Foot and ankle impairments affect balance and mobility in stroke (FAiMiS): the views and experiences of people with stroke

Purpose: To explore the nature and impact of foot and ankle impairments on mobility and balance in community-dwelling, chronic stroke survivors. Methods: A qualitative research design using face to face semi-structured, audio recorded interviews. Thirteen community-dwelling stroke survivors, all of whom had self-reported foot and ankle impairments, were interviewed (female n?=?6, mean age?=?67 years, SD?=?12 years, mean time since stroke?=?4 years, SD?=?6 years, right stroke n?=?7, left stroke n?=?6). A framework analysis approach was used to analyse and interpret transcribed interviews. Results: Three themes emerged: (1) Impact. The influence of foot and ankle impairments on mobility and balance. (2) Standing out. How participants felt they “stood out” because of their impairments and wanted to be normal. (3) Help. The specific help and advice participants received in managing their problems. Conclusions: Foot and ankle impairments such as pain, altered somatosensory input and weakness significantly contribute to problems with community ambulation, balance and fear of falling in people with chronic stroke. Specific foot and ankle impairments may also negatively contribute to perceptions of physical appearance and self-esteem. Therapeutic management approaches within clinical practice appear to focus mostly on the gross performance of the lower limb with little emphasis on the specific assessment or treatment of the foot or ankle.

• Implications for Rehabilitation

• Foot pain, sensory impairments and muscle weakness in the foot and ankle can impact on community ambulation, balance and fear of falling following stroke.

• Foot and ankle function post-stroke should be routinely assessed and monitored.

• Clinicians should be aware of the potentially distressing negative perceptions associated with altered gait patterns, footwear and orthotic use.

     

Role of ankle foot orthoses in functional stability of individuals with stroke

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke. Methods: Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO. Results: When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p?<?0.05). Conclusions: The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke.

• Implications for Rehabilitation

• Functional stability is impaired in individuals with stroke.

• Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control.

• Individuals with stroke improved their functional stability while they were provided with AFOs.

• Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.

     

Improved design and development of a functional moulded prosthetic foot

Purpose: In the Indian scenario, the Jaipur foot is a low-cost breakthrough that enabled the disabled person to adapt to the Indian environment. The aim of this study is to modify the present foot in terms of ankle support design and method of fabrication, foot moulds profile and the inner core material in order to improve the performance and durability. Method: The optimized design of ankle support and flat foot profile moulds suitable for both left and right foot were developed through CAD/CAM and prosthetic feet were fabricated using ethylene vinyl acetate (EVA) foam as an appropriate alternative core material for microcellular rubber (MCR). The developed prosthetic feet were tested for rigidity by load-deflection analysis in universal testing machine. Result: EVA foot had shown better rigidity than conventional MCR foot, which will help in weight transfer during walking and increase the durability. The CAD modeled ankle support and single block EVA had made the manufacturing process easy and reduced the weight of foot and improved Gait to the person fitted with it due to improved flat foot profile. Conclusion: The new artificial foot had proven to be efficacious technically as well as functionally, which is clearly borne out from the extremely positive feedback given by the amputees.

• Implications of Rehabilitation

• Persons with below knee amputation are usually provided with transtibial prosthesis, which allows for easier ambulation and helps them to get back to their normal life.

• Transtibial prosthesis is an artificial limb that replaces a lower limb that is amputated below the knee.

• In our study, a new prosthetic foot with a modified ankle support and flat foot profile using better inner-core material than the conventional Jaipur foot was developed and the process was also optimized for mass production. The developed prosthetic foot can be fitted with both above and below knee exoskeleton type of prosthesis.

     

Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS)

Purpose: The present study aimed to assess the psychometric properties of the Finnish version of the Lower Extremity Functional Scale (LEFS) among foot and ankle patients.

Methods: The LEFS was translated and cross-culturally adapted to Finnish. We assessed the test–retest reliability, internal consistency, floor-ceiling effect, construct validity and criterion validity in patients who underwent surgery due to musculoskeletal pathology of the foot and ankle (N?=?166).

