hypotheses that when plantarflexion is resisted, individuals would (1) increase plantarflexor ankle torque and muscle activity locally at the resisted ipsilateral ankle, but (2) at higher forces, exhibit a generalized response that also uses the unresisted joints and limb. Further, we expected (3) short-term retention into gait immediately after removal of resistance. Methods Ten healthy young adults walked at 1.25 m s−1 for four 10-min discrete bouts, each comprising baseline, exposure to active exosuit-applied resistance, and post-active sections. In each bout, a different force magnitude was applied based on individual baseline ankle torques. The peak resistance torque applied by the exosuit was 0.13 ± 0.01, 0.19 ± 0.01, 0.26 ± 0.02, and 0.32 ± 0.02 N m kg−1, in the LOW, MED, HIGH, and MAX bouts, respectively. Results (1) Across all bouts, participants increased peak ipsilateral biological ankle torque by 0.13–0.25 N m kg−1 (p < 0.001) during exosuit-applied resistance compared to corresponding baselines. Additionally, ipsilateral soleus activity during stance increased by 5.4–11.3% (p < 0.05) in all but the LOW bout. (2) In the HIGH and MAX bouts, vertical ground reaction force decreased on the ipsilateral limb while increasing on the contralateral limb (p < 0.01). Secondary analysis found that the force magnitude that maximized increases in biological ankle torque without significant changes in limb loading varied by subject. (3) Finally, peak ipsilateral plantarflexion angle increased significantly during post-exposure in the intermediate HIGH resistance bout (p < 0.05), which corresponded to the greatest average increase in soleus activity (p > 0.10). Conclusions Targeted resistance of ankle plantarflexion during stance by an exosuit consistently increased local ipsilateral plantarflexor effort during active resistance, but force magnitude will be an important parameter to tune for minimizing the involvement of the unresisted joints and limb during training.

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Gait and Muscle Activity Changes in Patients in the Recovery Phase of Stroke with Continuous Use of Ankle–Foot Orthosis with Plantarflexion Resistance

Cited by 11 publications

References 18 publications

Knee joint movement and muscle activity changes in stroke hemiplegic patients on continuous use of knee-ankle-foot orthosis with adjustable knee joint

Knee joint movement and muscle activity changes in stroke hemiplegic patients on continuous use of knee-ankle-foot orthosis with adjustable knee joint

Machine learning analysis to predict the need for ankle foot orthosis in patients with stroke

Ankle resistance with a unilateral soft exosuit increases plantarflexor effort during pushoff in unimpaired individuals

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