Swipe om te navigeren naar een ander artikel
The online version of this article (https://doi.org/10.1186/s13047-019-0348-8) contains supplementary material, which is available to authorized users.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
To reduce gait problems in individuals with non-spastic calf muscle weakness, spring-like ankle-foot orthoses (AFOs) are often applied, but they are not individually optimized to treatment outcome. The aim of this proof-of-concept study was to evaluate the effects of modifying the stiffness for two spring-like AFO types with shoes-only as reference on gait outcomes in three individuals with calf muscle weakness due to polio.
We assessed 3D gait biomechanics, walking speed and walking energy cost for shoes-only and five stiffness conditions of a dorsal-leaf-spring AFO and a spring-hinged AFO. Outcomes were compared between stiffness conditions in the two AFOs and three subjects.
Maximum ankle dorsiflexion angle decreased with increasing stiffness in both AFOs (up to 6–8°) and all subjects. Maximum knee extension angle changed little between stiffness conditions, however different responses between the AFOs and subjects were observed compared to shoes-only. Walking speed remained unchanged across conditions. For walking energy cost, we found fairly large differences across stiffness conditions with both AFOs and between subjects (range 3–15%).
Modifying AFO stiffness in individuals with non-spastic calf muscle weakness resulted in substantial differences in ankle biomechanics and walking energy cost with no effect on speed. Our results provide proof-of-concept that individually optimizing AFO stiffness can clinically beneficially improve gait performance.
Additional file 1: Gait biomechanics of subject A (calf muscle strength MRC 4). Shoes-only (1) is performed at the DLS-AFO testing day, Shoes-only (2) is performed at the SH-AFO testing day. Abbreviations: DLS-AFO: dorsal-leaf-spring ankle-foot-orthosis, SH-AFO: spring-hinged ankle-foot-orthosis, k: stiffness in N•m•deg− 1, DF: dorsiflexion, PF: plantarflexion, EX: extension, FL: flexion, Gen: generation, Abs: absorption, CoP: center of pressure. (TIF 1005 kb)
Additional file 2: Gait biomechanics of subject B (calf muscle strength MRC 4). Since all AFO conditions were tested at one day there is only one shoes-only (Shoes-only (1)) condition performed. Abbreviations: DLS-AFO: dorsal-leaf-spring ankle-foot-orthosis, SH-AFO: spring-hinged ankle-foot-orthosis, k: stiffness in N•m•deg− 1, DF: dorsiflexion, PF: plantarflexion, EX: extension, FL: flexion, Gen: generation, Abs: absorption, CoP: center of pressure. (TIF 995 kb)
Additional file 3: Gait biomechanics of subject C (calf muscle strength MRC 0). Shoes-only (1) is performed at the DLS-AFO testing day, Shoes-only (2) is performed at the SH-AFO testing day. Abbreviations: DLS-AFO: dorsal-leaf-spring ankle-foot-orthosis, SH-AFO: spring-hinged ankle-foot-orthosis, k: stiffness in N•m•deg− 1, DF: dorsiflexion, PF: plantarflexion, EX: extension, FL: flexion, Gen: generation, Abs: absorption, CoP: center of pressure. (TIF 1057 kb)
Perry J, Burnfield JM. Gait analysis, Normal and pathological function. 2nd ed. Thorofare (NJ: Slack Incorporated; 2010.
Ploeger HE, Bus SA, Brehm MA, Nollet F. Ankle-foot orthoses that restrict dorsiflexion improve walking in polio survivors with calf muscle weakness. Gait Posture. 2014;40:391–8. CrossRef
Beekman C, Perry J, Boyd LA, Newsam CJ, Mulroy SJ. The effects of a dorsiflexion-stopped ankle-foot orthosis on walking in individuals with incomplete spinal cord injury. Top Spinal Cord Inj Rehabil. 2000;5:54–62. CrossRef
Sutherland DH, Cooper L, Daniel D. The role of the ankle plantar flexors in normal walking. J Bone Joint Surg Am. 1980;62:354–63. CrossRef
Ploeger HE, Bus SA, Nollet F, Brehm MA. Gait patterns in association with underlying impairments in polio survivors with calf muscle weakness. Gait Posture. 2017;58:146–53. CrossRef
Bregman DJ, Harlaar J, Meskers CG, de Groot V. Spring-like ankle foot orthoses reduce the energy cost of walking by taking over ankle work. Gait Posture. 2011;35:148–53. CrossRef
Brehm MA, Nollet F, Harlaar J. Energy demands of walking in persons with postpoliomyelitis syndrome: relationship with muscle strength and reproducibility. Arch Phys Med Rehabil. 2006;87:136–40. CrossRef
Jensen MP, Alschuler KN, Smith AE, Verrall AM, Goetz MC, Molton IR. Pain and fatigue in persons with postpolio syndrome: independent effects on functioning. Arch Phys Med Rehabil. 2011;92:1796–801. CrossRef
Perry J, Clark D. Biomechanical abnormalities of post-polio patients and the implications for orthotic management. NeuroRehabilitation. 1997;8:119–38. CrossRef
Nollet F, Noppe CT. Orthoses for persons with postpolio syndrome. In: Hsu JD, Michael JW, Fisk JR, editors. AAOS atlas of orthoses and assistive devices. Philadelphia, PA: Mosby Inc. an affilitate of Elsevier Inc.; 2008. p. 411–7.
