Effects of the ankle angle of an ankle foot orthosis on foot pressure during the gait in healthy adults

[Purpose] The purpose of this study was to investigate the effects of the ankle angle of an ankle foot orthosis (AFO) on foot pressure during the gait in healthy adults. [Subjects] Sixteen healthy males with neither orthopedic nor neurological problems participated in this study. [Methods] Subjects walked on a walkway at a self-selected pace with an AFO set at four different ankle angles (−5°, 0°, 5°, and 10°). Foot pressure was measured randomly according to the ankle angle of the AFO using an F-scan system. Three trials were measured and averaged for data analysis. [Results] The peak foot pressure of the hallux, 2nd–5th toes, 2nd and 3rd metatarsal heads, 4th and 5th metatarsal heads, and the heel showed significant differences among the AFO ankle angles: angles of 0° and −5° increased the foot pressure of the lateral legions, and the peak foot pressure of the heel at an AFO ankle angle of 10° was significantly greater than those of the other angles. [Conclusion] The ankle angle of the AFO affected foot pressure and gait patterns during gait. The results suggest that the appropriate angle for an AFO is between 5° and 10° when AFOs are prescribed by clinicians.Key words: Ankle foot orthosis, Ankle angle, Gait     

Effects of vibratory orthosis on balance in idiopathic Parkinson's disease

Purpose. It was hypothesised that lumbar vibration stimulation applied by a vibratory orthosis improves balance in people with Parkinson's disease (PD).

Methods. The overall stability index and the percent of elapsed time in different zones and quadrants on the platform of Biodex balance system were evaluated. General conditions of eyes-open and eyes-close, each with two situations of motors On and motors Off of vibratory orthosis were considered.

Results. Balance in PD patients improved in eyes-open condition rather than eyes-close. The balance also improved in eyes-open condition with motors On rather than that in motors Off. In eyes-close condition, balance was lesser in motors On than that in motors Off situation. The results also suggest that in PD patients, body trajectories on the platform of Biodex balance system follow a random-like chaotic behaviour.

Conclusions. A new orthosis in rehabilitation of PD patients was introduced to enhance balance and decrease risk of fall. It promotes new ideas for rehabilitation of similar neurological diseases. The possibility of enhancing balance in PD patients in a short-term setting was evaluated. Results showed balance enhancement in PD patients in eyes-open condition. However, in eyes-close condition, we are not sure of its effectiveness.     

The effects of a movement with music program on measures of balance and gait speed in healthy older adults

A group of 16 healthy older adults participated in a movement with music program to enhance physical flexibility, balance, and gait speed. The program, designed by a Laban Movement Analyst, consisted of 14 movement sequences set to music composed to reflect the dynamics, rhythm, timing, and phrasing of the movements. After 5 weeks, individuals showed statistically significant increases in measures of one-foot stance balance, gait speed, and functional reach. From the 5th to the 14th week, improvements continued in all measures but were not statistically significant.     

Effects of Pilates on the risk of falls,gait, balance and functional mobility in healthy older adults: A randomised controlled trial

ObjectiveTo investigate the effects of Pilates on falls risk, fear of falling, postural balance, functional mobility, spatiotemporal gait parameters, mobility and physical activity in older adults.DesignRandomized Controlled Trial (RCT).MethodsSixty-one older adults, mean age 70.08 (SD = 5.51) were randomly allocated into a Pilates group (PG, n = 29) or control group (CG, n = 32). Intervention comprised a 12-week Pilates program, with exercises performed twice a week and supplementary exercises at home. The Montreal Cognitive Assessment (MOCA), was used to screen cognition. Primary outcomes: Fear of falling, postural balance (force platform), gait velocity (electronic walkway). Secondary outcomes: Functional mobility, mobility, physical activity, and spatiotemporal parameters of gait. Statistical analysis was carried out using Generalized Estimating Equations (GEE). Covariates were adjusted.ResultsPositive effects were found for time effects: Time Up and Go (TUG), anteroposterior (AP) and mediolateral (ML) directions of balance, cadence, (stance, step and double support time). The step and double support time showed significant differences between the two groups (p < 0.05). Interaction between time and groups was found for FRT. Age was a significant factor in TUG, FRT, postural balance for AP under open eyes conditions. Health status was significant for ML in eyes open condition. Gait was significant for age, height and health status.ConclusionEffects of 12 weeks of Pilates intervention on functional mobility, mobility, postural balance and spatiotemporal gait parameters were identified. Further trials of a longer duration are warranted to determine the effectiveness of Pilates on falls prevention.     

