DOI QR코드

DOI QR Code

The effect of gait training with an elastic ankle-foot orthosis on balance and walking ability of persons with chronic stroke: a randomized controlled trial

  • Chi, Ming Hao (Rehabilitation Center, Bobath Memorial Hospital) ;
  • Yim, Jong Eun (Department of Physical Therapy, Sahmyook University) ;
  • Yi, Dong hyun (Department of Physical Therapy, The Graduate School, Sahmyook University)
  • Received : 2020.12.02
  • Accepted : 2020.12.29
  • Published : 2020.12.31

Abstract

Objective: The purpose of this study was to investigate the effect of treadmill exercise on the posture and walking speed of chronic stroke survivors with an ankle-foot orthosis. Design: Randomized controlled trial. Methods: Twenty-four chronic persons with chronic stroke admitted to Bobath Memorial Hospital in Seongnam city were divided into two groups by random blind method. Treadmill exercise with an elastic ankle-foot orthosis was performed in the experimental group and treadmill exercise was performed in the control group. The experiment was carried out for 6 weeks, and the experiment was carried out three times a week for 20 minutes per session. To measure the effect, static balance was measured using the MTD system before and after training, and the Berg Balance Scale (BBS) was used to measure functional balance. Results: There was a statistically significant difference between the 2 groups in the BBS measurement results for confirming the functional balance (p<0.05). Also, there was a significant difference between the 2 groups in single limb support time, step time and step length (p<0.05). Conclusions: In this study, it was found that treadmill exercise with an elastic ankle-foot orthosis in persons with chronic stroke was effective in maintaining functional balance, walking ability, step length, and step time. Therefore, it is necessary to use a flexible ankle-foot orthosis with proper treadmill exercise as a method of improving balance and walking speed of chronic stroke survivors.