Results: The test–retest reliability was high (ICC = 0.93, 95% CI: 0.91–0.95). The standard error of measurement was 4.1 points. The Finnish LEFS showed high internal consistency (Cronbach’s α?=?0.96). A slight ceiling effect occurred as 17% achieved the maximum score. The LEFS correlation was strong with the 15D Mobility dimension (r?=?0.74) and overall HRQoL (r?=?0.66), pain during foot and ankle activity (r=??0.69) and stiffness (r=??0.62). LEFS correlated moderately with foot and ankle pain at rest (r=??0.50) and with physical activity (r?=?0.46).

Conclusions: The Finnish version of the LEFS showed reliability and validity comparable to those of the original version. This study indicates that the Finnish version of the LEFS serves both clinical and scientific purposes in assessing lower-limb function.

• Implications for Rehabilitation

• The Finnish version of the Lower Extremity Functional Scale (LEFS) is a reliable and valid tool for assessing lower-extremity musculoskeletal disability in Finnish-speaking population.

• Investigation of the psychometric properties of the Finnish version of the LEFS showed validity and reliability comparable to those of the original English version.

• The Finnish LEFS is easy to complete and suitable for clinical, rehabilitation and research purposes.

     

Using musculoskeletal modeling to evaluate the effect of ankle foot orthosis tuning on musculotendon dynamics: a case study

Purpose: This case study examines the influence of an ankle foot orthosis footwear combination (AFO-FC) on musculotendon lengths and gait kinematics and kinetics after right thrombotic stroke resulting in left hemiplegia. Methods: Gait analysis was performed over three visits where the subject walked with an AFO-FC with two shank-to-vertical angle (SVA) alignments, a posterior leaf spring AFO (PLS AFO), and shoes alone. Biomechanical and musculoskeletal modeling was used to evaluate musculotendon lengths, kinematics, and kinetics for each condition. Results: The AFO-FC improved walking speed and non-paretic kinematics compared to the PLS AFO and shoes alone. The operating length of the paretic gastrocnemius decreased with the AFO-FC improving knee kinematics in swing, but not stance. As the SVA of the AFO-FC was reduced from 15° to 12°, internal ankle plantar flexor moment increased. Conclusions: Musculoskeletal modeling demonstrated that the AFO-FC altered gastrocnemius operating length during post-stroke hemiplegic gait. Using these tools to evaluate muscle operating lengths can provide insight into underlying mechanisms that may improve gait and guide future AFO-FC design.

• Implications for Rehabilitation

• Modeling musculotendon operating lengths during movement has the potential to inform how ankle foot orthoses (AFO) affect tight muscles and improve mobility after stroke.

• Adjusting shank-to-vertical angle (SVA) of the AFO-footwear combination (AFO-FC) has the potential to improve gait kinematics by controlling length of the pathologic gastrocnemius and maximizing internal ankle plantar flexor moment of individuals with neuromuscular disorders.

     

Strength deficits of the paretic lower extremity muscles were the impairment variables that best explained restrictions in participation after stroke

Purpose: To evaluate which measures of physical impairments of both upper extremity (UE) and lower extremity (LE) would predict restrictions in participation with 105 community-dwelling stroke subjects.

Methods: For this cross-sectional, exploratory study, participation was assessed by the daily activity and social role domains of the Assessment of Life Habits (LIFE-H). The potential predictors included measures of physical impairments (UE and LE motor recovery, sensation, motor coordination, and strength deficits).

Results: Step-wise multiple linear regression analyses revealed that, for the daily activity domain, LE strength deficits and UE motor recovery explained 28% of the variance in the LIFE-H scores and LE strength deficits alone explained 22% (F?=?29.5; p< .0001). For the social role domain, LE strength deficits and sensation explained 22% of the variance in the LIFE-H scores and LE strength deficits alone explained 16% (F?=?20.6; p< .0001).

Conclusions: Strength deficits of the LE muscles were the physical impairment variables that best predicted participation in both daily activity and social role domains of the LIFE-H. Although significant, UE motor recovery and LE sensation added little to the explained variance. Future research is needed to determine whether progressive resistance strength training program enhances participation after stroke.

• Implications for Rehabilitation

• Residual strength deficits of the LE muscles were the physical impairments that showed to be the main predictors of restrictions in participation, as determined by the daily activity and social role domains of the LIFE-H 3.1.

• It is possible that stroke individuals would benefit from physical interventions aiming at improving the strength of the LE muscles, when the goal is to enhance participation.

