Effect Of Ankle Research Articles

Effects of ankle–foot orthoses on gait parameters in post-stroke patients with different Brunnstrom stages of the lower limb: a single-center crossover trial

BackgroundAnkle-foot orthoses (AFO) can improve gait posture and walking ability in post-stroke patients. However, the effect of AFO on gait parameters in post-stroke patients according to the Brunnstrom stage of stroke recovery of the lower limbs remains unclear. The study aimed to investigate whether stroke patients with different Brunnstrom stages benefit from wearing AFO.MethodsTwenty-five post-stroke participants included 18 men (50 ± 13 years) and 7 women (60 ± 15 years). The patients were divided based on Brunnstrom stage III or IV of the lower limbs. All patients underwent the gait and timed up and go (TUG) test using a gait analysis system while walking barefoot or with an AFO. The spatiotemporal and asymmetric parameters were analyzed.ResultsAll 25 patients completed the study. Significant differences were observed between barefoot and AFO use in TUG time (P < 0.001) but not walking velocity (P > 0.05). The main effect of the swing time ratio was significant in both groups (P < 0.05); however, the main effects of stride length, stance time, and gait asymmetry ratio were nonsignificant (P > 0.05). For barefoot versus AFO, the main effects of stride length (P < 0.05) and swing time (P < 0.01) ratios were significant, whereas those of stance time and gait asymmetry ratio were nonsignificant (P > 0.05).ConclusionsPost-stroke patients with lower Brunnstrom stages benefitted more from AFO, particularly in gait asymmetry.

Effects of Ankle Pumping Exercises on Limb Edema in Critically ill Patients with Acute Respiratory Distress Syndrome

Acute Respiratory Distress Syndrome (ARDS) is an acute respiratory disease in which the respiratory activity of the lungs is compromised due to secretion of fluid in the alveoli of lungs and thus depriving the blood stream with optimal oxygen supply. Objective: To determine the effects of ankle pumping exercises on limb edema in critically ill patients with acute respiratory distress syndrome Methods: A sample of 67 patients was selected by using non-probability convenient sampling from different hospital settings. Ventilated patients or those having endotracheal tube, age between 40-65 years, and either gender were included in the study. Results: The effect of Range of Motion (ROM) on ARDS patients was as high as 91 %. There were 61(91.0) responders who experienced edema reduced by ankle pumping 54(80.6) found prone position and 13(19.4) found supine position effective 53(79.1) having resonant sound and 14(20.9) with hyper stony dullness 24(35.8) person having added sound and 43(64.2) crepitus sound in this study. In this study, 20 out of 67 patients who were admitted to the intensive care unit (ICU) developed acute onset of severe dyspnea, hypoxemia, and cyanosis and decreased respiratory system compliance, despite supplemental oxygen and mechanical ventilation. Edema had been reduced by ankle pumping in 61 subjects. Conclusions: Patients with ARDS report improvement in symptoms with physiotherapy treatment, ROM exercises had remarkable effects on such patients.

Comparison of the Immediate Effect of Ankle and Hip Joint Thera-band Exercise on the Balance Ability

Comparison of the Immediate Effect of Ankle and Hip Joint Thera-band Exercise on the Balance Ability

발목근력운동이 여자 청소년태권도선수의 발목가동범위, 등속성 근기능 및 정적 균형에 미치는 영향

발목근력운동이 여자 청소년태권도선수의 발목가동범위, 등속성 근기능 및 정적 균형에 미치는 영향

Effects of Ankle and Hip Strategy Training on Improving the Center of Pressure Movements and Limits of Stability in Stroke Patients

Background: Stroke patients have leg muscle weakness and impaired balance resulting in compensatory changes. To restore balance in these patients, functional training using postural strategy is needed. Objective: To examine the effects of ankle and hip strategy training on the center of pressure (COP) movement and limits of stability (LOS) in standing posture in stroke patients. Design: The study was an assessor-blinded and randomized-controlled clinical trial. Methods: Thirty patients were randomly assigned to an ankle strategy training group and a ankle/ hip strategy training group. Patients in the ankle strategy training group underwent ankle strategy exercise for 30 min, and those in the ankle/ hip strategy training group underwent 15 min of ankle strategy exercise and 15 min of hip strategy exercise. Both groups underwent training thrice a week for four weeks. Forward, backward, paretic side, and non-paretic side COP movements and LOS were measured using BioRescue. Results: After the intervention, except for the backward area in the ankle strategy training group, the COP movement area and the LOS were significantly improved in both the groups. In addition, these improvements were significantly higher in ankle/ hip strategy training group than that in the ankle strategy training group. Conclusions: Ankle strategy training in addition to hip strategy training improves COP movement (forward-backward, paretic side area, and nonparetic side area) and LOS in stroke patients.

