Kinematic and kinetic asymmetries in hemiplegic patients' gait initiation patterns.

OBJECTIVE: To assess the kinetic and kinematic characteristics of hemiplegic stroke patients' gait initiation patterns during the various gait initiation phases. DESIGN AND SUBJECTS: Gait initiation was studied in 3 hemiplegic subjects with a spastic equinus varus foot and 3 control subjects. METHODS: Temporal and kinetic analysis of gait initiation was performed with 2 AMTI force plates, and kinematic analysis of gait initiation with an ELITE optoelectronic system. A one-way ANOVA was performed directly on the phase durations, forces, centre of pressure displacements, stride length, and ankle motion range. RESULTS: Duration of the monopodal phase was shorter in hemiplegic patients when the affected leg rather than the sound one was used as the supporting leg. Propulsion forces were exerted by the hemiplegic patients' sound leg during the postural phase. Hemiplegic patients' body weight was supported more by the sound leg than by the affected leg. Knee was lifted higher on the affected side during the swing phase to compensate for the equinus. Initial contact was performed with a flat foot on the affected side. CONCLUSION: Quantitative data obtained on the gait initiation phase suggest that hemiplegic patients develop asymmetrical adaptive posturo-motor strategies to compensate for their impairments.     

脑卒中患者步行能力与下肢三维运动学及动力学相关性分析

目的:通过对脑卒中偏瘫患者下肢三维运动学和动力学的分析,寻找偏瘫患者步态特点,比较分析步行能力与运动学和动力学之间的关系,从运动力学角度探讨偏瘫患者异常步行的原因,寻找康复治疗中需解决的关键问题。方法:选择首次脑卒中后可以独立步行10m以上的右侧偏瘫患者20例为实验组,正常健康中老年人16例为对照组。采用Vicon和AMTOR6-7进行三维步态运动学和动力学检测和分析。结果:实验组与正常对照组比较,脑卒中患者与健康中老年人在步频、跨步时间、双腿支撑时间、步时、离地比率、步长、跨步长和步速同侧比较差异有显著性意义(P<0.05),患侧离地占步态周期百分比和健侧单腿支撑时间实验组与对照组比较差异有显著性意义(P<0.05)。矢状面上同侧髋关节伸展角度、膝关节屈曲角度和踝关节背伸及跖屈角度比较差异都有显著性意义(P<0.05)。同侧髋关节屈伸力矩、同侧膝关节伸直力矩和患侧踝关节背伸力矩实验组和对照组相比差异有显著性意义(P<0.05),步行能力(步速)与患侧髋关节伸展、健侧膝关节屈曲、双侧膝关节伸展、双侧踝关节背伸和跖屈角度相关,均有显著性意义(P<0.05);同时也和双侧髋关节屈伸、膝关节伸展和踝关节背伸力矩相关(P<0.01)。结论:①步长是脑卒中偏瘫患者步态异常的重要参考指数;②髋关节和膝关节伸展,踝关节背伸和跖屈是步态异常的重要表现;③下肢髋关节和膝关节屈伸肌群和踝关节背伸肌群的力量是影响步行能力的重要因素。     

放散式体外冲击波对脑卒中患者下肢痉挛及三维步态参数的效果研究

摘要 目的：观察放散式体外冲击波对脑卒中偏瘫患者下肢痉挛,步态时空、对称性参数以及运动学参数的影响。 方法：选取40例符合入选标准的脑卒中偏瘫患者,将其随机分为试验组及对照组,每组20例。试验组进行常规康复治疗和患侧下肢放散式体外冲击波治疗（每周2次）,连续3周,对照组进行常规治疗和安慰性冲击波治疗。分别于治疗前、第三周全部治疗结束后使用三维步态分析仪器检测并获得两组患者的步态参数。同时比较两组患者治疗前后腘绳肌、股四头肌、小腿三头肌改良Ashworth分级（MAS）评分,以及患侧下肢的Fugl-Meyer（FMA）评分。 结果：在第三周治疗结束后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相、踝关节最大背屈角度、踝关节最大跖屈角度均较治疗前明显提高（P<0.05）,步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、患侧健侧摆动相比值均较治疗前明显减小（P<0.05）。组间对比显示,治疗后试验组患者步幅、步频、步速、步态周期、步长偏差、踝关节最大背屈角度、踝关节最大跖屈角度均优于对照组（P<0.05）。治疗后试验组腘绳肌、股四头肌、小腿三头肌MAS评分及患侧下肢FMA评分均较治疗前改善(P<0.05),并优于对照组(P<0.01,P<0.05)。 结论：放散式体外冲击波能有效改善脑卒中偏瘫患者步态时空、运动学、对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。同时可以降低患侧下肢的痉挛,提高下肢运动功能。     