     

Risk of fall for people with diabetes

Abstract

Purpose: To examine the risk of fall for people with diabetes compared with healthy control subjects. Correlation between tactile sensation and postural control was examined for subjects with diabetes. Methods: Subjects with type 2 diabetes were classified into two groups: (i) diabetes without neuropathy (n?=?23) and (ii) diabetic peripheral neuropathy (DPN) (n?=?9). Age-matched healthy control subjects (n?=?32) were recruited. Tactile sensation, equilibrium scores (ES), strategy scores and sensory analysis scores from the Sensory Organization Test (SOT) were compared among the groups. Results: Subjects with diabetes without neuropathy demonstrated impaired postural control upon the disruption of somatosensory inputs. Subjects with DPN lost balance upon being deprived of visual inputs. A decrease in tactile sensation was associated with a decrease in the ESs in all subjects with diabetes (r?=??0.35 to ?0.77; p?<?0.05), and they tend to use more hip strategy for postural control upon being deprived of visual inputs. Conclusions: Different postural control strategies are adopted by various subgroups of subjects with diabetes. Subjects with DPN demonstrated a significant shift from ankle to hip strategies for balance tests when vision was deprived.

• Implications for Rehabilitation

• The severity of diabetic peripheral neuropathy (DPN) is associated with the risk of fall.

• Different compensatory strategies in balance control have been adopted by different subgroups of people with diabetes.

• In order to minimize the risk of fall, specific balance training program should be offered to different subgroups of people with diabetes.

• The balance training should emphasize on optimizing the competence of their existing compensatory postural control strategies.

     

Treadmill training with an incline reduces ankle joint stiffness and improves active range of movement during gait in adults with cerebral palsy

Purpose: We investigated if 30?min of daily treadmill training with an incline for 6 weeks would reduce ankle joint stiffness and improve active range of movement in adults with cerebral palsy (CP).

Methods: The study was designed as a randomized controlled clinical trial including 32 adults with CP (GMFCS 1–3) aged 38.1 SD 12 years. The training group (n?=?16) performed uphill treadmill training at home daily for 30?min for 6 weeks in addition to their usual activities. Passive and reflex mediated stiffness and range of motion (ROM) of the ankle joint, kinematic and functional measures of gait were obtained before and after the intervention/control period. Intervention subjects trained 31.4 SD 10.1 days for 29.0 SD 2.3?min (total) 15.2?h.

Results: Passive ankle joint stiffness was reduced (F?=?5.1; p?=?0.031), maximal gait speed increased (F?=?42.8, p?F?=?5.3, p?F?=?12.5; p?Conclusion: Daily treadmill training with an incline for 6 weeks reduces ankle joint stiffness and increases active ROM during gait in adults with CP. Intensive gait training may thus be beneficial in preventing and reducing contractures and help to maintain functional gait ability in adults with CP.

• Implications for rehabilitation

• Uphill gait training is an effective way to reduce ankle joint stiffness in adult with contractures.

• 6 weeks of daily uphill gait training improves functional gait parameters such as gait speed and dorsal flexion during gait in adults with cerebral palsy.

     

Quasi-experimental evaluation of a home care model for patients with stroke in China

Purpose: To evaluate the effectiveness of a modified home care model in China.

Methods: First-time stroke survivors were recruited from a comprehensive teaching hospital in China. Subjects in the intervention group (n?=?168) received modified home care involving detailed pre-discharge preparation and post-discharge follow-up lasting one month. The following outcomes were assessed at the end of follow-up: length of hospital stay, satisfaction with acute hospitalisation, medication compliance, complications and stroke-related re-hospitalisation. The outcomes were compared for the intervention group and a historical control group (n?=?173) who received routine care.

Results: Modified home care was associated with shorter acute hospitalisation (11.29?±?2.18 vs. 12.36?±?4.33 d, p?=?0.03), higher compliance [161 (95.83%) vs. 92 (53.18%), p?=?0.004] and ability to perform daily activities (38.25?±?10.22 vs. 32.08?±?10.32, p?=?0.03), and a lower rate of re-hospitalisation [2 (1.19%) vs. 11 (6.36%), p?=?0.02].

