Investigating the underlying biomechanical mechanisms leading to falls in long-term ankle-foot orthosis and functional electrical stimulator users with chronic stroke

Nevisipour, Masood; Honeycutt, Claire F.

doi:10.1016/j.gaitpost.2021.11.025

Cited by 8 publications

(7 citation statements)

References 34 publications

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“…The temporal pro le of locomotor learning as we report across 9 weeks training cannot be directly compared to assistive devices such as AFO's or FES, in which outcomes are often measured after prolonged usage, such as a year, or while wearing the device [21][22]. Implications for neural learning vs generalized neuromuscular re-education are quite different for assistive versus therapeutic devices, across different time-frames, and with respect to functional mobility outcomes [23][24]. Our earlier task-oriented training in persons with HPG showed neuroplasticity in convergent subcortical brain networks subserving locomotor control [25].…”

Section: Clinical and Mechanistic Implications For Neuromuscular Re-e...mentioning

confidence: 92%

Dorsiflexion Specific Ankle Robotics to Enhance Motor Learning After Stroke: A Preliminary Report

Roy,

Hennessie,

Hafer-Macko

et al. 2024

Preprint

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Background Robotics has emerged as a promising avenue for gait retraining of persons with chronic hemiparetic gait and footdrop, yet there is a gap regarding the biomechanical adaptations that occur with locomotor learning. We developed an ankle exoskeleton (AMBLE) enabling dorsiflexion assist-as-needed across gait cycle sub-events to train and study the biomechanics of motor learning stroke. This single-armed, non-controlled study investigates effects of nine hours (9 weeks x 2 sessions/week) locomotor task-specific ankle robotics training on gait biomechanics and functional mobility in persons with chronic hemiparetic gait and foot drop. Subjects include N = 16 participants (8 male, 8 female) age 53 ± 12 years with mean 11 ± 8 years since stroke. All baseline and post-training outcomes including optical motion capture for 3-D gait biomechanics are conducted during unassisted (no robot) over-ground walking conditions. Findings: Robotics training with AMBLE produced significant kinematic improvements in ankle peak dorsiflexion angular velocity (°/s, + 44 [49%], p < 0.05), heel-first foot strikes (%steps, + 14 [15%], p < 0.01) toe-off angle (°, + 83[162%], p < 0.05), and paretic knee flexion (°, + 20 [30%], p < 0.05). Improvements in gait temporal-spatial parameters include increased paretic step length (cm, + 12 [20%], p < 0.05), reduced paretic swing duration (%GC, -3[6%], p < 0.05), and trend toward improved step length symmetry (-16 [11%], p = 0.08). Functional improvements include 10-meter comfortable (m/s, + 13 [16%], p < 0.01) and fastest (m/s, + 13 [15%], p < 0.01) walking velocities, 6-minute timed walk distance (m, + 16 [19%], p < 0.01) and Dynamic Gait Index scores (+ 15 [15%], p < 0.01). Subjects’ perceived improvements surpassed the minimal clinically important difference on the Stroke Impact Scale (SIS) mobility subscale (+ 11 [19%], p < 0.05). Conclusions AMBLE training improves paretic ankle neuromotor control, paretic knee flexion, and gait temporal-distance parameters during unassisted over-ground walking in persons with chronic stroke and foot drop. This locomotor learning indexed by an increase in volitional autonomous (non-robotic) control of paretic ankle across training translated to improvements in functional mobility outcomes. Larger randomized clinical trials are needed to investigate the effectiveness of task-specific ankle robotics, and precise training characteristics to durably improve gait, balance, and home and community-based functional mobility for persons with hemiparetic gait and foot drop. Clinical trial identifier: NCT04594837.

