A Study on the Distribution of Plantar Pressure in Adult Hemiplegia during Gait with the Use of Cane

  • Cha, Yong-Jun (Department of Rehabilitation Science, Graduate School, Daegu University) ;
  • Kim, Kyoung (Department of Physical Therapy, College of Rehabilitation Science, Daegu University)
  • Received : 2010.05.13
  • Accepted : 2010.06.14
  • Published : 2010.06.25

Abstract

Purpose: The purpose of this study was to investigate the plantar pressure distribution between the affected and unaffected side in adult hemiplegia during gait with the use of a quad-cane. Methods: Thirty-four stroke patients from 34 to 83 years of age were enrolled in this study, and in random order, all patients were asked to walk at their most comfortable speed three times along a walkway with the use of quad-cane over a period of three days. Plantar pressure distribution was measured with regard to foot contact pattern and center of pressure (CoP) trajectories during the stance phase, progressing from heel-strike to toe-off. The F-scan system was used to compare the foot pressure of the affected and unaffected sides. Results: A significant reduction in the total contact area, the width of fore foot (FF) and hind foot (HF), and anterior/posterior (AP) CoP trajectory of the affected side was found. However, contact pressure of the hind foot on the affected side during walking increased when compared to that on the unaffected side. Conclusion: We demonstrated that plantar pressure distribution on the affected side of adult hemiplegia patients was generally poorer than that on the unaffected side when these patients walked with cane assistance. However, the use of a quad-cane was shown to increase contact pressure of the hind foot on the affected side because weight can be borne on the affected side during heel-strike with use of the cane.

Keywords

References

  1. Alexander LD, Black SE, Patterson KK et al. Association between gait asymmetry and brain lesion location in stroke patients. Stroke. 2009;40(2):537-44. https://doi.org/10.1161/STROKEAHA.108.527374
  2. Willey JZ, Williams O, Boden-Albala B. Stroke literacy in Central Harlem: a high-risk stroke population. Neurology. 2009;73(23):1950-6. https://doi.org/10.1212/WNL.0b013e3181c51a7d
  3. Olaleye OA, Hamzat TK. Stroke rehabilitation: when should ambulation activities commence? Journal of the Nigeria Medical Rehabilitation Therapists. 2002;7(2):23-5.
  4. O'Young BJ, Young MA, Stiens A. Physical medicine and rehabilitation secrets. 2nd ed. Philadelphia, Hanley and Belfus, 2001:504-12.
  5. Kersten P. Principles of physiotherapy assessment and outcome measures. In: Stokes M, eds, Physical management in neurological rehabilitation. 2nd ed. Edinburgh, Elsevier, 2005: 31-2.
  6. Friedman PJ. Gait recovery after hemiplegic stroke. Int Disabil Stud. 1990;12(3)119-22. https://doi.org/10.3109/03790799009166265
  7. Skilbeck CE, Wade DT, Hewer RL et al. Recovery after stroke. J Neurol Neurosurg Psychiatry. 1983;46(1):5-8. https://doi.org/10.1136/jnnp.46.1.5
  8. Chang JS, Lee SY, Lee MH et al. The correlations between gait speed and muscle activation or foot pressure in stroke patients. J Kor Soc Phys Ther. 2009;21(3):47-52.
  9. Kuan TS, Tsou JY, and Su FC. Hemiplegic gait of stroke patients: The effect of using a cane. Arch Phys Med Rehabil. 1999;80(7):777-84. https://doi.org/10.1016/S0003-9993(99)90227-7
  10. Perry J. The mechanics of walking in hemiplegia. Clin Orthop. 1969;63:23-31.
  11. Mulley GP. Walking sticks. Br Med J (Clin Res Ed). 1988; 296(6620):475-6. https://doi.org/10.1136/bmj.296.6620.475
  12. Chen CL, Chen HC, Wong MK et al. Temporal stride and force analysis of cane-assisted gait in people with hemiplegic stroke. Arch Phys Med Rehabil. 2001;82(1):43-8. https://doi.org/10.1053/apmr.2001.18060
  13. Lu CL, Yu B, Basford JR et al. Influences of cane length on the stability of stroke patients. Journal of Rehabilitation and Development. 1997;34(1):91-100.
  14. Mueller MJ, Sinacore DR, Hoogstrate S et al. Hip and ankle walking strategies: effect on peak plantar pressures and implications for neuropathic ulceration. Arch Phys Med Rehabil. 1994;75(11):1196-200. https://doi.org/10.1016/0003-9993(94)90004-3
  15. Wong AM, Pei YC, Hong WH et al. Foot contact pattern analysis in hemiplegic stroke patients: An implication for neurologic status determination. Arch Phys Med Rehabil. 2004;85(10):1625-30. https://doi.org/10.1016/j.apmr.2003.11.039
  16. Fuller EA. Center of pressure and its theoretical relationship to foot pathology. J Am Podiatr Med Assoc. 1999;89(6):278- 91. https://doi.org/10.7547/87507315-89-6-278
  17. Han TR, Paik NJ, Im MS. Quantification of the path of center of pressure (COP) using an F-scan in-shoe transducer. Gait Posture. 1999;10(3):248-54. https://doi.org/10.1016/S0966-6362(99)00040-5
  18. Gaviria M, D'Angeli M, Chavet P et al. Plantar dynamics of hemiplegic gait: a methodological approach. Gait Posture. 1996;4(4):297-305. https://doi.org/10.1016/0966-6362(95)01055-6
  19. Buurke JH, Hermens HJ, Erren-Wolters CV et al. The effect of walking aids on muscle activation patterns during walking in stroke patients. Gait Posture. ;22(2):164-70. https://doi.org/10.1016/j.gaitpost.2004.09.003