Conclusions: Home care may be associated with higher quality of life and reduced dependency among stroke patients in China.

• Implications for Rehabilitation

• Home care can be effective method at improving the physical and psychological well-being of stroke survivors in China.

• The home care model in this study can improve health outcomes as well as reduce healthcare resources utilisation.

• Home care models for stroke survivors should be adapted to local healthcare policies and resources.

     

The efficacy of foot orthoses on alteration to center of pressure displacement in subjects with flat and normal feet: a literature review

Purpose: The aim of this review was to evaluate and compare the effect of foot orthoses on center of pressure (CoP) displacement in healthy patients and those with flat foot. Method: The search strategy was based on the Population Intervention Comparison Outcome (PICO) method. A search was performed in PubMed, Science Direct, Google scholar and ISI web of knowledge databases by using selected keywords. Seventeen articles were selected for final evaluation. The procedure was followed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Result: The results of the literature review demonstrated that there is lack of evidence to show that FOs improve CoP displacement in subjects with flat foot. Conclusion: There is no consistent evidence to prove the efficacy of FOs on altering CoP displacement in healthy subjects but in those with flat foot, FOs decreased CoP excursion.

• Implications for Rehabilitation

• Foot orthoses (FOs) have become an integral part of the treatment of injuries of the foot, ankle, and lower extremity.

• Assessment of FOs effect on the COP displacement can help to provide a better understanding of the body’s compensatory mechanisms and their therapeutic effects.

• There is no consistent evidence to prove the efficacy of FOs on CoP displacement in healthy subjects but in flat foot subjects foot orthoses decreased CoP excursion has been demonstrated.

     

Impact of depression following a stroke on the participation component of the International Classification of Functioning,Disability and Health

Purpose: To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF).

Method: Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann–Whitney test was used to compare the participation scores between the two groups. Spearman’s correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance.

Results: The group with depression had low participation scores (p?=?0.04). A statistically significant negative correlation of moderate magnitude was found between depression and participation (r?= ?0.6; p ?=?0.04). The linear regression model demonstrated that depression is a moderate predictor of participation (r²?=?0.51; p?=?0.001).

Conclusions: Depression is a moderate predictor of participation among stroke survivors, explaining 51% of the decline of this aspect. Thus, depression should be diagnosed, monitored and treated to ensure a better prognosis regarding social participation following a stroke.

• Implications for Rehabilitation

• Individuals with post-stroke depression experience a lower degree of social participation.

• Depression explains 51% of the decline in participation following a stroke.

• The present findings can serve as a basis to assist healthcare professionals involved in the rehabilitation of stroke survivors and can assist in the establishment of adequate treatment plans in stroke rehabilitation.

     

Short stick exercises for fall prevention among older adults: a cluster randomized trial

Abstract

Purpose: To investigate the effects of short stick exercise (SSEs) on fall prevention and improvement of physical function in older adults. Methods: A cluster randomized trial was conducted in five residential care facilities. The intervention group (n?=?51) practiced SSEs for six months, followed by routine care for six more months. The control group (n?=?54) received ordinary care for 12 months. The primary outcome measure was the number of fallers, taking into account the time to first fall using the Kaplan–Meier method. The secondary outcome measures were physical and mental functions. Results: The number of fallers was significantly lower in the intervention group (n?=?6) than in the control group (n?=?16) during the 12 months. The adjusted hazard ratio for a first fall in the intervention group compared with the control group was 0.15 (CI, 0.03 to 0.74, p?=?0.02). The fall-free period was significantly longer in the intervention group than in controls (mean?±?SD, 10.1?±?3.0 versus 9.0?±?4.1 months, p?=?0.027). The functional reach and sit and reach tests were significantly improved at three and six months. Conclusion: The SSEs appeared effective for fall prevention and improvement of physical function in older adults.

• Implications for Rehabilitation

• The newly developed short stick exercises appear an effective means of reducing falls among older adults in residential care facilities.

• The short stick exercises seem to have an immediate effect on improving physical functions.

• Effects gained by performing the short stick exercises, such as static balance, flexibility and agility may last for six months.

• The short stick exercises were found to be easy for older adults to practice continuously in residential care facilities.