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Section: Clinical and Mechanistic Implications For Neuromuscular Re-e...mentioning

confidence: 92%

Dorsiflexion Specific Ankle Robotics to Enhance Motor Learning After Stroke: A Preliminary Report

Roy,

Hennessie,

Hafer-Macko

et al. 2024

Preprint

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“…A randomized, parallel-group controlled design (RCT) was included in six papers in which one group of the patients used an AFO and the control group was evaluated with only shoes or other AFOs [46][47][48][49][50][51]. One study included a non-randomized parallel-group trial in which participants were not assigned randomly to two groups [52]. Seven papers evaluated the immediate effect of an AFO (without adaptation) [27,29,33,36,40,43,49], and other studies assessed the short-term (< 3 months) [24,26,28,30,31,35,37,38,[40][41][42]44,48,50,52] or long-time effects (> 3 months) [23,34,39,46,47,50,51] of an orthosis.…”

Section: Description Of Studiesmentioning

confidence: 99%

“…One study included a non-randomized parallel-group trial in which participants were not assigned randomly to two groups [52]. Seven papers evaluated the immediate effect of an AFO (without adaptation) [27,29,33,36,40,43,49], and other studies assessed the short-term (< 3 months) [24,26,28,30,31,35,37,38,[40][41][42]44,48,50,52] or long-time effects (> 3 months) [23,34,39,46,47,50,51] of an orthosis. Most studies had small sample sizes (4-61 subjects), and a sample size calculation (power) was reported in five studies [36,42,45,46,49].…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Author/ Year Abe(2009) 37 Assawapalangchai(2017) 38 Cakar(2010) 28 De Sèze(2011) 50 de Wit (2004) 51 Doğan (2011) 25 Erel (2011) 46 Hale(2013) 32 Hyun(2015) 33 Maeda(2009) 23 Nevisipour(2019) 52 Nikamp(2017) 47 Nikamp(2017) 48 Pardo (2015) 40 Pavlik (2008) 39 Simons (2009) 34 Sheffler(2006) 29 Tomioka(2017) 31 Tyson(2009) 36 Tyson(2001) 35 Wang(2005) 43 Yue (2013) 55…”

Section: Author Contributionsmentioning

confidence: 99%

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Contract size changes in the options market: effects on market efficiency and investor behaviour

Park

Ryu

2021

Applied Economics

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Purpose: To determine and compare the effect of ankle-foot orthosis (AFOs) types on functional outcome measurements in individuals with (sub)acute or chronic stroke impairments.Methods: PubMed, Web of Knowledge, Embase, Scopus, ProQuest, and Cochrane were searched from inception until September-2020. Methodological quality assessment of 30 studies was conducted based on the Downs and Black checklist. Functional indices were pooled according to their standardized mean difference (SMD) and 95% confidence intervals (CI) in a random-effect model. A narrative analysis was performed where data pooling was not feasible.Results: Overall pooled results indicated improvements in favor of AFOs versus without for the

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“…However, studies have found that several physical conditions significantly impact the gait parameters of post-stroke patients when applying AFO, including AFO type [ 8 , 9 ], course of disease [ 10 , 11 ], walking velocities [ 12 ], walking loads [ 13 ], adaptability designs [ 14 ], and walking slopes [ 15 ]. In addition, the Brunnstrom stage (BS) is a major influencing factor.…”

Section: Introductionmentioning

confidence: 99%

Effects of ankle–foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial

Wu,

Meng,

Yang

et al. 2024

Eur J Med Res

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Background Ankle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO. Methods Twenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed. Results All 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05). Conclusions Post-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.

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Investigating the underlying biomechanical mechanisms leading to falls in long-term ankle-foot orthosis and functional electrical stimulator users with chronic stroke

Cited by 8 publications

References 34 publications

Dorsiflexion Specific Ankle Robotics to Enhance Motor Learning After Stroke: A Preliminary Report

Dorsiflexion Specific Ankle Robotics to Enhance Motor Learning After Stroke: A Preliminary Report

Contract size changes in the options market: effects on market efficiency and investor behaviour

Effects of ankle–foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial

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