Abstract
Categorization based on quasi-joint stiffness (QJS) may help clinicians select appropriate ankle foot orthoses (AFOs). The objectives of the present study were to classify the gait pattern based on ankle joint stiffness, also called QJS, of the gait in patients after stroke and to clarify differences in the type of AFO among 72 patients after stroke. Hierarchical cluster analysis was used to classify gait patterns based on QJS at least one month before the study, which revealed three distinct subgroups (SGs 1, 2, and 3). The proportion of use of AFOs, articulated AFOs, and non-articulated AFOs were significantly different among SGs 1–3. In SG1, with a higher QJS in the early and middle stance, the proportion of the patients using articulated AFOs was higher, whereas in SG3, with a lower QJS in both stances, the proportion of patients using non-articulated AFOs was higher. In SG2, with a lower QJS in the early stance and higher QJS in the middle stance, the proportion of patients using AFOs was lower. These findings indicate that classification of gait patterns based on QJS in patients after stroke may be helpful in selecting AFO. However, large sample sizes are required to confirm these results.
Highlights
In 2019, the global prevalence of stroke was 101.5 million people [1]
ankle foot orthoses (AFOs) stiffness in the dorsiflexion direction causes the storage of energy and return of energy in the late stance during gait, while AFO stiffness in the plantarflexion direction causes a limitation of the ankle plantarflexion angle [13,14]
The objectives of this study were to clarify (i) if the gait patterns of patients after stroke could be categorized based on quasi-joint stiffness (QJS) and (ii) differences in spatial and temporal parameters, joint kinematics and kinetics, and daily-use of AFO among these groups
Summary
In 2019, the global prevalence of stroke was 101.5 million people [1]. At the end of rehabilitation, approximately half of stroke patients achieve the ability to walk independently [2]. An improvement in forward propulsion is necessary to increase community ambulation, ankle kinetics, which is an important factor for determining propulsion during gait, is often disturbed in patients after strokes [8,9]. AFOs have been used in patients who have difficulty walking after stroke to improve gait patterns, gait speed, and energy expenditure [10,11,12]. A systematic review of AFO use in patients after stroke did not show significant improvement in ankle kinetics after the use of AFOs [15,16]. There is less evidence of AFO stiffness in ankle kinetics during gait in patients after stroke [13]
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