Gait In Hemiplegic Patients Research Articles

The effect of the concept of modified unaffected-side active treatment on the gaits of patients with central nervous system damage

This study was conducted to investigate the effects of unaffected-side active treatment on the gait of hemiplegic patients. The study subjects were 20 patients who showed hemiplegic symptoms after a stroke. Through a random classification method, the subjects were divided into an experimental group (n = 10) who underwent treadmill exercise based on the concept of unaffected-side active treatment to strengthen the paretic side lower extremity after proprioceptive neuromuscular facilitation (PNF) treatment and a control group (n = 10) who underwent general treadmill training without unaffected side-active treatment after PNF treatment. The therapeutic interventions were performed three times a week for 4 weeks. To analyze behavioural motor motions, the patient's gait speeds and ankle angles were measured using the timed up-and-go (TUG) and the Dartfish program before treatment and 14 and 28 days after beginning treatment. The study results showed that the TUG and ankle angles significantly differed between the experimental and control groups at 14 and 28 days after beginning treatment. These significant differences between the two groups were verified. In conclusion, a lower limb strengthening treadmill exercise based on unaffected-side active treatment can increase gait speed and ankle angle by improving motor control ability

The Effects of Multi-Exergames Training on Balance and Gait in Hemiplegic Patients

Background: Hemiplegia shows the partial weakness of the body where balance and walking abilities are majorly affected. Exergaming can enhance balance after a stroke by utilizing game-specific exercises. Hence, the study aims to identify the effects of multi-exergames training on the parameters of balance and gait in hemiplegic subjects. Methods: The selected study subjects were forty-two as per the inclusion criteria and were allotted to a single group using convenient sampling. The Berg balance scale (BBS) was used to measure balance parameters, and the Dynamic gait index (DGI) was used for gait. The subjects were given exergaming training combined with conventional physical therapy exercises for 6 consecutive weeks 4 times a week. After a post-test evaluation, the pre-test and post-test data were examined using descriptive and interferential statistics. Findings: The study findings for the DGI pre-test were (16.83±1.102), and the Post-test was (21.05±1.248, P = 0.001). BBS pre-test was (41.02±3.605) and Post-test was (46.33±3.746, P = 0.001). A significant improvement was noted in the balance and gait parameters using paired t-tests. Novelty and Applications: There is a paucity of literature on the efficacy of multi-exergames training on balance and gait in hemiplegic patients. Hence there is a need to study the effects of multi-exergames training on balance and gait in hemiplegic patients.

Acute effects of Kinesio Taping on lower-limb coordination of gait in hemiplegic patients

BackgroundKinesio taping can effectively strengthen weakened muscles, increase walking speed, and improve dynamic balance in hemiplegic patients, but its effect on lower-limb coordination is not clear. Improving lower-limb coordination in hemiplegic patients can decrease risk of fall during walking. Research questionThis study utilized continuous relative phase to depict the pattern and variability of lower-limb coordination in hemiplegic patients and healthy subjects during walking, and investigate whether it has the acute effect of Kinesio Taping on lower-limb coordination in hemiplegic patients during walking. MethodsGait was measured by a three-dimensional motion capture system for 29 hemiplegic patients (KT group) and 15 healthy subjects (control group). Mean continuous relative phase (MCRP) and mean continuous relative phase variability (MCRPV) were calculated to describe and evaluate lower-limb coordination. ResultsKT intervention only changed the coordination between the bilateral ankle joints in hemiplegic patients. Before the intervention, the MCRP of the two ankles (AA-MCRP) in the stance period of the control group was greater than the KT group (P < 0.001), the MCRPV of the two ankles (AA-MCRPV) in the swing period was lower than that in KT group (P < 0.001). After the intervention, the AA-MCRP in the stance period of the KT group increased (P < 0.001), the AA-MRPV in the swing period of KT group significantly decreased (P = 0.001). SignificanceImmediate ankle KT intervention can result in the in-phase or anti-phase coordination between the two ankles developing to out-of-phase coordination during the stance period of the affected limb during walking, and increase the stability of the out-of-phase coordination between the two ankles during the swing period of the affected limb. KT can be used in rehabilitation treatment for hemiplegic patients to improve acute coordination between the patients' ankles.