Asymmetry of gait initiation in patients with unilateral knee arthritis

OBJECTIVE: To identify how patients with knee arthritis modify their equilibrium and movement control strategies during gait initiation. DESIGN: Observational study. SETTING: University hospital movement analysis laboratory. PARTICIPANTS: Twelve patients with unilateral knee arthritis and 12 healthy control subjects. MAIN OUTCOME MEASURES: Durations of the phases of gait initiation (ie, postural, monopodal, and double-support phases), center-of-pressure displacements, ground reaction forces, pelvic velocity, step length, and knee range of motion were measured using a movement analysis system and force plates. RESULTS: Gait initiation was slower in patients than in controls no matter which leg was the supporting one. In patients, the durations of the postural and the monopodal phases were modified in an asymmetrical way according to the leg used as the supporting one. The postural phase was lengthened and the monopodal phase was shortened when the affected leg was the supporting one. Opposite effects were observed when the sound leg was supporting. Step length, knee range of motion, and maximal pelvic velocity were reduced in patients whatever the side of the supporting leg. CONCLUSION: Gait initiation is an asymmetrical process in unilateral knee arthritis patients, who develop adaptive posturomotor strategies that shorten the monopodal phase on the affected leg.     

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

Background

A 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.

Methods

Eleven 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.

Findings

The 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.

Interpretation

Wearing 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.     

Hemiplegic gait of stroke patients: the effect of using a cane.

OBJECTIVE: To assess the effects of cane use on the hemiplegic gait of stroke patients, focusing on the temporal, spatial, and kinematic variables. DESIGN: Case-control study comparing the effect of walking with and without a cane using a six-camera computerized motion analysis system. SETTING: Stroke clinic of a tertiary care hospital. PARTICIPANTS: Fifteen ambulatory stroke patients were analyzed, including 10 men and 5 women (mean age, 56.9 years; mean time since stroke, 9.8 weeks). Nine age-matched healthy elderly subjects were recruited as a control group. RESULTS: Stroke patients walking with a cane showed significantly increased stride period, stride length, and affected side step length, as well as decreased cadence and step width (p < .05) in comparison with those who walked without a cane. There were no significant differences in the gait phases and the five gait events of hemiplegic gait walking with or without a cane. Cane use thus may have more effect on spatial variables than on temporal variables. The affected-side kinematics of hemiplegic gait with a cane showed increased pelvic obliquity, hip abduction, and ankle eversion during terminal stance phase; increased hip extension, knee extension, and ankle plantar-flexion during preswing phase; and increased hip adduction, knee flexion, and ankle dorsiflexion during swing phase as compared with hemiplegic gait without a cane. A cane thus improved the hemiplegic gait by assisting the affected limb to smoothly shift the center of body mass toward the sound limb and to enhance push off during preswing phase. It also improved circumduction gait during swing phase. CONCLUSION: Stroke patients walking with a cane demonstrated more normal spatial variables and joint motion than did those without a cane.     

