Deans' stroke musings: Ankle–foot orthosis with dorsiflexion resistance using spring-cam mechanism increases knee flexion in the swing phase during walking in stroke patients with hemiplegia

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, July 21, 2020

Ankle–foot orthosis with dorsiflexion resistance using spring-cam mechanism increases knee flexion in the swing phase during walking in stroke patients with hemiplegia

Putting Spring-cam Back Into Stroke Patients Steps

But is it better than either of these two? Your doctor has some comparisons to do.

Spring-based wearable device could help those with certain neurological conditions walk again - Kickstart

World’s first ‘bionic knee brace’ returns energy to your joints to boost leg strength

DaiOwaki^b KeitaHonda^a KenichiroFukushi^c NoriyoshiHiroi^c TakeoNozaki^c Shin-ichiIzumi^a^d

https://doi.org/10.1016/j.gaitpost.2020.06.029 Get rights and content

Highlights

•: Newly developed spring-cam mechanism (CAM) produces ankle dorsiflexion resistance.
•: CAM was added to AFO with plantarflexion resistance mechanism (AFO-P).
•: The AFO-P with CAM (AFO-PCAM) had dorsiflexion and plantarflexion resistance.
•: Effect of the AFO-PCAM on gait kinematics in hemiplegic patients was examined.
•: The AFO-PCAM increased knee flexion in swing during gait in hemiplegic patients.

Abstract

Background

Ankle–foot orthoses with plantarflexion resistance (AFO-Ps) improve knee flexion in the stance phase on the paretic side in patients with hemiparesis. However, AFO-Ps decrease ankle power generation in the late stance phase and do not improve the knee flexion in the swing phase based on insufficient push-off at the late stance, resulting in lower toe clearance.

Research question

This study sought to investigate the effect of an AFO with dorsiflexion resistance, which was implemented by our developed device with spring–cam mechanism attached to the AFO-P (Gait Solution; Pacific Supply Co., Ltd., Japan), on kinetics and kinematics in the lower limb during gait in patients with hemiparesis.

Methods

Eleven patients with hemiparesis due to stroke walked on a 7-m walkway at a self-selected comfortable pace in the following conditions: (a) walking using the AFO-P with the proposed device with a spring–cam mechanism (AFO-PCAM), (b) walking using the AFO-P without our device (AFO-P), and (c) walking using no device (barefoot condition). Gait kinematics and kinetics were collected using a three-dimensional motion analysis system and four ground-reaction force plates. Changes in all parameters from the barefoot to AFO-PCAM and AFO-P conditions were compared using the Wilcoxon signed-rank test.

Results

In the AFO-PCAM condition, decrease in the maximum ankle power generation in the late-stance phase was significantly smaller than that in the AFO-P condition (p = 0.041). We noted a significant higher change in knee flexion in the paretic swing phase in the AFO-PCAM condition relative to that in the AFO-P condition (p = 0.016). The effect size for the comparisons of change was large (r ≧ 0.5).

Significance

Our device facilitated the realization of the ankle plantarflexion power in the late-stance phase because of dorsiflexion resistance, increasing the knee flexion angle during the swing phase.