Τhe effect of task oriented approach on gait of hemiplegic patients: a case series study

The last few years, the main purpose of the treatment of the hemiplegic patient, is to regain his ability to execute functional activities of daily living independently. According to the latest studies, the effectiveness as well as the importance of task-oriented approach (TOA), is apparent and determining to reacquire the patient’s lost independency, through the practice of the specified functional activities. The aim of this study is to investigate a program of TOA on gait of hemiplegic patients. A sample of 5 post stroke patients was selected from according to the inclusion criteria. A TOA intervention was executed through the practice of 10 functional activities, related to gait, from Monday to Friday for 4 weeks. At the end of each week, gait and balance assessments were performed through the 10-meter walk test (10 MWT), the Berg balance scale (BBS), and the timed up and go test (TUG). The analysis indicates that TOA is extremely effective for stroke patients with mediocre and minor gait and balance deficits, as the difference was statistically significant (p&lt;0.05). The statistically significant difference was from the first assessment T1 to the final assessment T5 and was proven through BBS, TUG and 10 MWT. In conclusion, TOA is a quite beneficial and a cost-effective intervention for the rehabilitation of gait and balance for stroke patients, while consequently improving the quality of their everyday life, independently from their original functional status.

Effects of whole body vibration combined with extracorporeal shock wave therapy on spasticity and balance gait parameters in hemiplegic patients with stroke.

Stroke patients may have various sensory-motor disorders, such as spasticity, muscle weakness or sensory damage. Spasticity affects 20% to 40% of stroke patients. Patients with spasticity may have problems such as pain, motor function damage, and the decreased range of motion, which leads to decline of activity and quality of daily life. Extracorporeal shock wave therapy (ESWT) is a technique that can improve post-stroke spasticity. Whole body vibration (WBV), as a passive neuromuscular muscle stimulation technique, can improve the posture control, muscle strength, and muscle work of different people. At present, there are still few studies using WBV combined with ESWT for the treatment of hemiplegic patients with stroke. This study aims to explore the effects of WBV combined with ESWT on spasticity of the affected lower limb and gait function in stroke patients. From March 2020 to March 2021, 50 hemiplegic patients with stroke were treated in the Department of Rehabilitation Medicine of the First Hospital of Changsha and they were assigned into a control group and a combined group, 25 cases per group. Both groups carried out conventional treatment, while the control group undertook the ESWT and fake WBV based on conventional treatment, and the combined group undertook ESWT after WBV and conventional treatment. Modified Ashworth Scale (MAS), Lower Extremity portion of the Fugl-Meyer Motor Assessment (FMA-LE), Berg Balance Scale (BBS), and parameters of three-dimensional gait analysis including kinematic parameters (peak value of hip flexion and knee flexion) and spatiotemporal parameters (velocity, cadence and stride length) were assessed before and after 4-week treatment between the 2 groups. After 4 weeks of treatment, MAS scores in 2 groups were lower than before (both P<0.05), and the combined group was lower than the control group (P<0.001); BBS and FMA-LE scores were higher than those before treatment (both P<0.05), and the combined group was higher than the control group (both P<0.001); in the control group, the walking speed, stride frequency, and stride length were higher than those before treatment (all P<0.05), and there was no significant difference between the peak value of flexion hip and peak value of flexion knee (both P<0.05); the peak value of hip flexion, peak value of knee flexion, step speed, step frequency, and stride length in the combined group were higher than those before treatment (all P<0.05), and were higher than those in control group (P<0.05 or P<0.001). WBV combined with ESWT can improve the spasticity and motor function of the affected lower extremity, balance, and gait in hemiplegic patients with stroke.

Effects of Affected Side One Leg Standing Training with PNF Sprinter and Skater Patterns on the Balance and Gait Function in Hemiplegic Patients

This study was conducted to investigate the effect of affected side one leg standing training with PNF sprinter and skater patterns, which have a pattern like that of actual gait, on the balance function and gait function of chronic hemiplegic patients due to stroke. 23 inpatients diagnosed with stroke due to hemiplegia at a rehabilitation hospital located in South Korea. The patients were randomly divided into a experimental group and a control group. The experimental group performed PNF Sprinter and Skater Pattern training, and the control group performed balance pad training. Each group was trained for 30 minutes three times a week for six weeks. Static balance was measured using Biorescue, while dynamic balance was measured using the TUG. Gait function was measured using 10MWT, 6MWT. Both groups exhibited statistically significant improvements in static and dynamic balance function after the training (p&lt;.05). The experimental group exhibited statistically significant increases in gait function after training (p&lt;.05). A significant difference was observed between the two groups (p&lt;.05). One leg standing training on the affected side using the PNF sprinter and skater patterns resulted in significant improvement in both balance and functional performance of gait in hemiplegic patients due to chronic stroke.