偏瘫步态髋关节角度研究

目的分析偏瘫患者步态的髋关节角度特征。方法对20例偏瘫患者和年龄、身高、体重匹配的20例正常人进行步态分析,分析其髋关节特征。结果偏瘫患者患侧髋关节首次着地时刻、站立相最大伸展角度、足尖离地时关节角度、迈步相最大屈曲角度、矢状面膝关节角度范围与正常人的差异存在显著性意义。结论研究偏瘫步态髋关节特征可协助进行临床评价及制定针对性步态矫正方案。     

A new hip-knee-ankle-foot sling: kinematic comparison with a traditional ankle-foot orthosis

In this study, we performed a kinematic analysis of a new, low-cost sling for the lower limb, compared to a common ankle-foot orthosis (AFO). Gait with no orthosis, with the AFO, and with the new sling was analyzed in one hemiplegic subject. Both the AFO and the sling reduced the mean angle and ROM (range of movement) of the ankle and the vertical displacement of the center of mass. The sling, but not the AFO, restored the normal sequence heel-strike, forefoot contact of the affected side. The sling, but not the AFO, reduced the affected limb stance and stride duration, increased stride length, and improved walking speed. In conclusion, the proposed sling for the lower limb equally improved the affected ankle kinematics in contrast to the traditional AFO, and it also improved some gait variables in this hemiplegic subject.     

Adaptations to mass perturbations in transtibial amputees: Kinetic or kinematic invariance?

OBJECTIVE: To establish the adaptation strategy transtibial amputees use after mass perturbation of their prosthetic lower leg. DESIGN: We investigated whether the measured adaptations to mass perturbation of the lower leg in transtibial amputees can better be described as (1) a kinetic invariance strategy in which kinetics (joint torques) remain the same while kinematics (joint angles) change or (2) a kinematic invariance strategy in which kinematics remain the same while kinetics change. SETTING: A gait laboratory. PARTICIPANTS: Ten transtibial amputees. INTERVENTIONS: Five different mass conditions. MAIN OUTCOME MEASURES: Measured joint torques and angles during the swing phase in the different mass conditions. RESULTS: Mass perturbation induced more significant changes and larger effect sizes in joint torques than in joint angles. CONCLUSIONS: Transtibial amputees adapt to mass perturbation primarily by maintaining the same kinematic pattern and adjusting their joint torques, that is, they use a kinematic invariance strategy. This implies that manipulating prosthetic inertial properties does not directly influence gait kinematics and that inertial properties should be evaluated in terms of the energetic cost of the swing phase.     

Asymmetries in dynamic plantar pressure distribution measurement in able-bodied gait: application to the study of the gait asymmetries in children with hemiplegic cerebral palsy]

OBJECTIVES: The aim of this study was to analyse, firstly, the plantar pressure distribution in healthy subjects in order to validate or invalidate the previous studies results on the asymmetrical profile of the stance phase. The studies of asymmetries was based on the identification of a propulsive foot and a loading foot from a concept introduced by Viel. Secondly, the approach was applied to the study of gait asymmetries in two children with hemiplegic cerebral plasy. MATERIAL AND METHOD: Thirty healthy control subjects and two hemiplegic children (H1 and H2) performed a walking test at self selected speed. The recordings of dynamic parameters were realized thanks to an in-shoe plantar pressure analysis system (Parotec, by Paromed Medizintechnik, GMBH, Germany). The pressure peaks were determined from the recording of pressures under eight footprint locations. A program calculated the sum of forces under the heel and determined the loading foot. By defect, the second foot is the propulsive foot. RESULTS: The asymmetrical profile of the human normal stance phase was validated. Under the heel, the pressure peaks lower by 28 % were noticed beneath the loading foot compared to the propulsive foot. Inversely, under the metatarsal heads and the hallux, the pressure peaks were greater by 32 % beneath the propulsive foot. For the two hemiplegic children, the plantar pressure profile equally highlighted significant differences between the unaffected and affected feet. The pressure peaks under the affected heel were respectively lower by 21 % and 97 % for H1 and H2. The loading function was found and associated to the affected limb. The propulsive function was not systematically found under the unaffected foot. DISCUSSION: The analysis of plantar pressure measurements during able-bodied gait showed differences between the two lower limbs. These dynamic asymmetries are the results of a natural functional organization of the supports differentiating a loading foot and a propulsive foot and corroborating the concept proposed by Viel. The hemiplegic gait also presented dynamic asymmetries partially agreement with a personalized functional logic of loading and propulsion. However, the asymmetrical profile can also result a gait self-optimization strategy compensating biomechanical, anatomical and physiological disorders linked to the cerebral deficiency.     