     

Longitudinal changes in activity participation in the first year post-stroke and association with depressive symptoms

Abstract

Research question: 1. Does activity participation improve over time in the first year after stroke? 2. What is the association of depressive symptoms on retained activity participation 12-months post-stroke adjusting for neurological stroke severity and age? 3. Is an improvement in activity participation associated with a decrease in depressive symptoms between 3- and 12-months post-stroke?

Design: Longitudinal observational study of activity participation and depressive symptoms in ischemic stroke survivors.

Participants: A total of 100 stroke survivors with mild neurological stroke severity.

Methods: A total of 100 stroke survivors were recruited from five metropolitan hospitals and assessed at 3- and 12-months post-stroke using measures of activity participation (Activity Card Sort-Australia (ACS-Aus)) and depressive symptoms (Montgomery–Asberg Depression Rating Scale Structured Interview Guide (MADRS-SIGMA)).

Results: There was a significant association between time (pre-stroke to 3-months post-stroke) and current activity participation (?5.2 activities 95% CI ?6.8 to ?3.5, p?<?0.01) and time (pre-stroke to 12-months) and current activity participation (?2.1 activities 95% CI ?3.7 to ?0.5, p?=?0.01). At 12-months post-stroke, a one-point increase in depressive symptoms was associated with a median decrease of 0.3% (95% CI ?1.4% to ?0.1%, p?=?0.02) of retained overall activity participation, assuming similar neurological stroke severity and age. A decrease in depressive symptoms between 3- and 12-months post-stroke was associated with an improvement of 0.31 (95% CI ?0.5 to ?0.1, p?=?0.01) in current activity participation.

Conclusions: Activity participation improves during the first year of recovery post-stroke in stroke survivors with mild neurological stroke severity and is associated with depressive symptoms over time and at 12-months post-stroke.

• Implications for rehabilitation

• Improvements in participation occur in the first 3-months post-stroke and continue to a lesser degree in the first year after stroke.

• Depressive symptoms are associated with lower participation at 12-months.

• A multidimensional approach targeting depressive symptoms and increasing participation in the early months post-stroke and throughout the first-year after stroke is recommended to increase overall recovery following stroke.

• A focus on increasing leisure activity participation is recommended to improve depressive symptoms.

Trial registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12610000987066.     

Prevalence and impact of disability and sexual dysfunction on Health-Related Quality of Life of Nigerian stroke survivors

Purpose: To investigate the impact of disability and sexual dysfunction on Health-Related Quality of Life (HRQoL) among Nigerian stroke survivors (SSv) and to determine their association using sexual functioning (SF), Global Disability Measure and Function (GDMF), and demographic profiles.

Methods: This study involved 121 consecutive SSv attending healthcare services in two tertiary health facilities in Nigeria. Demographic details were obtained through interview while HRQoL, SF, and Global Disability (GD) were assessed using Stroke-Specific Quality of Life (SS-QoL-12), Changes in Sexual Functioning Questionnaire (CSFQ-14), and World Health Organization Disability Assessment Schedule (WHODAS-2.0), respectively. Determinants of HRQoL were explored using the Poisson regression analysis.

Results: Most of the SSv had moderate/severe GD (95%) and low SF (86.8%). Their HRQoL decreased with increase in their age (p?=?0.005) and with increase in GD (p?=?0.001). This association remained unchanged even when adjusted for SF (p?=?0.001). Those with low SF but with mild GD had relatively better HRQoL than those with moderate/severe GD even when they had higher SF. Their HRQoL was negatively impacted by their GD but not by their SF despite direct correlation between SF and HRQoL. With a unit increase in level of GD, there was 8% decrease in HRQoL scores in psychosocial and 17% decrease in physical domains.

Conclusion: Although sexual dysfunction and global disability are prevalent among Nigerian SSv, their low HRQoL is determined by their disability and not by SF. Hence, effort at reducing global disability should be the focus of rehabilitation after stroke.

• Implication for Rehabilitation

• Global functional and sexual deficiencies abound in stroke survivors and they impact negatively on their overall quality of life.

• Sexual dysfunction correlates negatively on physical and psychosocial wellbeing of stroke survivors.

• Rehabilitation goal(s) should focus disability reduction and improvement of sexual functioning to enhance quality of life.

• Rehabilitation professionals should equip themselves with tools to counsel stroke survivors on sex issue since sexual dysfunction is common post stroke.