The effectiveness of botulinum toxin on spasticity and gait of hemiplegic patients after stroke: A systematic review and meta-analysis

The aim of the study is to evaluate the evidence supporting the efficacy of botulinum toxin type A (BTA) injections in lower limb of hemiplegic patients, after stroke or cerebrovascular accident, and their gait analysis. This study included: randomized controlled trials (RCTs), non-randomized or controlled clinical trials (CCTs) or cluster trials, clinical trials of various phases (I-III), interrupted time series (ITS) studies with at least three data points before and after the intervention, controlled before and after (CBA) studies, prospective and retrospective comparative cohort studies, case-control and multicentred studies. The patients included in these studies had similar characteristics: age over 18 years, history of stroke and following hemiplegia, minimum modified Ashworth scale (MAS) score of 2 and duration since stroke over 6 months. The number of studies included in this review was 21. A meta-analysis was performed on a fraction of them depending on the reported index and the methodology as reported in detail in the results section. MAS score, following BTA injections, was significantly improved (Hedges’ g: −1.17; 95% CI: −1.66, 0.67; p < 0.001). The same applied for the 10 Meter Walk Test (MWT) (−0.35; 95% CI: −0.68, −0.02; p = 0.016). The gait velocity showed improvement, yet without statistical significance (0.27; 95% CI: −0.09, 0.63; p = 0.285). We concluded that botulinum toxin injections showed effectiveness on lower limb hypertonia reduction of hemiplegic patients after stroke. Apart from significantly reducing the MAS scores, 10 MWT was also improved. However, more research is required in order to determine the advancement in specific gait and posture parameters.

Safety and long-term effects on gait of hemiplegic patients in equinovarus foot deformity surgical correction followed by immediate rehabilitation: a prospective observational study.

Equinovarus foot deformity (EVFD) is the most common lower limb deformity in stroke patients. Immobilization following EVFD surgical correction is known to have a negative impact on muscle rearrangement with possible loss of walking ability in stroke patients. In a previous study, safe and positive effects at one-month follow-up after surgery were obtained with an early rehabilitation treatment (ERT) characterized by immediate walking and training. To determine long-term safety and efficacy of functional surgery followed by early rehabilitation (FSER). A 12 months prospective observational study. Outpatients clinic, Gait and Motion Laboratory, Sol et Salus Hospital, Rimini, Italy. Twenty-four adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55±13 years, affected side 12L/12R, time from lesion 5±4 years. Patients received clinical and instrumental evaluation by gait analysis (GA) before (T0), one, three and twelve months after surgery. Safety was defined as the absence of any complication consequent to FSER. Efficacy was assessed by the recovery in ankle kinematics, walking speed and space-time parameters. No clinical complication (thrombosis, surgical wound infection, muscle or tendon injury, muscle hematoma) arose in the sample during the follow-up year. Variables relating to ankle kinematics improved towards their normal values at one month after surgery. These were maintained at 3 and 12 months, with a significant difference between follow-ups and pre-surgical values (Durbin-Conover Test, P<0.01). Gait speed, cadence, anterior step length and stride length of the affected side showed a statistical improvement at 3 and 12 months (Wilcoxon test, P=0.012 and P=0.001, respectively). Stride width decreased at 1 month after surgery and showed a further stable reduction at 3 months (P=0.008). The ERT protocol with immediate rehabilitation starting on the first day after surgical correction was safe and effective in providing a long-term correction of EVFD. Ankle dorsiflexion improved both in stance and swing, allowing for a significative improvement in walking speed. FSER can be considered an encouraging approach in the management of EVFD, with durable results.