Walking on uneven ground: How do patients with unilateral cerebral palsy adapt?

BackgroundChildren with cerebral palsy experience movement disorders that influence gait stability. It is likely that gait stability further decreases when walking on uneven compared to even ground. Therefore, the aim of this study was to investigate gait on uneven ground in children with unilateral cerebral palsy.MethodsTwenty children with unilateral cerebral palsy and twenty typically developing children performed a three-dimensional gait analysis when walking on even and uneven ground. Spatio-temporal parameters, full-body joint kinematics and centre of mass displacements were compared.FindingsOn uneven versus even ground, both groups showed decreased cadence, increased stance phase and double support time, increased toe clearance height, and increased knee and hip flexion during swing phase. Whereas only the typically developing children walked slower and had increased dorsiflexion and external foot progression during stance phase, only the patients showed increased stride width, increased elbow flexion (affected and non-affected side), and kept the centre of mass more medial when standing on the affected leg.InterpretationPatients and healthy children use similar adaptation mechanisms when walking on uneven ground. Both groups increased the toe clearance height by increasing knee and hip flexion during swing. However, whereas patients enlarge their base of support by increasing stride width, healthy children do so by increasing their external foot progression angle. Furthermore, patients seem to feel more insecure and hold their arms in a position to prepare for falls on uneven ground. They also do not compensate with their non-affected side for their affected side on uneven ground.     

3D preliminary analysis gait in stroke patients: knee flexion in compensatory strategies]

OBJECTIVE: The aim of this preliminary study was to assess strategies of walking a stride in stroke patients with spastic right hemiplegia. MATERIAL AND METHODS: Gait was recorded in 3D in seven patients without other locomotion disorders. Kinematics data were studied only on the sagittal plane. The position and trajectory markers on the right side were studied during the swing phase in comparison with static standing position. Results were confronted with angular data. RESULTS: Three walking models were defined: 1) near normal gait with normal mobility in the knee; 2) gait with hicking while the flexion of the knee was reduced; 3) gait with a "talus" foot without motor recovery necessitating a pendular movement. DISCUSSION: The second pathological group was characterized with insufficient flexion in the knee in lifting the foot from the floor. In this group, patients adopted a compensation strategy with hicking in making the stride without touching the floor. We raised the question of limiting this adaptive strategy in order to enhance their remaining mobility. CONCLUSION: A 3D strategy gait analysis, before therapeutic choices, seems to confirm the value of analysing kinematic data in stroke patients with hemiplegia. The amplitude of knee mobility and hip compensation strategy can be specifically studied to improve the effectiveness of therapeutic strategies (orthesis, selective tibial neurotomy, botulinum toxin).     

Sprint kinematics of athletes with lower-limb amputations.

OBJECTIVE: To determine and compare the kinematics of the sound and prosthetic limb in five of the world's best unilateral amputee sprinters. SUBJECTS: Five men, all unilateral lower-limb amputee (one transfemoral, four transtibial) athletes. The individual with transfemoral amputation used a Endolite Hi-activity prosthesis incorporating a CaTech hydraulic swing and stance control unit, a Flex-Foot Modular III, and an ischial containment total contact socket. Those with transtibial amputations used prostheses incorporating a Flex-Foot Modular III and patellar tendon-bearing socket, with silicone sheath liner (Iceross) and lanyard suspension. DESIGN: Case series. Subjects were videotaped sprinting through a performance area. Sagittal plane lower-limb kinematics derived from manual digitization (at 50 Hz) of the video were determined for three sprint trials of the prosthetic and sound limb. Hip, knee, and ankle kinematics of each subject's sound and prosthetic limb were compared to highlight kinematic alterations resulting from the use of individual prostheses. Comparisons were also made with mean data from five able-bodied men who had similar sprinting ability. RESULTS: Sound limb hip and knee kinematics in all subjects with amputation were comparable to those in able-bodied subjects. The prosthetic knee of the transfemoral amputee athlete fully extended early in swing and remained so through stance. In the transtibial amputee athletes, as in able-bodied subjects, a pattern of stance flexion-extension was evident for both limbs. During stance, prosthetic ankle angles of the transtibial amputee subjects were similar to those of the sound side and those of able-bodied subjects. CONCLUSION: Prosthetic limb kinematics in transtibial amputee subjects were similar to those for the sound limb, and individuals achieved an "up-on-the-toes" gait typical of able-bodied sprinting. Kinematics for the prosthetic limb of the transfemoral amputee subject were more typical of those seen for walking. This resulted in a sprinting gait with large kinematic asymmetries between contralateral limbs.     