     

Translation,cross-cultural adaptation and validity of the Brazilian version of the Foot and Ankle Ability Measure questionnaire

Purpose: To translate and cross-culturally adapt the Foot and Ankle Ability Measure (FAAM) questionnaire and verify the psychometric properties of the Brazilian–Portuguese version of this instrument.

Methods: Analysis of validity was carried out by applying the Rasch model and evaluating correlations with the Short Form-36 (SF-36) Physical Function (PF) subscale. Test–retest reliability and internal consistency were analyzed with the intraclass correlation coefficient (ICC_2,1) and Cronbach’s alpha tests, respectively.

Results: Ninety subjects with various foot and ankle musculoskeletal disorders (age 37.05 SD 10.49 years) were included. The ICC_2,1 was 0.88 and 0.82 with Cronbach’s alphas of 0.93 and 0.90 for the “Activities of Daily Living” (ADL) and “Sports” subscales, respectively. Correlations with the SF-36 PF were 0.78 (p?95: 0.62–0.87) and 0.65 (p?95: 0.45–0.79) for the ADL and Sports subscales, respectively. Item reliability indices in Rasch analysis were 0.91 (ADL) and 0.84 (Sports). Three items from the ADL subscale (14.2%) did not match the expectations of the model. All items from the Sports subscale fit the model.

Conclusions: There is evidence of validity and reliability of the FAAM-Brazil. Rasch analysis indicated that three items of the ADL subscale did not fit the model in the sample studied.

• Implications for Rehabilitation

• Self-report questionnaires are commonly used in both clinical practice and research because of their ability to efficiently collect information. If the instrument is created properly, the information collected can be used to interpret the effect of clinical conditions on physical function.

• The Foot and Ankle Ability Measure (FAAM) is an evaluative instrument that assesses functional limitations for those with foot- and ankle-related disorders. It was translated into four languages and has evidence of validity, reliability, and responsiveness.

• Evidence of validity and reliability is provided for the FAAM-Brazil when applied to subjects with a wide range of foot and ankle musculoskeletal disorders.

     

Optimising the effects of rigid ankle foot orthoses on the gait of children with cerebral palsy (CP) – an exploratory trial

Purpose: This exploratory trial investigated the effects of rigid ankle foot orthoses (AFO) with an optimally cast Angle of the Ankle in the AFO (AAAFO) on the gait of children with Cerebral Palsy (CP), and whether tuning of the AFO – Footwear Combination (AFO-FC) further affected gait. Methods: Eight children with CP underwent gait analysis and tuning of their AFO-FCs using a 3-D motion analysis system. Comparisons were carried out for selected gait parameters between three conditions – barefoot, non-tuned AFO-FC and tuned AFO-FC. Results: In comparison to barefoot gait, walking with a non-tuned AFO-FC produced significant (p?Conclusions: The findings of the current study indicate the potential benefits of using rigid AFO-FC with optimal AAAFO and tuning of AFO-FCs. This study emphasises the need for categorising children with CP based on their gait patterns when investigating the effects of interventions such as AFOs.

• Implications for Rehabilitation

• Rigid ankle foot orthoses (AFO) cast at an optimal angle to accommodate the length of gastrocnemius muscle may positively influence walking in children with Cerebral Palsy (CP).

• Tuning of the AFO-Footwear Combination (AFO-FC) has potential benefits to the walking of children with CP, depending on their gait abnormalities.

• When investigating the effects of interventions such as AFOs, it is important to categorise children with CP based on their gait abnormalities.

     

A single robotic session that guides or increases movement error in survivors post-chronic stroke: which intervention is best to boost the learning of a timing task?

Purpose: Timing deficits can have a negative impact on the lives of survivors post-chronic stroke. Studies evaluating ways to improve timing post stroke are scarce. The goal of the study was to evaluate the impact of a single session of haptic guidance (HG) and error amplification (EA) robotic training interventions on the improvement of post-stroke timing accuracy.

Materials and methods: Thirty-four survivors post-chronic stroke were randomly assigned to HG or EA. Participants played a computerized pinball-like game with their affected hand positioned in a robot that either helped them perform better (HG) or worse (EA) during the task. A baseline and retention phase preceded and followed HG and EA, respectively, in order to assess their efficiency at improving absolute timing errors. The impact of the side of the stroke lesion on the participants’ performance during the timing task was also explored for each training group.

