Customized passive-dynamic ankle-foot orthoses can improve walking economy and speed for many individuals post-stroke.
Ankle–foot orthosis
Gait biomechanics
Mechanical cost-of-transport
Poststroke gait
Walking energy
Journal
Journal of neuroengineering and rehabilitation
ISSN: 1743-0003
Titre abrégé: J Neuroeng Rehabil
Pays: England
ID NLM: 101232233
Informations de publication
Date de publication:
29 Jul 2024
29 Jul 2024
Historique:
received:
08
11
2023
accepted:
17
07
2024
medline:
29
7
2024
pubmed:
29
7
2024
entrez:
28
7
2024
Statut:
epublish
Résumé
Passive-dynamic ankle-foot orthoses (PD-AFOs) are often prescribed to address plantar flexor weakness during gait, which is commonly observed after stroke. However, limited evidence is available to inform the prescription guidelines of PD-AFO bending stiffness. This study assessed the extent to which PD-AFOs customized to match an individual's level of plantar flexor weakness influence walking function, as compared to No AFO and their standard of care (SOC) AFO. Mechanical cost-of-transport, self-selected walking speed, and key biomechanical variables were measured while individuals greater than six months post-stroke walked with No AFO, with their SOC AFO, and with a stiffness-customized PD-AFO. Outcomes were compared across these conditions using a repeated measures ANOVA or Friedman test (depending on normality) for group-level analysis and simulation modeling analysis for individual-level analysis. Twenty participants completed study activities. Mechanical cost-of-transport and self-selected walking speed improved with the stiffness-customized PD-AFOs compared to No AFO and SOC AFO. However, this did not result in a consistent improvement in other biomechanical variables toward typical values. In line with the heterogeneous nature of the post-stroke population, the response to the PD-AFO was highly variable. Stiffness-customized PD-AFOs can improve the mechanical cost-of-transport and self-selected walking speed in many individuals post-stroke, as compared to No AFO and participants' standard of care AFO. This work provides initial efficacy data for stiffness-customized PD-AFOs in individuals post-stroke and lays the foundation for future studies to enable consistently effective prescription of PD-AFOs for patients post-stroke in clinical practice. NCT04619043.
Sections du résumé
BACKGROUND
BACKGROUND
Passive-dynamic ankle-foot orthoses (PD-AFOs) are often prescribed to address plantar flexor weakness during gait, which is commonly observed after stroke. However, limited evidence is available to inform the prescription guidelines of PD-AFO bending stiffness. This study assessed the extent to which PD-AFOs customized to match an individual's level of plantar flexor weakness influence walking function, as compared to No AFO and their standard of care (SOC) AFO.
METHODS
METHODS
Mechanical cost-of-transport, self-selected walking speed, and key biomechanical variables were measured while individuals greater than six months post-stroke walked with No AFO, with their SOC AFO, and with a stiffness-customized PD-AFO. Outcomes were compared across these conditions using a repeated measures ANOVA or Friedman test (depending on normality) for group-level analysis and simulation modeling analysis for individual-level analysis.
RESULTS
RESULTS
Twenty participants completed study activities. Mechanical cost-of-transport and self-selected walking speed improved with the stiffness-customized PD-AFOs compared to No AFO and SOC AFO. However, this did not result in a consistent improvement in other biomechanical variables toward typical values. In line with the heterogeneous nature of the post-stroke population, the response to the PD-AFO was highly variable.
CONCLUSIONS
CONCLUSIONS
Stiffness-customized PD-AFOs can improve the mechanical cost-of-transport and self-selected walking speed in many individuals post-stroke, as compared to No AFO and participants' standard of care AFO. This work provides initial efficacy data for stiffness-customized PD-AFOs in individuals post-stroke and lays the foundation for future studies to enable consistently effective prescription of PD-AFOs for patients post-stroke in clinical practice.
TRIAL REGISTRATION
BACKGROUND
NCT04619043.
Identifiants
pubmed: 39069629
doi: 10.1186/s12984-024-01425-7
pii: 10.1186/s12984-024-01425-7
doi:
Banques de données
ClinicalTrials.gov
['NCT04619043']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
126Subventions
Organisme : Congressionally Directed Medical Research Programs
ID : W81XWH-18-1-0502
Informations de copyright
© 2024. The Author(s).
Références
CDC. Centers for Disease Control and Prevention. 2022. Stroke Facts|cdc.gov. Available from: https://www.cdc.gov/stroke/facts.htm .