Lehmann JF, Condon SM, de Lateur BJ, Smith JC. Ankle-foot orthoses: effect on gait abnormalities in tibial nerve paralysis. Arch Phys Med Rehabil. 1985;66:212–8. CrossRef
Danielsson A, Sunnerhagen KS. Energy expenditure in stroke subjects walking with a carbon composite ankle foot orthosis. J Rehabil Med. 2004;36:165–8. CrossRef
Wolf SI, Alimusaj M, Rettig O, Doderlein L. Dynamic assist by carbon fiber spring AFOs for patients with myelomeningocele. Gait Posture. 2008;28:175–7. CrossRef
Desloovere K, Molenaers G, Van Gestel L, Huenaerts C, Van Campenhout A, Callewaert B, Van de Walle P, Seyler J. How can push-off be preserved during use of an ankle foot orthosis in children with hemiplegia? A prospective controlled study. Gait Posture. 2006;24:142–51. CrossRef
Bartonek A, Eriksson M, Gutierrez-Farewik EM. Effects of carbon fibre spring orthoses on gait in ambulatory children with motor disorders and plantarflexor weakness. Dev Med Child Neurol. 2007;49:615–20. CrossRef
Collins SH, Kuo AD. Recycling energy to restore impaired ankle function during human walking. PLoS One. 2010;5:e9307. CrossRef
Bregman DJ, van der Krogt MM, de Groot V, Harlaar J, Wisse M, Collins SH. The effect of ankle foot orthosis stiffness on the energy cost of walking: a simulation study. Clin Biomech. 2011;26:955–61. CrossRef
Collins SH, Wiggin MB, Sawicki GS. Reducing the energy cost of human walking using an unpowered exoskeleton. Nature. 2015;255:212–5. CrossRef
Bregman DJJ, Harlaar J, Meskers CGM, de Groot V. Spring-like ankle foot orthoses reduce the energy cost of walking in patients with reduced ankle push-off only when their stiffness is appropriate. Chapter 6 in thesis. The Optimal Ankle Foot Orthosis. ISBN 978–90–6464-486-3. 2011:105–24.
Harper NG, Esposito ER, Wilken JM, Neptune RR. The influence of ankle-foot orthosis stiffness on walking performance in individuals with lower-limb impairments. Clin Biomech (Bristol, Avon). 2014;29:877–84. CrossRef
Aids to the examination of the peripheral nervous system. London: Her Majesty’s Stationery Office; Medical Research Council, 1976.
Beasley WC. Quantitative muscle testing: principles and applications to research and clinical services. Arch Phys Med Rehabil. 1961;42:398–425. PubMed
Cave EF, Roberts SM. A method of measuring and recording joint function. J Bone Joint Surg. 1936;18:455–66.
Jagadamma KC, Coutts FJ, Mercer TH, Herman J, Yirrel J, Forbes L, Van Der Linden ML. Effects of tuning of ankle foot orthoses-footwear combination using wedges on stance phase knee hyperextension in children with cerebral palsy - preliminary results. Disabil Rehabil Assist Technol. 2009;4:406–13. CrossRef
Bregman DJ, Rozumalski A, Koops D, de Groot V, Schwartz M, Harlaar J. A new method for evaluating ankle foot orthosis characteristics: BRUCE. Gait Posture. 2009;30:144–9. CrossRef
Kerkum YL, Brehm MA, Buizer AI, van den Noort JC, Becher JG, Harlaar J. Defining the mechanical properties of a spring-hinged ankle foot orthosis to assess its potential use in children with spastic cerebral palsy. J Appl Biomech. 2014;30:728–31. CrossRef
Brehm MA. The clinical assessment of energy expenditure in pathological gait [dissertation]. Amsterdam: Ponsen & Looijen BV; 2007.
Hausswirth C, Bigard AX, Le Chevalier JM. The Cosmed K4 telemetry system as an accurate device for oxygen uptake measurements during exercise. Int J Sports Med. 1997;18:449–53. CrossRef
Garby L, Astrup A. The relationship between the respiratory quotient and the energy equivalent of oxygen during simultaneous glucose and lipid oxidation and lipogenesis. Acta Physiol Scand. 1987;129:443–4. CrossRef
Kerkum YL, Buizer AI, van den Noort JC, Becher JG, Harlaar J, Brehm MA. The effects of varying ankle foot orthosis stiffness on gait in children with spastic cerebral palsy who walk with excessive knee flexion. PLoS One. 2015;10:e0142878. CrossRef
Russell Esposito E, Blanck RV, Harper NG, Hsu JR, Wilken JM. How does ankle-foot orthosis stiffness affect gait in patients with lower limb salvage? Clin Orthop Relat Res. 2014;472:3026–35. CrossRef
Andrysek J, Klejman S, Kooy J. Examination of knee joint moments on the function of knee-ankle-foot orthoses during walking. J Appl Biomech. 2013;29:474–80. CrossRef
Kerkum YL, Houdijk H, Brehm MA, Buizer AI, Kessels ML, Sterk A, van den Noort JC, Harlaar J. The shank-to-vertical-angle as a parameter to evaluate tuning of ankle-foot orthoses. Gait Posture. 2015;42:269–74. CrossRef
Kobayashi T, Leung AK, Akazawa Y, Hutchins SW. Design of a stiffness-adjustable ankle-foot orthosis and its effect on ankle joint kinematics in patients with stroke. Gait Posture. 2011;33:721–3. CrossRef
Kerkum YL, Brehm MA, van Hutten K, van den Noort JC, H J, Becher JG, Buizer AI. Acclimatization of the gait pattern to wearing an ankle-foot orthosis in children with spastic cerebral palsy. Clin Biomech (Bristol, Avon). 2015;30:617–22. CrossRef
Gatts S. Neural mechanisms underlying balance control in tai chi. Medicine and sport science. 2008;52:87–103. CrossRef
- Stiffness modification of two ankle-foot orthosis types to optimize gait in individuals with non-spastic calf muscle weakness – a proof-of-concept study
Hilde E. Ploeger
Niels F. J. Waterval
Sicco A. Bus
- BioMed Central