Abstract
Simple SummaryStroke patients commonly have different lower extremity biomechanical abnormalities that severely affect walking after damage to normal neural pathways, however, little attention has been paid to them, and current gait rehabilitation techniques have made limited efforts to provide patients with consistent, stable, and effective correction when walking. In the present study, we investigated whether customized insoles could improve gait performance in hemiplegic stroke patients, and the results showed that customized insoles could be a valid intervention that targets residual hemiplegic gait after stroke, thereby enhancing walking function and improving the quality of life of the patients.Background: Insoles have been widely applied to many diseases, but stroke involves complex problems and there is a paucity of research on the application of insoles in stroke patients. Aim: To evaluate the effect of customized insoles on gait in patients with hemiplegia. Design: A randomized controlled trial. Setting: Rehabilitation department of a hospital. Population: A total of 50 stroke patients were randomized into an experimental group (n = 25) or a control group (n = 25). Methods: Both groups received conventional gait training, which was conducted five times a week, every 40 min for four weeks and patients in the experimental group were required to wear customized insoles for at least 1 h per day for four weeks. The primary outcome measure was the Tinetti Gait Scale (TGS) and the secondary outcome measures were the plantar pressure test, 6-min walking test (6MWT), lower extremity Fugl–Meyer assessment (FMA-LE), Berg Balance Scale (BBS), and the modified Barthel index (MBI). Results: Compared to the control group, there were significant increases in the experimental group after four weeks (p = 0.014) and at the four week follow-up (p = 0.001) in the change in TGS, weight-bearing on the involved side (p = 0.012) or forefoot (p = 0.028) when standing, weight-bearing on the involved side (p = 0.01 6) or forefoot (p = 0.043) when walking, early stance phase (p = 0.023) and mid stance phase (p = 0.013) on the involved side, FMA-LE (p = 0.029), BBS (p = 0.005), and MBI (p = 0.009), but there were no differences in the late stance phase (p = 0.472) on the involved side when walking or in the 6MWT (p = 0.069). Conclusions: Customized insoles had great efficacy in enhancing gait performance in stroke patients.
Highlights
80% of stroke patients suffer from hemiplegic gait [1]
All were included in the statistical analysis and there was no significant difference between the experimental group and the control group for baseline demographic data and all outcome measures (Table 1)
After four weeks of intervention, the change in the Tinetti Gait Scale (TGS) in the experimental group was significantly different from the control group (p = 0.014)
Summary
80% of stroke patients suffer from hemiplegic gait [1]. Hemiplegic gait includes a prolonged swing phase, shortened stance phase, increased asymmetry in time and space on the involved side [2], and the lower extremity often presents as hip external rotation, knee hyperextension, foot drop, and varus [3]. Previous studies have reported that hemiplegic patients often experienced changes in plantar pressure due to biomechanical abnormalities of the lower extremities. These abnormalities altered the closed chain movement of the upper segment of the body, eventually aggravating abnormal gait [9,10,11]. Methods: Both groups received conventional gait training, which was conducted five times a week, every 40 min for four weeks and patients in the experimental group were required to wear customized insoles for at least 1 h per day for four weeks. The primary outcome measure was the Tinetti Gait Scale (TGS) and the secondary outcome measures were the plantar pressure test, 6-min walking test (6MWT), lower extremity Fugl–Meyer assessment (FMA-LE), Berg Balance Scale (BBS), and the modified Barthel index (MBI). Conclusions: Customized insoles had great efficacy in enhancing gait performance in stroke patients
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