Impact of Alternate Gait Training Using Knee-Ankle-Foot Orthoses with Oil Damper Ankle Hinge in Patients with Subacute Severe Hemiplegia.

Hiroaki Abe,Toru Okanuka,Kazutaka Nishiyama,Yasuhito Yonezawa,Koji Matsumoto,Yuichi Yamamoto

doi:10.3390/brainsci11111430

Hiroaki Abe, Toru Okanuka + Show 4 more

Open Access

https://doi.org/10.3390/brainsci11111430

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Journal: Brain sciences	Publication Date: Oct 28, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: Fukushima Medical University, Kohnan Hospital

Abstract

Patients with severe hemiplegia along with knee instability require knee–ankle–foot orthoses (KAFOs) for gait training. However, in these patients, it is unclear which type of walking training is more effective to improve gait function. Providing alternate gait training (AGT) improves walking function in patients with spinal cord injury, but it is still unclear whether this is effective in hemiplegic stroke patients. In this study, we defined “unified AGT” as AGT performed with the same therapeutic concept by physiotherapists. We then investigated whether AGT improved gait function quicker than our traditional gait training in hemiplegic stroke patients. We enrolled 15 subjects with severe hemiplegia and knee instability who had undergone unified AGT using KAFOs with hinged oil dampers at the ankles, and 30 historical control (HC) subjects who had undergone traditional gait training. We used multiple comparison and survival analyses to analyze the differences in the functional independence measure (FIM) gait score changes between the two groups. The multiple comparison revealed a significant increase (p < 0.05) in the FIM gait score compared with its initial score in the subjects with unified AGT. However, this improvement was not seen in the HC subjects. Additionally, the survival analysis of time taken to recover revealed a significant difference between the subjects with unified AGT and HC subjects (p < 0.05). These findings suggest that unified AGT using a KAFO facilitates gait improvement in patients with severe hemiplegia and knee instability.

Highlights

Regaining gait function is a major goal of stroke rehabilitation [1]
The use of several leg orthoses, such as ankle–foot orthosis (AFOs) and knee–ankle–foot orthoses (KAFOs), for patients with hemiplegic stroke, promotes active rehabilitation and facilitates an expedient return home following the improvement in daily living activities [4]
The historical control (HC) subjects were provided with the same physical therapy (PT), occupational therapy (OT), and speech therapy (ST) treatment as those provided to the alternate gait training (AGT) subjects

Summary

Introduction

A previous study reported that, at the end of rehabilitation, 21% of stroke patients had died, 18% were unable to walk, 11% could walk with assistance, and 50% could walk independently [2]. It has been reported that the time and extent of recovery are related to both the degree of initial impairment of walking function and the severity of lower leg paresis [2]. Gait function can be regained following sufficient gait training in some severe stroke patients [3]. The use of several leg orthoses, such as ankle–foot orthosis (AFOs) and knee–ankle–foot orthoses (KAFOs), for patients with hemiplegic stroke, promotes active rehabilitation and facilitates an expedient return home following the improvement in daily living activities [4].

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