片麻痺者の座位前傾動作の特徴と歩行との関係

片麻痺者の座位前傾動作の特徴と歩行との関係

Efficacy of Proprioceptive Neuromuscular Facilitation techniques to Pelvic girdle muscles in improving gait in hemiplegic patients

Efficacy of Proprioceptive Neuromuscular Facilitation techniques to Pelvic girdle muscles in improving gait in hemiplegic patients

Ankle muscle coactivation and its relationship with ankle joint kinematics and kinetics during gait in hemiplegic patients after stroke

Introduction: Increased ankle muscle coactivation during gait is a compensation strategy for enhancing postural stability in patients after stroke. However, no previous studies have demonstrated that increased ankle muscle coactivation influenced ankle joint movements during gait in patients after stroke.Purpose: To investigate the relationship between ankle muscle coactivation and ankle joint movements in hemiplegic patients after stroke.Methods: Seventeen patients after stroke participated. The coactivation index (CoI) at the ankle joint was calculated separately for the first and second double support (DS1 and DS2, respectively) and single support (SS) phases on the paretic and non-paretic sides during gait using surface electromyography. Simultaneously, three-dimensional motion analysis was performed to measure the peak values of the ankle joint angle, moment, and power in the sagittal plane. Ground reaction forces (GRFs) of the anterior and posterior components and centers of pressure (COPs) trajectory ranges and velocities were also measured.Results: The CoI during the SS phase on the paretic side was negatively related to ankle dorsiflexion angle, ankle plantarflexion moment, ankle joint power generation, and COP velocity on the paretic side. Furthermore, the CoI during the DS2 phase on both sides was negatively related to anterior GRF amplitude on each side.Conclusion: Increased ankle muscle coactivation is related to decreased ankle joint movement during the SS phase on the paretic side to enhance joint stiffness and compensate for stance limb instability, which may be useful for patients who have paretic instability during the stance phase after stroke.

片麻痺者の体幹機能評価と歩行における体幹の動きとの関係

片麻痺者の体幹機能評価と歩行における体幹の動きとの関係

Effects of a dynamic-ankle-foot orthosis (Liberté®) on kinematics and electromyographic activity during gait in hemiplegic patients with spastic foot equinus.

A dynamic-ankle-foot orthosis has recently emerged and consists of an elastic band allowing the variation of stiffness degree and adjusts dorsiflexion assistance in swing. The aim of this study was to quantify the biomechanical adaptations induced by this orthosis during gait in hemiplegic patients. Twelve hemiplegic patients performed two gait analyses (without and with the ankle-foot orthosis). Spatiotemporal, kinematic, kinetic and electromyographic gait parameters were quantified using an instrumented gait analysis system during the stance and swing phases. During swing, peak ankle dorsiflexion was greater with the orthosis and associated with a decrease of pelvic obliquity angle. In stance, peak ankle plantarflexion and dorsiflexion were greater with the orthosis and associated with an increase of ankle angle at heel strike and toe-off. Electromyographic activities of both the tibialis anterior and the medial gastrocnemius were greater with the orthosis. This dynamic-ankle-foot orthosis improved gait in hemiplegic patients with spastic foot equinus. The spatiotemporal adaptations seem to be caused mainly by the increase of ankle dorsiflexion during stance and swing phases. The changes in electromyographic activity were related to an active dorsiflexion in stance and swing phases and an active plantarflexion in stance phase.

A randomized comparison of energy consumption when using different canes, inpatients after stroke

Objectives: To investigate the differences in oxygen consumption associated with gait in hemiplegic patients according to the type of cane they use. Design: A randomized crossover design. Setting: University hospital-based rehabilitation center, Korea. Subjects: Thirty consecutive patients (mean ± SD age, 56.3 ± 3.2 years) with chronic stroke, 17 (56.7%) males and 13 (43.3%) females. Interventions: At approximately the same time of day for three consecutive days, each participant completed a walk with one of three randomly assigned types of canes: a single-point cane, a quad cane, and a hemi-walker. Main outcome measure: Energy expenditure (O2 rate, mL/kg/min), energy cost (O2 cost, mL/kg/m), and heart rate (HR) via a portable gas analyzer, a 10-meter walk test (10MWT), and a 6-minute walk test (6MWT). Results: Energy expenditure, gait endurance, and gait velocity for a single-point cane were higher (p<0.001 or p=0.005) than for any other type of cane. Energy cost (0.5 ± 0.2 mL/kg/m vs. 0.6 ± 0.2 mL/kg/m vs. 0.6 ± 0.2 ml/kg/m, respectively, p=0.001) was lower for the single-point cane, except for HR (p ≥ 0.05) after the Bonferroni correction (0.05/5=0.01). Conclusions: A single-point cane requires less oxygen use at a given speed, or permits greater speed for the same oxygen consumption.