Effects of lower leg muscle quality on gait variability in community-dwelling older and healthy young adults

[Purpose] We aimed to determine whether lower leg muscle echo intensity, an indicator of muscle quality, is a useful predictor of gait variability after examining the relationship between physical activity and gait variability in community-dwelling older and healthy young adults. [Participants and Methods] This study comprised two tasks. In the first task, 18 older and 25 young adults were included as participants. We examined the relationship between the amount of physical activity and gait variability in both groups. In the second task, muscle echo intensity related to gait variability in each group was measured using ultrasound echoes after identifying common factors related to gait variability in 19 older and 19 younger adults, and trends were compared. [Results] In the first task, gait variability was significantly higher in the younger group than in the older group. A significant negative correlation was found between the amount of physical activity and gait variability in both groups. In the second task, multiple regression analysis was performed for gait variability, and lower leg muscle echo intensity was identified as a significant factor. There was no difference in the correlation coefficient between gait variability and lower leg muscle echo intensity between the two groups. [Conclusion] Lower leg muscle quality was one of the causes of gait variability, suggesting that it is a useful predictor of gait sway status.     

佩戴踝足矫形器对痉挛型脑性瘫痪儿童足底压力步态的作用

背景:由于设计及方法的差异,佩戴蹀足矫形器对脑性瘫痪(脑瘫)儿童步行时运动学、运动力学、能耗等各方面的影响尚未取得统一的结果.目的:观察佩戴踝足矫形器对痉挛型脑瘫患儿足底压力步态特征的影响.方法:采用足底压力式步态分析系统对21例具有独立步行能力的痉挛型脑瘫儿童进行步态分析.分别记录同一天内、同一时间段、同一种身体状态下不佩戴踝足矫形器及佩戴踝足矫形器步行时每例脑瘫患儿足底压力式步态分析数据,包括时间参数、运动学参数以及各参数的绝对对称性指标,并进行对比.记录双足的足底压力重心偏移轨迹作为步行能力的定性直观观察指标,对比佩戴支具前后的足底压力重心偏移轨迹图并做对照描述.结果与结论:与未佩戴踝足矫形器相比,佩戴踝足矫形器使痉挛型脑瘫患儿步态周期时间缩短,步频增加(P<0.01).佩戴踝足矫形器步行时脑瘫儿童单足支撑期、单侧支撑期、单足摆动期、步态周期时间的绝对对称性指标值均较未佩戴矫形器时显著减少(P<0.05).痉挛型脑瘫儿童步行时双足的足底压力重心偏移轨迹表现出无序的特性,不能形成左右对称的蝴蝶状轨迹图.佩戴踝足矫形器后,足底压力中心偏移轨迹比未佩戴时有序,尖足步态患儿佩戴踝足矫形器后患足的足底压力偏移轨迹起始点后移.结果提示痉挛型脑瘫儿童佩戴踝足矫形器后步态周期时间缩短,步频增加,步态对称性改善,总体步行能力得到提高.足底压力式步态分析系统能以客观精确的数据和直观的图表表达,是评定脑瘫儿童步行能力的一种新型测试手段.     

新型互动式截瘫行走器在截瘫患者中的应用

目的 探讨新型互动式截瘫行走器(walkabout orthosis，WO)对截瘫患者的作用。方法 针对截瘫患者个体差异，制作并装配WO，对患者进行康复治疗及步态训练。结果 患者经过康复治疗及训练后，其Barthel指数明显提高，患者站立及步行能力明显改善，能够达到治疗性步行及家庭性步行。结论 康复治疗可以有效地改善患者的独立生活能力，WO能明显提高截瘫患者的行走能力，是较好的行走器之一。     

截瘫步行器的仿生效果

背景：截瘫步行器的临床应用,使截瘫患者重建步行功能成为可能,但截瘫步行器只为进行步行康复训练及简单的行走,距离真正意义上的步行功能代偿相差还很远。目的：对目前几种截瘫步行器的结构特点、作用机制及仿生效果进行归纳、分析。方法：应用计算机检索1990-01/2008-12PubMed数据库及万方数据库有关截瘫步行器的特点、仿生效果及临床应用方面的相关文献,英文检索词＂reciprocation gait orthosis,walkabout,bionice＂,中文检索词＂截瘫步行器,仿生＂。检索文献量总计32篇。结果与结论：目前无动力截瘫步行器运用较广泛,但对截瘫患者来说,通常只为进行步行康复训练及简单的行走,距离真正意义上的步行功能代偿相差还很远。运用最广的往复式截瘫步行器和互动截瘫步行器这两种截瘫步行器仿生效果较差,步态严重失真,体能消耗大,而由外部能源补充能耗的步行器则可以克服无动力步行器的不足,随着人工智能技术在机器人和许多工业领域得到了广泛应用,它的发展可为患者提供性能优良,安全可靠,更具有仿生性的截瘫步行器产品。     