Nadeau S, Gravel D, Arsenault AB, Bourbonnais D. Plantarflexor weakness as a limiting factor of gait speed in stroke subjects and the compensating role of hip flexors. Clin Biomech. 1999;14(2):125–35.
doi: 10.1016/S0268-0033(98)00062-X
Pak S, Patten C. Strengthening to promote functional recovery poststroke: an evidence-based review. Top Stroke Rehabil. 2008;15(3):177–99.
pubmed: 18647724
doi: 10.1310/tsr1503-177
Dickstein R. Rehabilitation of gait speed after stroke: a critical review of intervention approaches. Neurorehabil Neural Repair. 2008;22(6):649–60.
pubmed: 18971380
doi: 10.1177/1545968308315997
Olney SJ, Richards C. Hemiparetic gait following stroke. Part I: Characteristics. Gait Posture. 1996;4(2):136–48.
doi: 10.1016/0966-6362(96)01063-6
Jonkers I, Stewart C, Spaepen A. The complementary role of the plantarflexors, hamstrings and gluteus maximus in the control of stance limb stability during gait. Gait Posture. 2003;17(3):264–72.
pubmed: 12770640
doi: 10.1016/S0966-6362(02)00102-9
Mulroy S, Gronley J, Weiss W, Newsam C, Perry J. Use of cluster analysis for gait pattern classification of patients in the early and late recovery phases following stroke. Gait Posture. 2003;18(1):114–25.
pubmed: 12855307
doi: 10.1016/S0966-6362(02)00165-0
Esquenazi A, Ofluoglu D, Hirai B, Kim S. The effect of an ankle-foot orthosis on temporal spatial parameters and asymmetry of gait in hemiparetic patients. PM&R. 2009;1(11):1014–8.
doi: 10.1016/j.pmrj.2009.09.012
Detrembleur C, Dierick F, Stoquart G, Chantraine F, Lejeune T. Energy cost, mechanical work, and efficiency of hemiparetic walking. Gait Posture. 2003;18(2):47–55.
pubmed: 14654207
doi: 10.1016/S0966-6362(02)00193-5
Farris DJ, Hampton A, Lewek MD, Sawicki GS. Revisiting the mechanics and energetics of walking in individuals with chronic hemiparesis following stroke: from individual limbs to lower limb joints. J NeuroEngineering Rehabil. 2015;12(1):24.
doi: 10.1186/s12984-015-0012-x
Franceschini M, Massucci M, Ferrari L, Agosti M, Paroli C. Effects of an ankle-foot orthosis on spatiotemporal parameters and energy cost of hemiparetic gait. Clin Rehabil. 2003;17(4):368–72.
pubmed: 12785244
doi: 10.1191/0269215503cr622oa
Stoquart G, Detrembleur C, Lejeune TM. The reasons why stroke patients expend so much energy to walk slowly. Gait Posture. 2012;36(3):409–13.
pubmed: 22555062
doi: 10.1016/j.gaitpost.2012.03.019
Mayo EN, Wood-Dauphinee S, Ahmed S, Carron G, Higgins J, Mcewen S, et al. Disablement following stroke. Disabil Rehabil. 1999;21(5–6):258–68.
pubmed: 10381238
doi: 10.1080/096382899297684
Vestling M, Tufvesson B, Iwarsson S. Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction. J Rehabil Med. 2003;35(3):127–31.
pubmed: 12809195
doi: 10.1080/16501970310010475
Kruk J. Physical activity and health. Phys Act Health.
Mokdad A, Marks J, Stroup D, Gerberding J. Correction: actual causes of death in the United States, 2020. JAMA. 2005;293(3):293–4.
pubmed: 15657315
doi: 10.1001/jama.293.3.293
Robison J, Wiles R, Ellis-Hill C, McPherson K, Hyndman D, Ashburn A. Resuming previously valued activities post-stroke: who or what helps? Disabil Rehabil. 2009;31(19):1555–66.
pubmed: 19479573
doi: 10.1080/09638280802639327
Ghose SS, Williams LS, Swindle RW. Depression and other mental health diagnoses after stroke increase inpatient and outpatient medical utilization three years poststroke. Med Care. 2005;43(12):1259–64.
pubmed: 16299438
doi: 10.1097/01.mlr.0000185711.50480.13
Arch ES, Reisman DS. Passive-dynamic ankle-foot orthoses with personalized bending stiffness can enhance net plantarflexor function for individuals poststroke. JPO J Prosthet Orthot. 2016;28(2):60.