Not all brawn, but some brain. Strength gains after training alters kinematic motor abundance in hopping.

BackgroundThe effects of resistance training on a muscle’s neural, architectural, and mechanical properties are well established. However, whether resistance training can positively change the coordination of multiple motor elements in the control of a well-defined lower limb motor performance objective remains unclear. Such knowledge is critical given that resistance training is an essential and ubiquitous component in gait rehabilitation. This study aimed to investigate if strength gains of the ankle and knee extensors after resistance training increases kinematic motor abundance in hopping.MethodsThe data presented in this study represents the pooled group results of a sub-study from a larger project investigating the effects of resistance training on load carriage running energetics. Thirty healthy adults performed self-paced unilateral hopping, and strength testing before and after six weeks of lower limb resistance training. Motion capture was used to derive the elemental variables of planar segment angles of the foot, shank, thigh, and pelvis, and the performance variable of leg length. Uncontrolled manifold analysis (UCM) was used to provide an index of motor abundance (IMA) in the synergistic coordination of segment angles in the stabilization of leg length. Bayesian Functional Data Analysis was used for statistical inference, with a non-zero crossing of the 95% Credible Interval (CrI) used as a test of significance.ResultsDepending on the phase of hop stance, there were significant main effects of ankle and knee strength on IMA, and a significant ankle by knee interaction effect. For example at 10% hop stance, a 1 Nm/kg increase in ankle extensor strength increased IMA by 0.37 (95% CrI [0.14–0.59]), a 1 Nm/kg increase in knee extensor strength decreased IMA by 0.29 (95% CrI [0.08–0.51]), but increased the effect of ankle strength on IMA by 0.71 (95% CrI [0.10–1.33]). At 55% hop stance, a 1 Nm/kg increase in knee extensor strength increase IMA by 0.24 (95% CrI [0.001–0.48]), but reduced the effect of ankle strength on IMA by 0.71 (95% CrI [0.13–1.32]).DiscussionResistance training not only improves strength, but also the structure of coordination in the control of a well-defined motor objective. The role of resistance training on motor abundance in gait should be investigated in patient cohorts, other gait patterns, and its translation into functional improvements.

Effect of ankle-foot orthoses on motor performance in cerebral palsy.

This commentary is on the original article by Ries and Schwartz on pages 219–225 of this issue.

Effect of Ankle and Hip Rehabilitation Intervention on Knee Landing Mechanics in Chronic Ankle Instability

Effect of Ankle and Hip Rehabilitation Intervention on Knee Landing Mechanics in Chronic Ankle Instability

Effects of ankle–foot braces on medial gastrocnemius morphometrics and gait in children with cerebral palsy

PurposeIn children with cerebral palsy (CP), braces are used to counteract progressive joint and muscle contracture and improve function. We examined the effects of positional ankle–foot braces on contracture of the medial gastrocnemius (MG) and gait in children with CP while referencing to typically developing children.MethodsSeventeen independently ambulant children with CP and calf muscle contracture (age 10.4 ± 3.0y) and 17 untreated typically developing peers (age 9.5 ± 2.6y) participated. Children with CP were analysed before and 16 ± 4 weeks after ankle–foot bracing. MG muscle belly length and thickness, tendon and fascicle length, as well as their extensibility were captured by 2D ultrasound and 3D motion capturing during passive, manually applied stretches. In addition, 3D gait analysis was conducted.ResultsPrior to bracing, the MG muscle–tendon unit in children with CP was 22 % less extensible. At matched amounts of muscle–tendon unit stretch, the muscle belly and fascicles in CP were 7 % and 14 % shorter while the tendon was 11 % longer. Spastic fascicles displayed 32 % less extensibility than controls. Brace wear increased passive dorsiflexion primarily with the knees flexed. During gait, children walked faster and foot lift in swing improved. MG muscle belly and tendon length showed little change, but fascicles further shortened (−11 %) and muscle thickness (−8 %) decreased.ConclusionsUse of ankle–foot braces improves function but may lead to a loss of sarcomeres in series, which could explain the shortened fascicles. To potentially induce gastrocnemius muscle growth, braces may also need to extend the knee or complementary training may be necessary to offset the immobilizing effects of braces.