Results: An improvement in timing performance was only noted following HG (8.9?±?4.9?ms versus 7.8?±?5.3?ms, p?=?0.032). Moreover, for the EA group only, participants with a left-sided stroke lesion showed a worsening in performance as compared to those with a right-sided stroke lesion (p?=?0.001).

Conclusion: Helping survivors post-chronic stroke perform a timing-based task is beneficial to learning. Future studies should explore longer and more frequent HG training sessions in order to further promote post stroke motor recovery.

• Implications for Rehabilitation

• Timing is crucial for the accomplishment of daily tasks.

• The number of studies dedicated to improving timing is scarce in the literature, even though timing deficits are common post stroke.

• This innovative study evaluated the impact of a single session of haptic guidance-HG and error amplification-EA robotic training interventions on improvements in timing accuracy among survivors post chronic stroke.

• HG robotic training improves timing accuracy more than EA among survivors post chronic stroke.

     

Design,construction, and evaluation of “sensor lock”: an electromechanical stance control knee joint

Background and aim: Most currently-available stance control knee ankle foot orthoses (SCKAFOs) still need full knee extension to lock the knee joint, and they are still noisy, bulky, and heavy. Therefore, the aim of this study was to design, construct, and evaluate an original electromechanical SCKAFO knee joint that could feasibly solve these problems, and thus address the problems of current stance control knee joints with regards to their structure, function, cosmesis, and cost.

Method: Ten able-bodied (AB) participants and two (knee ankle foot orthosis) KAFO users were recruited to participate in the study. A custom SCKAFO with the same set of components was constructed for each participant. Lower limb kinematics were captured using a 6-camera, video-based motion analysis system.

Results: For AB participants, significant differences were found between normal walking and walking with the SCKAFO for temporal-spatial parameters and between orthoses with two modes of knee joints in the healthy subjects. Walking with stance control mode produced greater walking speed and step length, greater knee flexion during swing, and less pelvic obliquity than walking with a locked knee, for both AB and KAFO users.

Conclusions: The feasibility of this new knee joint with AB people was demonstrated.

• Implications for rehabilitation

• Stance control knee ankle foot orthoses (SCKAFOs) are designed to stop knee flexion in stance phase and provide free knee movement during swing phase of walking.

• Due to their high cost, size, excessive weight, and poor performance, few SCKAFO were optimal clinically and commercially.

• The feasibility of the new knee joint with able-bodied people and poliomyelitis subjects was demonstrated.

     

Body composition and physical function after progressive resistance and balance training among older adults after stroke: an exploratory randomized controlled trial

Purpose: To evaluate whether improvements in physical function are related to changes in body composition after a three-month progressive resistance and balance exercise program among individuals approximately one to three years after stroke.

Methods: In this randomized controlled trial, 43 community-dwelling subjects (65–85 years, mean age 73?±?5 years, 73% men) were allocated to a progressive resistance and balance exercise program twice weekly for three months (intervention group [IG], n?=?20) or a control group (n?=?23). The main outcome measures were fat mass (kg) and fat-free mass (kg), as measured by bioelectrical impedance analyses (Tanita^®). Physical function was measured using the six-minute walk test.

Results: Complete case analyses revealed reduced fat mass in the IG compared with the control (?1.5 vs. (0).13% of body weight, respectively; effect size?=0.62; p?=?0.048). In contrast, no between-group difference in fat-free mass was observed. The six-minute walk test was improved (25 vs. ?10 m, respectively, effect size =0.69, p?=?0.039) at three months in favor of the IG. The reduced fat mass was associated with an improved six-minute walk test (r?=?0.48, p?=?0.038) in the IG.

Conclusions: Three-month progressive resistance and balance training was associated with reduced fat mass, which was related to improvements in walking capacity in older adults approximately one year after stroke.

• Implications for rehabilitation

• This three-month PRB group exercise program supported by motivational discussions and daily home-based exercises indicate the following:

• ??Improved walking capacity was associated with a reduction in fat mass.

• ??IGF-1 is reduced, possibly indicating improved insulin sensitivity.