核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响

摘要 目的：应用步态分析,观察核心稳定性训练对脑卒中偏瘫患者步态时空参数和对称性参数的影响。 方法：选取脑卒中偏瘫患者60例,按随机数字表法将其分为观察组及对照组,每组30例。两组均进行常规治疗,观察组在此基础上给予核心稳定性训练。分别于治疗前和治疗6周后使用三维步态分析仪器检测并获得两组患者的步态参数。 结果：治疗6周后,两组患者步频、步幅、步速、患侧摆动相和健侧摆动相均较治疗前明显提高（P<0.01）,步宽、步态周期、双支撑相、患侧支撑相、健侧支撑相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值均较治疗前显著减小（P<0.01）。组间比较显示,观察组患者的步频、步幅、步速、步宽、步态周期、双支撑相、健侧支撑相、健侧摆动相、步长偏差、健侧患侧支撑相比值和患侧健侧摆动相比值改善均明显优于对照组（P<0.05或0.01）。 结论：核心稳定性训练能有效改善脑卒中偏瘫患者步态时空参数和对称性参数,提高脑卒中偏瘫患者的步行功能和步态的对称性。     

Interactions between foot placement, trunk frontal position, weight-bearing and knee moment asymmetry at seat-off during rising from a chair in healthy controls and persons with hemiparesis

OBJECTIVE: To assess the interaction of foot placement, trunk frontal position, weight-bearing and knee moment asymmetry at seat-off when rising from a chair. DESIGN: Cross-sectional study. SUBJECTS: Seventeen subjects with hemiparesis and 15 healthy controls. METHODS: Trunk position, weight-bearing and knee moment asymmetry were quantified by kinetic and kinematic analysis when the subjects rose from a chair using 3 different foot placements: spontaneous, symmetrical and asymmetrical. Asymmetry was defined by the ratio between sides. RESULTS: In the healthy controls, the spontaneous and symmetrical foot placements were associated with an almost vertical trunk position and a symmetrical weight-bearing and knee moment. The asymmetrical foot placement resulted in a trunk displacement towards the foot placed behind, with more weight-bearing and higher moment on this side. The opposite was observed in the hemiparetic participants where the spontaneous and symmetrical foot conditions determined a trunk position and an asymmetry bias towards the unaffected side. Placing the affected foot behind the other reduced the asymmetrical behaviour. CONCLUSION: Changes in weight-bearing are partly associated with the frontal trunk position, and foot placement manipulations can be used to modify weight-bearing distribution. Inference on weight-bearing is possible by observing the trunk position during the sit-to-stand task in persons with hemiparesis.     

Lower-leg inertial properties in transtibial amputees and control subjects and their influence on the swing phase during gait

OBJECTIVES: To identify the factors that constitute optimal inertial properties for a lower-limb prosthesis. DESIGN: Experimental, controlled; simulation using a subject-specific double-pendulum model based on individual kinematic data and leg inertial properties. Simulation outcomes were compared with gait analysis data. SETTING: A gait laboratory. PARTICIPANTS: Ten transtibial amputees and 10 matched healthy controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Inertial properties of the lower leg; kinematics and kinetics of the swing phase; and kinematics of double-pendulum model simulations. RESULTS: In all amputees, inertial properties were reduced. No between-group differences existed in kinematics; hip and knee joint torques and powers were reduced in the amputees. Deviations between the double-pendulum model and experimental data were larger in the amputees than in the control subjects. CONCLUSIONS: Although current lightweight prostheses have less optimal pendular behavior, their light weight requires smaller joint torques to influence the pendular trajectory. Therefore, optimal inertial properties, in terms of swing phase kinematics and kinetics, will be a compromise between pendular properties and efficient control.     