Development of an assist controller with robot suit HAL for hemiplegic patients using motion data on the unaffected side.

Among several characteristics seen in gait of hemiplegic patients after stroke, symmetry is known to be an indicator of the degree of impairment of walking ability. This paper proposes a control method for a wearable type lower limb motion assist robot to realize spontaneous symmetric gait for these individuals. This control method stores the motion of the unaffected limb during swing and then provides motion support on the affected limb during the subsequent swing using the stored pattern to realize symmetric gait based on spontaneous limb swing. This method is implemented on the robot suit HAL (Hybrid Assistive Limbs). Clinical tests were conducted in order to assess the feasibility of the control method. Our case study involved participation of one chronic stroke patient who was not able to flex his right knee. As a result, the walking support for hemiplegic leg provided by the HAL improved the subject's gait symmetry. The feasibility study showed promising basis for the future clinical study.

The efficacy of neuroprosthesis in young hemiplegic patients, measured by three different gait indices: Early results

To evaluate functional electrical stimulation (FES) neuroprothesis as a method to improve gait in hemiplegic patients, using three different gait scoring methods as measures. Five hemiplegic patients (four with cerebral palsy at GMFCS I, one with diffuse pontine glioma) with a mean age of 16.5years were given a FES neuroprosthesis (NESS(®) L300™) that was applied and calibrated individually. After an adaptation period during which the participants increased their daily use of the neuroprosthesis, gait was assessed with the stimulation off and with the FES on. Kinematic, kinetic, and temporal spatial data were determined using motion analysis and summarized by three scoring methods: Gait Profile Score (GPS), Gait Deviation Index (GDI), and Gillette Gait Index (GGI). Indices were calculated using the Gaitabase program available online. Patients were followed for a minimum of 1year. When comparing gait with and without stimulation, all scoring methods showed improvement. GPS and GDI of the affected leg were significantly improved: 12.23-10.23° (p=0.017) and 72.36-78.08 (p=0.002), respectively. By applying the movement analysis profile, the decomposed GPS score, we found that only the ankle dorsiflexion and the foot progression angle were significantly changed. GGI of the affected leg showed improvement, but without statistical significance: 168.88-131.64 (p=0.221). Total GPS of legs and the GPS, GDI, and GGI of the nonaffected leg showed improvement without statistical significance. At the 1-year follow-up, all patients expressed high satisfaction and continued to use the device. Dorsiflexion functional electrical stimulation improves gait in hemiplegic patients, as reflected by GPS, GDI, and GGI.

Variations in Kinematics during Clinical Gait Analysis in Stroke Patients

In addition to changes in spatio-temporal and kinematic parameters, patients with stroke exhibit fear of falling as well as fatigability during gait. These changes could compromise interpretation of data from gait analysis. The aim of this study was to determine if the gait of hemiplegic patients changes significantly over successive gait trials. Forty two stroke patients and twenty healthy subjects performed 9 gait trials during a gait analysis session. The mean and variability of spatio-temporal and kinematic joint parameters were analyzed during 3 groups of consecutive gait trials (1–3, 4–6 and 7–9). Principal component analysis was used to reduce the number of variables from the joint kinematic waveforms and to identify the parts of the gait cycle which changed during the gait analysis session. The results showed that i) spontaneous gait velocity and the other spatio-temporal parameters significantly increased, and ii) gait variability decreased, over the last 6 gait trials compared to the first 3, for hemiplegic patients but not healthy subjects. Principal component analysis revealed changes in the sagittal waveforms of the hip, knee and ankle for hemiplegic patients after the first 3 gait trials. These results suggest that at the beginning of the gait analysis session, stroke patients exhibited phase of adaptation,characterized by a “cautious gait” but no fatigue was observed.