doi: 10.1097/JPO.0000000000000089
Bregman DJJ, Rozumalski A, Koops D, de Groot V, Schwartz M, Harlaar J. A new method for evaluating ankle foot orthosis characteristics: BRUCE. Gait Posture. 2009;30(2):144–9.
pubmed: 19520576
doi: 10.1016/j.gaitpost.2009.05.012
Condie DN. The modern era of orthotics. Prosthet Orthot Int. 2008;32(3):313–23.
pubmed: 18825575
doi: 10.1080/03093640802113006
Faustini MC, Neptune RR, Crawford RH, Stanhope SJ. Manufacture of passive dynamic ankle-foot orthoses using selective laser sintering. IEEE Trans Biomed Eng. 2008;55(2):784–90.
pubmed: 18270017
doi: 10.1109/TBME.2007.912638
Arch ES, Stanhope SJ. Passive-dynamic ankle–foot orthoses substitute for ankle strength while causing adaptive gait strategies: a feasibility study. Ann Biomed Eng. 2015;43(2):442–50.
pubmed: 25023660
doi: 10.1007/s10439-014-1067-8
Waterval NFJ, Brehm MA, Harlaar J, Nollet F. Individual stiffness optimization of dorsal leaf spring ankle–foot orthoses in people with calf muscle weakness is superior to standard bodyweight-based recommendations. J NeuroEngineering Rehabil. 2021;18(1):97.
doi: 10.1186/s12984-021-00890-8
Waterval NFJ, Nollet F, Harlaar J, Brehm MA. Precision orthotics: optimising ankle foot orthoses to improve gait in patients with neuromuscular diseases; protocol of the PROOF-AFO study, a prospective intervention study. BMJ Open. 2017;7(2): e013342.
pubmed: 28246134
pmcid: 5337712
doi: 10.1136/bmjopen-2016-013342
Waterval NFJ, Brehm MA, Altmann VC, Koopman FS, Den Boer JJ, Harlaar J, et al. Stiffness-optimized ankle–foot orthoses improve walking energy cost compared to conventional orthoses in neuromuscular disorders: a prospective uncontrolled intervention study. IEEE Trans Neural Syst Rehabil Eng. 2020;28(10):2296–304.
pubmed: 32833637
doi: 10.1109/TNSRE.2020.3018786
Koller C, Reisman D, Richards J, Arch E. Understanding the effects of quantitatively prescribing passive-dynamic ankle–foot orthosis bending stiffness for individuals after stroke. Prosthet Orthot Int. 2021;45(4):313.
pubmed: 33840749
doi: 10.1097/PXR.0000000000000012
Ploeger HE, Waterval NFJ, Nollet F, Bus SA, Brehm MA. Stiffness modification of two ankle-foot orthosis types to optimize gait in individuals with non-spastic calf muscle weakness—a proof-of-concept study. J Foot Ankle Res. 2019;12(1):41.
pubmed: 31406508
pmcid: 6686412
doi: 10.1186/s13047-019-0348-8
Waterval NFJ, Brehm MA, Harlaar J, Nollet F. Description of orthotic properties and effects evaluation of ankle-foot orthoses in non-spastic calf muscle weakness. J Rehabil Med. 2020;10.
Waterval NFJ, Nollet F, Harlaar J, Brehm MA. Modifying ankle foot orthosis stiffness in patients with calf muscle weakness: gait responses on group and individual level. J NeuroEng Rehabil. 2019;16(1):120.
pubmed: 31623670
pmcid: 6798503
doi: 10.1186/s12984-019-0600-2
Haight DJ, Russell Esposito E, Wilken JM. Biomechanics of uphill walking using custom ankle-foot orthoses of three different stiffnesses. Gait Posture. 2015;41(3):750–6.
pubmed: 25743775
doi: 10.1016/j.gaitpost.2015.01.001
Harper NG, Esposito ER, Wilken JM, Neptune RR. The influence of ankle-foot orthosis stiffness on walking performance in individuals with lower-limb impairments. Clin Biomech. 2014;29(8):877–84.
doi: 10.1016/j.clinbiomech.2014.07.005
Russell Esposito E, Choi HS, Owens JG, Blanck RV, Wilken JM. Biomechanical response to ankle–foot orthosis stiffness during running. Clin Biomech. 2015;30(10):1125–32.
doi: 10.1016/j.clinbiomech.2015.08.014
Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.
pubmed: 17695343
doi: 10.3758/BF03193146
Collins JD, Arch ES, Crenshaw JR, Bernhardt KA, Khosla S, Amin S, et al. Net ankle quasi-stiffness is influenced by walking speed but not age for older adult women. Gait Posture. 2018;62:311–6.