Keywords

References

  1. Mahabir D, Bickram L, Gulliford MC. Stroke in Trinidad and Tobago: burden of illness and risk factors. Rev Panam Salud Publica 1998;4:233-7.
  2. O'Sullivan SB, Schmitz TJ. Physical rehabilitation: assessment and treatment. 3rd ed. Philadelphia (PA): F.A. Davis; 1994.
  3. Melzer I, Oddsson LI. The effect of a cognitive task on voluntary step execution in healthy elderly and young individuals. J Am Geriatr Soc 2004;52:1255-62.
  4. Chen CL, Yeung KT, Wang CH, Chu HT, Yeh CY. Anterior ankle-foot orthosis effects on postural stability in hemiplegic patients. Arch Phys Med Rehabil 1999;80:1587-92.
  5. Eng JJ, Chu KS. Reliability and comparison of weight-bearing ability during standing tasks for individuals with chronic stroke. Arch Phys Med Rehabil 2002;83:1138-44.
  6. Bleyenheuft C, Cockx S, Caty G, Stoquart G, Lejeune T, Detrembleur C. The effect of botulinum toxin injections on gait control in spastic stroke patients presenting with a stiff-knee gait. Gait Posture 2009;30:168-72.
  7. Gok H, Kucukdeveci A, Altinkaynak H, Yavuzer G, Ergin S. Effects of ankle-foot orthoses on hemiparetic gait. Clin Rehabil 2003;17:137-9.
  8. Nolan KJ, Savalia KK, Yarossi M, Elovic EP. Evaluation of a dynamic ankle foot orthosis in hemiplegic gait: a case report. NeuroRehabilitation 2010;27:343-50.
  9. Nolan KJ, Savalia KK, Lequerica AH, Elovic EP. Objective assessment of functional ambulation in adults with hemiplegia using ankle foot orthotics after stroke. PM R 2009;1:524-9.
  10. McCain KJ, Pollo FE, Baum BS, Coleman SC, Baker S, Smith PS. Locomotor treadmill training with partial body-weight support before overground gait in adults with acute stroke: a pilot study. Arch Phys Med Rehabil 2008;89:684-91.
  11. Kelly JO, Kilbreath SL, Davis GM, Zeman B, Raymond J. Cardiorespiratory fitness and walking ability in subacute stroke patients. Arch Phys Med Rehabil 2003;84:1780-5.
  12. Bohannon RW, Larkin PA, Smith MB, Horton MG. Relationship between static muscle strength deficits and spasticity in stroke patients with hemiparesis. Phys Ther 1987;67:1068-71.
  13. Park YH. The effects of ankle proprioceptive control program on the balance and walking in the persons with stroke [Master thesis]. Seoul: Sahmyook University; 2009.
  14. Yang S, Hwang WH, Tsai YC, Liu FK, Hsieh LF, Chern JS. Improving balance skills in patients who had stroke through virtual reality treadmill training. Am J Phys Med Rehabil 2011;90:969-78.
  15. Son JC. The effects of ankle strength exercise on the ability of balance control of patients with stroke [Master thesis]. Yong In: Yong In University; 2005.
  16. Lehmann JF, Esselman PC, Ko MJ, Smith JC, deLateur BJ, Dralle AJ. Plastic ankle-foot orthoses: evaluation of function. Arch Phys Med Rehabil 1983;64:402-7.
  17. Geboers JF, Janssen-Potten YJ, Seelen HA, Spaans F, Drost MR. Evaluation of effect of ankle-foot orthosis use on strength restoration of paretic dorsiflexors. Arch Phys Med Rehabil 2001;82:856-60.
  18. Boehme R. Myofascial release and its application to neuro-developmental treatment. Milwaukee (WI): Boehme Workshops; 1991.
  19. Cho SH, Song BB. The effects of elastic ankle-foot orthosis on balance and gait for the patients with stroke. J Spec Educ Rehabil Sci 2016;55:269-85.
  20. Bogle Thorbahn LD, Newton RA. Use of the Berg Balance Test to predict falls in elderly persons. Phys Ther 1996;76:576-83;discussion 584-5.
  21. Shumway-Cook A, Woollacott MH. Motor control: translating research into clinical practice. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins; 2007.
  22. Geurts AC, de Haart M, van Nes IJ, Duysens J. A review of standing balance recovery from stroke. Gait Posture 2005;22:267-81.
  23. Tyson SF, Hanley M, Chillala J, Selley A, Tallis RC. Balance disability after stroke. Phys Ther 2006;86:30-8.
  24. Nichols DS. Balance retraining after stroke using force platform biofeedback. Phys Ther 1997;77:553-8.
  25. Marigold DS, Eng JJ. The relationship of asymmetric weightbearing with postural sway and visual reliance in stroke. Gait Posture 2006;23:249-55.
  26. Chen CK, Hong WH, Chu NK, Lau YC, Lew HL, Tang SF. Effects of an anterior ankle-foot orthosis on postural stability in stroke patients with hemiplegia. Am J Phys Med Rehabil 2008;87:815-20.
  27. Simons CD, van Asseldonk EH, van der Kooij H, Geurts AC, Buurke JH. Ankle-foot orthoses in stroke: effects on functional balance, weight-bearing asymmetry and the contribution of each lower limb to balance control. Clin Biomech (Bristol, Avon) 2009;24:769-75.
  28. Cakar E, Durmus O, Tekin L, Dincer U, Kiralp MZ. The ankle-foot orthosis improves balance and reduces fall risk of chronic spastic hemiparetic patients. Eur J Phys Rehabil Med 2010;46:363-8.
  29. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1995;76:27-32.
  30. Kim CM, Eng JJ, Whittaker MW. Effects of a simple functional electric system and/or a hinged ankle-foot orthosis on walking in persons with incomplete spinal cord injury. Arch Phys Med Rehabil 2004;85:1718-23.
  31. Tyson SF, Kent RM. Effects of an ankle-foot orthosis on balance and walking after stroke: a systematic review and pooled metaanalysis. Arch Phys Med Rehabil 2013;94:1377-85.
  32. Esquenazi A, Ofluoglu D, Hirai B, Kim S. The effect of an ankle-foot orthosis on temporal spatial parameters and asymmetry of gait in hemiparetic patients. PM R 2009;1:1014-8.
  33. Tyson SF, Thornton HA. The effect of a hinged ankle foot orthosis on hemiplegic gait: objective measures and users' opinions. Clin Rehabil 2001;15:53-8.
  34. Blaya JA, Herr H. Adaptive control of a variable-impedance ankle-foot orthosis to assist drop-foot gait. IEEE Trans Neural Syst Rehabil Eng 2004;12:24-31.