In stroke patients, changing from a knee-ankle-foot orthosis (KAFO) to an ankle-foot orthosis (AFO) is an important element of gait acquisition. During this process, gait training wearing a KAFO with a free motion knee joint is widely experienced, but foot adjustment is largely dependent on empirical rules. According to reports on AFOs, while there is no disagreement on the effectiveness of plantar flexion resistance, opinion is divided over dorsiflexion resistance that presumably supplements knee extension, such as suppression of the propulsive force. In the present study, we examined the ground reaction force during walking with or without applying plantar dorsiflexion resistance in 12 healthy subjects wearing a KAFO with a free motion knee joint. We found that even when plantar dorsiflexion resistance was applied, the propulsive force was maintained, and the knee joint tended to be stabilized in the direction of extension. These results suggest the possibility that plantar dorsiflexion resistance in KAFO may be an effective adaptation toward changing to an AFO.
In recent years, patients with hemiplegia after stroke have enjoyed increasing opportunities to use various walking assistive devices for gait training. In the present study, we used the walking assistive device T-Support (Kawamura Gishi Co., Ltd.), which assists the function of paralyzed lower limbs utilizing the tension of elastic bands, and validated the effects of wearing the assistive device on gait factors in hemiplegic patients. Fifteen patients hospitalized in the convalescent ward who were undergoing gait training using an ankle-foot orthosis were enrolled in the study. The results showed that wearing the assistive device improved the walking speed as well as increasing the gastrocnemius muscle activity and the ankle joint plantar flexion moment at the end of the stance phase. These findings suggest the effectiveness of using the assistive device in gait training for hemiplegic patients.
In recent years, the introduction of robot in the rehabilitation area has been drawing attention, and the walking assisting robot is also recommended in the stroke guidelines for 2015. In this study, we examined the effect of a walking exercise assist (Gait Exercise Assist Robot : GEAR) in terms of its clinical application to the case of stroke hemiplegia. Eighteen-day intervention improved the walking speed and gait ability. This may be due to factors such as gradual control of the knee joint, a guaranteed amount of walking exercise through multiple step exercise on the patient’/s own and a motor learning effect using the visual feedback function against sensory disorder. From these results, it was reconfirmed that walking exercise using GEAR is a useful tool for stroke hemiplegia cases. In future it is thought that as the number of cases increased, it will be important to make more efficient and practical protocols and to accumulate and examine long-term data.