Effects of ankle-foot orthoses on functional recovery after stroke: a propensity score analysis based on Japan rehabilitation database.

ObjectivesThe purpose of the present study was to investigate potential effects of ankle–foot orthoses (AFOs) on the functional recovery of post-acute stroke patients following rehabilitation.Subjects and MethodsThis study is a retrospective cohort study. Participants were in-hospital stroke patients registered in the Japan Rehabilitation Database between 2005 and 2012. A total of 1862 patients were eligible after applying exclusion criteria. Propensity score analysis was applied to adjust for potential bias and to create two comparable groups. An additional subset analysis focused on Functional Independence Measure (FIM) scores on admission.ResultsIn this sample, 30.7% of 1863 eligible patients were prescribed AFOs. Propensity score matched analysis showed that patients with AFOs had significantly higher scores than those without them for discharge FIM (mean: 91.3 vs 85.8; p=0.02), FIM gain (mean: 28.9 vs 23.5; p<0.001), and FIM efficiency (mean: 0.27 vs 0.22; p<0.001). Inverse probability weighting analysis showed similar results. In the subset analysis, patients with AFOs had significantly higher discharge FIM compared with those without them in the low admission FIM subgroup only. In addition, patients with AFOs performed independent exercise more than those without them (p<0.001).ConclusionsThese data suggest that stroke survivors may have better functional recovery if they are prescribed an AFO than if they are not prescribed an AFO. The use of AFOs is considered to be a feasible option to improve functional recovery of stroke rehabilitation patients.

The effect of ankle–foot orthosis plantarflexion stiffness on ankle and knee joint kinematics and kinetics during first and second rockers of gait in individuals with stroke

BackgroundStiffness of an ankle–foot orthosis plays an important role in improving gait in patients with a history of stroke. To address this, the aim of this case series study was to determine the effect of increasing plantarflexion stiffness of an ankle–foot orthosis on the sagittal ankle and knee joint angle and moment during the first and second rockers of gait. MethodsGait data were collected in 5 subjects with stroke at a self-selected walking speed under two plantarflexion stiffness conditions (0.4Nm/° and 1.3Nm/°) using a stiffness-adjustable experimental ankle–foot orthosis on a Bertec split-belt fully instrumented treadmill in a 3-dimensional motion analysis laboratory. FindingsBy increasing the plantarflexion stiffness of the ankle–foot orthosis, peak plantarflexion angle of the ankle was reduced and peak dorsiflexion moment was generally increased in the first rocker as hypothesized. Two subjects demonstrated increases in both peak knee flexion angle and peak knee extension moment in the second rocker as hypothesized. The two subjects exhibited minimum contractility during active plantarflexion, while the other three subjects could actively plantarflex their ankle joint. InterpretationIt was suggested that those with the decreased ability to actively plantarflex their ankle could not overcome excessive plantarflexion stiffness at initial contact of gait, and as a result exhibited compensation strategies at the knee joint. Providing excessively stiff ankle–foot orthoses might put added stress on the extensor muscles of the knee joint, potentially creating fatigue and future pathologies in some patients with stroke.

Effects of ankle and knee braces on leg stiffness during hopping

In a spring-mass model (Figure 1-A), the stiffness of the leg spring (leg stiffness; Kleg) is thought to be an important factor in musculoskeletal performance in hopping, running and jumping [1]. Despite the fact that many athletic activities are performed with joint stabilizers, little is known about the Kleg with ankle and/or knee braces. A previous study demonstrated that neither ankle taping nor bracing affected the Kleg during hopping at 3.0 Hz [2]. However, it remains unclear if this constant Kleg exists or changes at other hopping frequencies. The purpose of this study was to more extensively investigate the effect of ankle and knee braces on the Kleg over a range of hopping frequencies. Figure 1 A: Spring-mass model for hopping. This model consists of a body mass and a massless linear spring supporting the body mass. The model is shown at the beginning of the ground contact phase (left), the middle of ground contact phase (middle), and at the ... Ten male participants performed one-legged hopping in place, matching metronome beats at 2.2, 2.6, and 3.0 Hz. Based on a spring-mass model, we calculated Kleg using an inertial sensor (Myotest ®, Myotest SA, Switzerland). Commercially-available ankle and knee braces (Ankle Guard-soft and Knee Guard-Ligament3, ALCARE, Japan) were used to constrain these joints, respectively. Statistical analysis revealed the existence of a significant main effect of hopping frequency (F(1.22, 10.97)= 48.16, p< 0.01; Figure 1-B) on Kleg but no significant main effect of brace conditions (F(3.00, 27.00)= 0.15, p= 0.926), nor a significant interaction between hopping frequency and brace conditions (F(6.00, 54.00)= 0.94, p= 0.472) on Kleg. These results indicate that neither ankle nor knee bracing affects the Kleg in a range of hopping frequency.