截瘫步行器的仿生效果

背景:截瘫步行器的临床应用,使截瘫患者重建步行功能成为可能,但截瘫步行器只为进行步行康复训练及简单的行走,距离真正意义上的步行功能代偿相差还很远.目的:对目前几种截瘫步行器的结构特点、作用机制及仿生效果进行归纳、分析.方法:应用计算机检索1990-01/2008-12 PubMed数据库及万方数据库有关截瘫步行器的特点、仿生效果及临床应用方面的相关文献,英文检索词"reciprocation gait orthosis,walkabout,bionice",中文检索词"截瘫步行器,仿生".检索文献量总计32篇.结果与结论:目前无动力截瘫步行器运用较广泛,但对截瘫患者来说,通常只为进行步行康复训练及简单的行走,距离真正意义上的步行功能代偿相差还很远.运用最广的往复式截瘫步行器和互动截瘫步行器这两种截瘫步行器仿生效果较差,步态严重失真,体能消耗大,而由外部能源补充能耗的步行器则可以克服无动力步行器的不足,随着人工智能技术在机器人和许多工业领域得到了广泛应用,它的发展可为患者提供性能优良,安全可靠,更具有仿生性的截瘫步行器产品.     

Dynamic balance during gait in children and adults with Generalized Joint Hypermobility

Background

The purpose of the study was to investigate if differences of the head and trunk stability and stabilization strategies exist between subjects classified with Generalized Joint Hypermobility and healthy controls during gait. It was hypothesized that joint hypermobility could lead to decreased head and trunk stability and a head stabilization strategy similar to what have been observed in individuals with decreased locomotor performance.

Methods

A comparative study design was used wherein 19 hypermobile children were compared to 19 control children, and 18 hypermobile adults were compared to 18 control adults. The subjects were tested during normal walking and walking on a line. Kinematics of head, shoulder, spine and pelvis rotations were measured by five digital video cameras in order to assess the segmental stability (angular dispersion) and stabilization strategies (anchoring index) in two rotational components: roll and yaw.

Findings

Hypermobile children and adults showed decreased lateral trunk stability in both walking conditions. In hypermobile children, it was accompanied with decreased head stability as the head was stabilized by the inferior segment when walking on a line. Several additional differences were observed in stability and stabilization strategies for both children and adults.

Interpretation

Stability of the trunk was decreased in hypermobile children and adults. This may be a consequence of decreased stability of the head. Hypermobile children showed a different mode of head stabilization during more demanding locomotor conditions indicating delayed locomotor development.The findings reflect that Generalized Joint Hypermobility probably include motor control deficits.     

虚拟现实训练对有平衡障碍的小脑梗死患者平衡和步态的影响

目的:探讨虚拟现实训练对有平衡障碍的小脑梗死患者平衡和步态的影响。方法:前瞻性收集2016年6月—2017年12月浙江中医药大学附属第二医院神经内科和康复科住院的急性小脑梗死患者54例,随机分为对照组(n=27)和观察组(n=27)。对照组接受传统平衡训练3周,观察组接受基于虚拟现实技术的平衡训练3周。治疗前后采用Berg平衡量表(BBS)评定平衡功能,Gait Watch三维步态分析系统分析患者步态。结果:治疗3周后,观察组BBS动态评分,BBS静态评分及BBS总分均较对照组明显升高(t=2.029, P=0.048;t=2.115, P=0.039;t=2.757, P=0.008)。步态分析结果提示:观察组步频和患侧摆动相较对照组明显升高(t=2.235, P=0.030;t=2.148, P=0.036),步态不对称指数较对照组明显下降(t=-2.107, P=0.040);观察组步速和跨步长较对照组明显增高(t=2.395, P=0.020;t=2.451, P=0.018),步宽较对照组明显降低(t=-2.035, P=0.047);观察组步行时患侧髋关节和膝关节最大活动角度较对照组明显增大(t=2.054, P=0.045;t=2.324, P=0.024)。结论:虚拟现实训练较传统平衡训练能更有效改善小脑梗死患者的平衡功能和步态异常。     