Three-point gait crutch walking: variability in ground reaction force during weight bearing

OBJECTIVE: To investigate variability in ground reaction force (GRF) and kinematics on both sides during 3-point partial weight-bearing (PWB) crutch walking. DESIGN: Within-subject comparisons of kinematic and kinetic data collected at different levels of 3-point crutch walking: 10%, 50%, and 90% PWB at comfortable speeds. SETTING: An applied biomechanics lab in a university setting.An applied biomechanics lab in a university setting. PARTICIPANTS: Twelve healthy college students (9 women, 3 men). MAIN OUTCOME MEASURES: Spatial and temporal variables, major peak kinematic data, and peak GRFs from force platforms during the gait cycle. RESULTS: Large variations were found in replicating the target levels of PWB, particularly at 10% and 90% PWB. Subjects had a shorter stance phase and longer swing phase during the crutch walking gait cycle. Velocity significantly decreased (p =.006) because of decreased cadence (p =.002). Slightly greater hip abduction and external rotation on the noninvolved side and slightly less hip adduction and internal rotation on the involved side indicated that the center of gravity shifted slightly from the involved side toward the noninvolved side. There was no increase in vertical GRF, and there was a relatively constant loading pattern on the noninvolved side. CONCLUSIONS: Subjects have difficulty replicating a prescribed weight-bearing restriction. A shift of the center of gravity toward the noninvolved side may reduce the weight distribution on the involved side.     

反复促通疗法对痉挛型偏瘫脑瘫儿童步行功能的影响

目的:探讨反复促通疗法对痉挛型偏瘫脑性瘫痪(SHCP)儿童步行功能的影响。方法:选取SHCP儿童40例，随机分为2组各20例。对照组每天给予常规康复训练60min,观察组每天给予反复促通疗法训练60min,共4周。训练前后采用10m步行测试(10MWT)评价步行速度，三维步态分析系统评价患侧下肢处于支撑中期和摆动中期时髋、膝、踝关节角度以及处于足跟着地期时踝关节角度。结果:训练后2组自选步行速度(SWS)和最快步行速度(MWS)均较治疗前显著增加(P<0.01),且观察组显著高于对照组(P<0.01)。训练后患侧下肢处于支撑中期时与训练前比较，2组患侧髋关节屈曲角度明显降低(P<0.05),患侧膝关节屈曲角度明显增加(P<0.05),患侧踝关节背屈角度明显增加(P<0.05),且观察组各项改善程度均优于对照组(P<0.05);训练后患侧下肢处于摆动中期时与训练前比较，2组患侧髋、膝关节屈曲角度明显增加(P<0.05),且观察组改善程度均优于对照组(P<0.05);训练后患侧下肢处于摆动中期时观察组患侧踝关节背屈角度较训练前及对照组明显增加...     

BiosStep-assisted walking in spinal cord-injured patients: an evaluation report

BiosStep is a functional neuromuscular stimulation system designed to assist the gait of people with central nervous system injuries. It stimulates the quadriceps during the stance phase and the nerves in the popliteal space to produce the swing phase of the gait cycle. The gait obtained with BiosStep was assessed using kinematic analysis and it was compared with nondisabled gait. Moreover, the evolution of the physiological cost of walking using BiosStep was evaluated and compared with the gait obtained with mechanical orthoses. The kinematic analysis of the three lower limb joints showed that the angular excursion morphologies of BiosStep-assisted gait were similar to those obtained in healthy gait, but with minor amplitudes. The physiological cost indexes for the BiosStep-assisted gait were higher than those computed for the mechanical-orthoses-assisted gait. Results show the necessity to continue improving the strategies to obtain more functional movements and enhance the training of patients.