The effects of robot-assisted walking compared with body weight supported treadmill training for retraining walking ability and improving the gait of hemiplegic patients after stroke

Objective To compare the effects of robot-assisted gait training with supported treadmill training (BWSTT) for hemiplegic patients after stroke.Methods A randomized,single-blind,controlled study was performed.Forty-eight hemiplegic patients were divided randomly into a BWSTT group and a robot group with 24 in each Both groups received routine rehabilitation training.The robot group also received robot-assisted gait training,while the BWSTT group received treadmill training in which their body weight was supported.Both groups trained 20-30 minutes daily,5 days a week for 8 weeks in addition to their normal rehabilitation sessions.Their lower extremity functions and walking ability were assessed with the simplified Fugl-Meyer assessment (FMA) and using functional ambulation categories (FACs).Average step length,percentage of loading time on each foot and 3 min walking distance were tested using a Biodex Gait Trainer.All the assessments were administered before and 8 weeks after treatment.Results Both groups showed significant improvements in terms of the FMA,FACs,average step length,loading time on each foot and 3 min walking distance.The robot group,on average,showed significantly better improvements in average step length,percentage of loading time on each foot and 3 min walking distance than the BWSTT group.There was no significant difference in lower extremity function or walking ability in terms of the FMA or FACs.Conclusions Robot-assisted training gives better results than BWSTT in terms of improving average step length,equalizing the loading time on each foot and 3 min walking distance. Key words: Lower-limb rehabilitation; Robots; Treadmill training; Walking ability; Gait

Effects of a knee–ankle–foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum

BackgroundA knee–ankle–foot orthosis may be prescribed for the prevention of genu recurvatum during the stance phase of gait. It allows also to limit abnormal plantarflexion during swing phase. The aim is to improve gait in hemiplegic patients and to prevent articular degeneration of the knee. However, the effects of knee–ankle–foot orthosis on both the paretic and non-paretic limbs during gait have not been evaluated. The aim of this study was to quantify biomechanical adaptations induced by wearing a knee–ankle–foot orthosis, on the paretic and non-paretic limbs of hemiplegic patients during gait. MethodsEleven hemiplegic patients with genu recurvatum performed two gait analyses (without and with the knee–ankle–foot orthosis). Spatio-temporal, kinematic and kinetic gait parameters of both lower limbs were quantified using an instrumented gait analysis system during the stance and swing phases of the gait cycle. FindingsThe knee–ankle–foot orthosis improved spatio-temporal gait parameters. During stance phase on the paretic side, knee hyperextension was reduced and ankle plantarflexion and hip flexion were increased. During swing phase, ankle dorsiflexion increased in the paretic limb and knee extension increased in the non-paretic limb. The paretic limb knee flexion moment also decreased. InterpretationWearing a knee–ankle–foot orthosis improved gait parameters in hemiplegic patients with genu recurvatum. It increased gait velocity, by improving cadence, stride length and non-paretic step length. These spatiotemporal adaptations seem mainly due to the decrease in knee hyperextension during stance phase and to the increase in paretic limb ankle dorsiflexion during both phases of the gait cycle.

Effect of early compensation of distal motor deficiency by the Chignon ankle-foot orthosis on gait in hemiplegic patients: a randomized pilot study

Objective: To compare the effect of the Chignon ankle-foot orthosis on gait versus a standard ankle-foot orthosis. Method: A multicentre randomized study was conducted in seven rehabilitation centres. Hemiplegic patients were recruited after unilateral stroke lasting less than six months. Exclusion criteria were: impossibility to stand for 10 seconds; ankle passive dorsiflexion <5 degrees with knee flexed to 90 degrees; triceps spasticity ≥3/4 on the Ashworth modified scale; diseases that might impair active participation in the study. Thirteen patients were randomized to the Chignon group and 15 to the control group. Included patients were given a standard ankle-foot orthosis or Chignon ankle-foot orthosis. The Chignon ankle-foot orthosis is an articulated double-stopped custom-made orthosis with elements to assist dorsiflexion and plantar flexion. Gait speed improvement (ten-metre test), kinematic assessment, and functional scales were assessed. Results: Gain ratio of walking speed with the orthosis increased significantly more in the Chignon group than in the control group at day 0 (27.2 ± 36% versus −0.8 ± 17%; P = 0.006), day 30 (39.9 ± 19% versus 7.5 ± 17%; P = 0.0004) and day 90 (44.6 ± 27% versus 17.1 ± 0.3%; P = 0.04). There was also a significant improvement in kinematic parameters and spasticity in the Chignon group. Conclusion: Early compensation of distal motor deficiency by the Chignon ankle-foot orthosis improves the immediate gait of hemiplegics more than the standard ankle-foot orthosis and seems to modify motor recovery processes in the legs after stroke.