pubmed: 29609159
pmcid: 5960620
doi: 10.1016/j.gaitpost.2018.03.031
Plummer P, Behrman AL, Duncan PW, Spigel P, Saracino D, Martin J, et al. Effects of stroke severity and training duration on locomotor recovery after stroke: a pilot study. Neurorehabil Neural Repair. 2007;21(2):137–51.
pubmed: 17312089
doi: 10.1177/1545968306295559
Holden JP, Chou G, Stanhope SJ. Changes in knee joint function over a wide range of walking speeds. Clin Biomech. 1997;12(6):375–82.
doi: 10.1016/S0268-0033(97)00020-X
Khattra N, Tierney J, Yarlagadda S, Shevchenko N, Gillespie Jr J, Arch (Schrank) E, et al. Carbon fiber based custom orthoses for augmenting net ankle moment in gait. Int SAMPE Tech Conf. 2013;1271–8.
Kautz SA, Bowden MG, Clark DJ, Neptune RR. Comparison of motor control deficits during treadmill and overground walking poststroke. Neurorehabil Neural Repair. 2011;25(8):756–65.
pubmed: 21636831
pmcid: 4434587
doi: 10.1177/1545968311407515
Lewis CL, Ferris DP. Walking with increased ankle pushoff decreases hip muscle moments. J Biomech. 2008;41(10):2082–9.
pubmed: 18606419
pmcid: 2562040
doi: 10.1016/j.jbiomech.2008.05.013
Ebrahimi A, Goldberg SR, Wilken JM, Stanhope SJ. Constituent lower extremity work (CLEW) approach: a novel tool to visualize joint and segment work. Gait Posture. 2017;56:49–53.
pubmed: 28494322
doi: 10.1016/j.gaitpost.2017.04.024
Lewek MD, Sykes R. Minimal detectable change for gait speed depends on baseline speed in individuals with chronic stroke. J Neurol Phys Ther. 2019;43(2):122–7.
pubmed: 30702510
pmcid: 6361716
doi: 10.1097/NPT.0000000000000257
Bregman DJJ, van der Krogt MM, de Groot V, Harlaar J, Wisse M, Collins SH. The effect of ankle foot orthosis stiffness on the energy cost of walking: a simulation study. Clin Biomech. 2011;26(9):955–61.
doi: 10.1016/j.clinbiomech.2011.05.007
Bregman DJJ, Harlaar J, Meskers CGM, de Groot V. Spring-like ankle foot orthoses reduce the energy cost of walking by taking over ankle work. Gait Posture. 2012;35(1):148–53.
pubmed: 22050974
doi: 10.1016/j.gaitpost.2011.08.026
Kerkum YL, Buizer AI, van den Noort JC, Becher JG, Harlaar J, Brehm MA. The effects of varying ankle foot orthosis stiffness on gait in children with spastic cerebral palsy who walk with excessive knee flexion. PLoS ONE. 2015;10(11):e0142878.
pubmed: 26600039
pmcid: 4658111
doi: 10.1371/journal.pone.0142878
Kobayashi T, Leung AKL, Akazawa Y, Hutchins SW. Design of a stiffness-adjustable ankle–foot orthosis and its effect on ankle joint kinematics in patients with stroke. Gait Posture. 2011;33(4):721–3.
pubmed: 21376602
doi: 10.1016/j.gaitpost.2011.02.005
Collins SH, Wiggin MB, Sawicki GS. Reducing the energy cost of human walking using an unpowered exoskeleton. Nature. 2015;522(7555):212–5.
pubmed: 25830889
pmcid: 4481882
doi: 10.1038/nature14288
Voloshina AS, Kuo AD, Daley MA, Ferris DP. Biomechanics and energetics of walking on uneven terrain. J Exp Biol. 2013.
Meyer C, Killeen T, Easthope CS, Curt A, Bolliger M, Linnebank M, et al. Familiarization with treadmill walking: How much is enough? Sci Rep. 2019;9(1):5232.
pubmed: 30914746
pmcid: 6435738
doi: 10.1038/s41598-019-41721-0
Brehm M, Bus SA, Harlaar J, Nollet F. A candidate core set of outcome measures based on the international classification of functioning, disability and health for clinical studies on lower limb orthoses. Prosthet Orthot Int. 2011;35(3):269–77.
pubmed: 21937572
doi: 10.1177/0309364611413496