片麻痺歩行におけるトウクリアランス戦略に短下肢装具が与える影響：横断的研究

藤田医科大

The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study

Abstract Background Ankle–foot orthoses (AFOs) are frequently used to improve gait stability, toe clearance, and gait efficiency in individuals with hemiparesis. During the swing phase, AFOs enhance lower limb advancement by facilitating the improvement of toe clearance and the reduction of compensatory movements. Clinical monitoring via kinematic analysis would further clarify the changes in biomechanical factors that lead to the beneficial effects of AFOs. The purpose of this study was to investigate the actual impact of AFOs on toe clearance, and determine the best strategy to achieve toe clearance (including compensatory movements) during the swing phase. Methods This study included 24 patients with hemiparesis due to stroke. The gait performance of these patients with and without AFOs was compared using three-dimensional treadmill gait analysis. A kinematic analysis of the paretic limb was performed to quantify the contribution of the extent of lower limb shortening and compensatory movements (such as hip elevation and circumduction) to toe clearance. The impact of each movement related to toe clearance was assessed by analyzing the change in the vertical direction. Results Using AFOs significantly increased toe clearance (p = 0.038). The quantified limb shortening and pelvic obliquity significantly differed between gaits performed with versus without AFOs. Among the movement indices related to toe clearance, limb shortening was increased by the use of AFOs (p < 0.0001), while hip elevation due to pelvic obliquity (representing compensatory strategies) was diminished by the use of AFOs (p = 0.003). The toe clearance strategy was not significantly affected by the stage of the hemiparetic condition (acute versus chronic) or the type of AFO (thermoplastic AFOs versus adjustable posterior strut AFOs). Conclusions Simplified three-dimensional gait analysis was successfully used to quantify and visualize the impact of AFOs on the toe clearance strategy of hemiparetic patients. AFO use increased the extent of toe clearance and limb shortening during the swing phase, while reducing compensatory movements. This approach to visualization of the gait strategy possibly contributes to clinical decision-making in the real clinical settings. Trial registration UMIN000028946. Registered 31 August 2017 (retrospectively registered)

Additional file 3: of The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study

Figure S2. Experimental setting for clarifying measurement error. A: A 1-m-long aluminum bar with four markers on it. B-D: The participant held the aluminium bar in three ways while walking; parallel to his torso, parallel to the sagittal and horizontal planes, or parallel to the coronal and horizontal planes. (TIFF 135890 kb

Additional file 1: of The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study

Figure S1. Adjustable posterior strut ankle–foot orthosis (APS-AFO). (TIFF 22671 kb

Additional file 4: of The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study

Figure S3. Correlation among non-paretic hip elevation (at mid-swing), paretic knee flexion, and non-paretic hip drop at paretic mid-stance. A. Correlation between the non-paretic hip elevation at the paretic mid-swing and the paretic knee flexion at the paretic mid-stance. The correlation coefficient was 0.10 (p = 0.80). B. Correlation between the non-paretic hip elevation at the paretic mid-swing and the non-paretic hip drop at the paretic mid-stance. The correlation coefficient was − 0.60 (p < 0.01). C. Comparison of the non-paretic hip drop at the paretic mid-stance with and without AFO (p = 0.23). (TIFF 135890 kb

Additional file 2: of The impact of ankle–foot orthoses on toe clearance strategy in hemiparetic gait: a cross-sectional study

Supplemental methods and results. The details of additional experiment for clarifying measurement error.(DOCX 564 kb