The effect of ankle–foot orthoses on self-reported balance confidence in persons with chronic poststroke hemiplegia

One intervention often used to address physical impairments post stroke is an ankle-foot orthosis. Ankle-foot orthoses may improve walking speed, stride length, and gait pattern. However, effects on balance, crucial for safe ambulation, are thus far inconclusive. One aspect of balance shown to contribute to functional ability is self-efficacy. Self-efficacy, defined as the belief in one's ability to succeed in particular situations, has been shown to be more strongly associated with activity and participation (as defined by the International Classification of Functioning, Disability, and Health) than physical performance measures of gait or balance. We investigated whether self-efficacy, or balance confidence when referred to in the context of balance capabilities, is improved with ankle-foot orthosis use. Repeated measures study design. Balance confidence was measured using the Activities-specific Balance Confidence Scale in 15 persons with chronic poststroke hemiplegia, with and without their regular ankle-foot orthosis. Activities-specific Balance Confidence Scale scores were significantly higher (p ≤ 0.01) for the ankle-foot orthosis condition compared to no ankle-foot orthosis. One mechanism by which ankle-foot orthosis use may influence balance is improved balance confidence. Future work should explore the specific mechanisms underlying this improvement in self-efficacy. Clinical relevance Self-efficacy may be an important factor to consider when evaluating functioning post stroke. Rehabilitative interventions that improve balance confidence may help restore participation and overall functioning in pathological populations, particularly in the fall-prone poststroke population. Study results provide evidence for improvements in balance confidence with ankle-foot orthosis use.

The effect of ankle and knee bracing on joint stability and performance during different tasks

Braces are commonly used for prevention and treatment of ankle and knee injuries by individuals who take part in sporting activities which involve challenges to the stability of joints. However,...

Effects of Ankle and Hip Muscle Afferent Inputs on Rhythm Generation During Fictive Locomotion

Hip position and loading of limb extensors are major sensory cues for the initiation and duration of different phases during walking. Although these inputs have pathways projecting to the locomotor rhythm generator, their effects may vary in different parts of the locomotor cycle. In the present study, the plantaris (Pl), sartorius (Sart), rectus femoris (RF), and caudal gluteal (cGlu) nerves were stimulated at group I and/or group II strength during spontaneous fictive locomotion in 16 adult decerebrate cats. These nerves supply muscles that extend the ankle (Pl), flex the hip (Sart, RF), or extend the hip (cGlu). Stimuli were given at six epochs of the locomotor cycle to evaluate when they access the rhythm generator. Group I afferents from Pl nerve always reset the locomotor rhythm; stimulation during extension prolonged cycle period and extension phase duration, while stimulation during flexion terminated flexion and initiated extension. On the other hand, stimulating RF and cGlu nerves only produced significant effects on the rhythm in precise epochs, particularly during mid-flexion and/or mid- to late extension. Stimulating the Sart nerve produced complex effects on the rhythm that were not distributed evenly to all extensor motor pools. The most consistent effect was reduced flexion phase duration with stimulation during flexion, particularly at group II strength, and prolongation of the extension phase but only in late extension. That hip muscle afferents reset the rhythm in only specific epochs of the locomotor cycle suggests that the rhythm generator operates with several subdivisions to determine phase and cycle durations.

Ice Application Effects on Peroneus Longus and Tibialis Anterior Motoneuron Excitability in Subjects with Functional Ankle Instability

ABSTRACTEvidence that focally cooling the ankle joint facilitates soleus and peroneus longus spinal reflex activity in healthy subjects has been reported. This response has been confirmed in individuals with a history of joint pathology for the soleus but not in the peroneus longus and tibialis anterior. The purpose of this study was to identify the effects of ankle cooling on isokinetic eversion and inversion torque and in peroneus longus, tibialis anterior H-reflex (Hmax:Mmax) in subjects with functional ankle instability (FAI). Twenty-four college aged subjects volunteered for this study. Peroneus longus and tibialis anterior Hmax:Mmax, and concentric eversion and inversion torque were recorded prior to and following each session. This protocol was used to compare FAI to healthy ankle group. There were no significant differences between groups. There were weak and no significant relationships between the corresponding muscles motoneuron excitability and their peak torque measurements. Ice application to the joint did not alter the peroneus longus or the tibialis anterior.