Effects of an ankle-foot orthosis on balance performance in patients with hemiparesis of different durations

OBJECTIVE: To examine the effects of an ankle-foot orthosis (AFO) on balance performance in patients with hemiparesis of short and long duration. DESIGN: Within-subject random order of intervention, cross-sectional study design. SETTINGS: Medical centres and district hospitals. SUBJECTS: Forty-two subjects with hemiparesis of short duration (< six months) and 61 subjects of long duration ( > 12 months). MEASUREMENTS: The balance and gait ability of subjects were evaluated both with an AFO and without. The static and dynamic balance activities were evaluated by the Balance Master System, whereas the functional balance was assessed with the Berg Balance Scale. The speed and cadence were also measured during a 10-metre walk. Paired t-test was used to determine the effect of the AFO. RESULTS: In subjects with hemiparesis of short duration, we found that subjects wearing an AFO showed significant improvements in (1) weight-bearing distribution during quiet standing (p = 0.042, 95% confidence interval (CI) 0.521, 7.325), (2) body sway during standing on foam surface with eyes open (p = 0.020, 95% CI 0.020, 0.680) and eyes closed (p = 0.041, 95% CI 0.023, 0.921), (3) movement velocity during limit of stability test (LOS)--toward the affected side (p = 0.037, 95% CI - 0.978, - 0.042) and nonaffected side (p = 0.008, 95% CI -2.223, - 0.377), (4) maximal excursion toward the affected side (p= 0.042, 95% CI -19.546, -0.071), and (5) speed (p=0.028, 95% CI -0.204, -0.017) and cadence (p= 0.021, 95% CI - 22.983, - 1.864). Such effects were not observed in subjects with hemiparesis of long duration. CONCLUSIONS: For the subjects with hemiparesis of short duration, the AFO improves the symmetry in quiet and dynamic standing balances. It also increases speed and cadence. However, its effectiveness is minimal for patients of long duration.     

C6—T6脊髓损伤患者应用往复式步行矫形器的疗效分析

目的：观察往复式步行矫形器对T6以上脊髓损伤患者心肺功能和ADL能力及步行能力的影响。方法：将40例C6—T6以上脊髓损伤患者分为观察组18例（装配往复式步行矫形器者）和对照组22例（未装配者）。对照组进行系统综合康复治疗（包括有氧训练、肌力训练、站立训练、平衡、转移训练、被动关节活动度训练、心肺功能训练、ADL训练、膀胱功能等其他综合康复训练），观察组进行系统综合康复治疗外还进行装配步行矫形器前训练、矫形器装配后训练及步态步行训练。结果：经过12周的训练后两组患者的心肺功能和日常生活活动能力明显改善，观察组明显优于对照组（P<0.05）。观察组18例患者装配矫形器及训练后患者10m步行时间平均87.27±39.57s， 6min步行距离为46.35±26.24m ，在装配往复式步行矫形器后7例可达到室内治疗性步行，11例可达到实用性步行，对照组无一例能步行。结论：往复式步行矫形器对改善T6以上脊髓损伤患者心肺功能、ADL能力及步行能力有重要意义。     

约束手臂摆动对健康青年人步态时空参数的影响

目的:明确约束手臂摆动对健康青年人步态时空参数的影响,探讨手臂摆动在步行中的作用。方法:选取健康青年人36例,其中男性18例,女性18例,平均年龄(22.72±3.54)岁,平均身高(167.35±9.15)cm,平均体重(63.62±16.29)kg。利用Gait Watch三维步态分析系统采集受试者在自然步态、双臂体侧、双臂体前、双臂体后、左臂体侧、左臂体前、左臂体后、右臂体侧、右臂体前、右臂体后共10种状态下的步态时空参数。不同约束状态均随机进行测试。分析不同约束手臂状态下步态时空参数同自然步态之间的差异。结果:不同手臂约束摆动状态下,步态周期、步频、步幅、步速、左步长、右步长、双支撑相同自然步态相比差异无显著性意义(P0.05)。左臂体侧、左臂体前、左臂体后三种约束条件下左支撑相、左摆动相同自然步态相比差异有显著性意义(P0.05);左臂体后、右臂体侧、右臂体前、右臂体后四种手臂约束条件下右支撑相、右摆动相与自然步态相比差异有显著性意义(P0.05)。结论:约束左侧手臂摆动后左下肢支撑相时间缩短,摆动相时间延长;约束右侧手臂摆动后右下肢支撑相时间延长,摆动相时间缩短。