Effect of Joint Motion on Safety of Portals in Posterior Ankle Arthroscopy

The purpose of this study was to determine the anatomic relation of the neural structures posteriorly crossing the ankle by use of classical ankle arthroscopy posterior portals and hindfoot endoscopy portals. The effect of ankle and hindfoot motions on portal-nerve distance was also determined. This study included 20 feet and ankles in 20 adult volunteers who had no complaints regarding their ankle joints. To obtain 6 fixed positions of the ankle and hindfoot (neutral-neutral, neutral-varus, neutral-valgus, dorsiflexion-neutral, dorsiflexion-varus, and dorsiflexion-valgus) during magnetic resonance imaging examination, feet were positioned in a polycaprolactone splint that was shaped before examination. Magnetic resonance imaging examinations were performed at all 6 positions, and the shortest distance between the sural and posterior tibial nerves to the portals was measured at 2 different levels. The mean distance between the posterior tibial nerve and the posteromedial portal was 16.5 +/- 5.6 mm and that between the sural nerve and the posterolateral portal was 13.1 +/- 3 mm at the hindfoot portal level. At the level of the posterior ankle arthroscopy portal, the mean distance from the posterior tibial nerve to the posteromedial portal line was 13.3 +/- 4.6 mm and that from the sural nerve to the posterolateral portal line was 9.7 +/- 2.9 mm. The differences in distances were statistically significant (P < .001) according to the paired t test. We determined that the sural nerve approached the posterolateral portal in the dorsiflexion-varus (P = .026), dorsiflexion-valgus (P = .014), dorsiflexion-neutral (P < .001), and neutral-varus (P = .035) positions, and all differences were statistically significant. We found that the posterior medial and lateral portals created at the level of the tip of the fibula as described by van Dijk et al. while the foot was in a neutral-neutral position provided the greatest margin of safety. We found no advantage of placing the ankle and hindfoot in different positions to avoid neurologic complications. These findings suggest that neurovascular structures draw away from the posterior portals of ankle arthroscopy distally; by lowering the level of portals toward the tip of the fibula and positioning the foot at neutral, arthroscopic surgeons will decrease the risk of iatrogenic lesions.

Gliding Resistance of the Posterior Tibial Tendon

Abnormal gliding of the posterior tibial tendon may lead to mechanical trauma, degeneration, and eventually posterior tibial tendon dysfunction. Our study analyzed the gliding resistance of the posterior tibial tendon in intact feet and in feet with simulated flatfoot deformity. An experimental system was developed that allowed direct measurement of gliding resistance at the tendon-sheath interface. Seven normal fresh-frozen cadaver foot specimens were studied, and gliding resistance between the posterior tibial tendon and sheath was measured. The effects of ankle and hindfoot position and the effect of flatfoot deformity on gliding resistance were analyzed. Gliding resistance was measured for 4.9 N applied load to the tendon. Mean gliding resistance for the neutral position was 77 +/- 13.1 (x10(-2) N). Compared to neutral position, dorsiflexion increased gliding resistance and averaged 130 +/- 38.9 (x10(-2) N), and plantarflexion decreased gliding resistance and averaged 35 +/- 12.6 (x10(-2) N). Flatfoot deformity increased gliding resistance compared to normal feet, averaging 104 +/- 17.0 (x10(-2) N) for neutral, 205 +/- 55.0 (x10(-2) N) for dorsiflexion, and 58 +/- 21.3 (x10(-2) N) for plantarflexion. The findings indicate that patients with a preexisting flatfoot deformity may be predisposed to develop posterior tibial tendon dysfunction because of increased gliding resistance and trauma to the tendon surface.

Effect of ankle and knee position on tension in the Achilles tendon.

The purpose of this study was to evaluate the relative contributions of ankle and knee position to tension in the Achilles tendon and to determine whether there exists a position of plantarflexion at which the passive tensioning effect of knee extension is eliminated. Seven matched pairs of fresh-frozen cadaver lower extremities were tested. A buckle transducer was used to measure forces in the tendon throughout the full range of knee motion, with the hindfoot fixed. Positioning the hindfoot in 20 degrees to 25 degrees of plantarflexion effectively eliminates tension in the Achilles tendon, regardless of knee position. This information is directly applicable both to the nonoperative treatment of ruptures of the Achilles tendon employing a short leg cast and to surgical repairs, in which tension must be controlled precisely.