Kinetic and kinematic parameters associated with late braking force and effects on gait performance of stroke patients.

Late braking force (LBF) is often observed in the late stance phase of the paretic lower limb of stroke patients. Nevertheless, the effects and association of LBF remain unclear. We examined the kinetic and kinematic parameters associated with LBF and its effect on walking. Herein, 157 stroke patients were enrolled. Participants walked at a comfortable speed selected by them, and their movements were measured using a 3D motion analysis system. The effect of LBF was analyzed as a linear relationship with spatiotemporal parameters. Multiple linear regression analyses were performed with LBF as the dependent variable and kinetic and kinematic parameters as independent variables. LBF was observed in 110 patients. LBF was associated with decreased knee joint flexion angles during the pre-swing and swing phases. In the multivariate analysis, trailing limb angle, cooperativity between the paretic shank and foot, and cooperativity between the paretic and non-paretic thighs were related to LBF (p < 0.01; adjusted R2 = 0.64). LBF in the late stance phase of the paretic lower limb reduced gait performance in the pre-swing and swing phases. LBF was associated with trailing limb angle in the late stance, coordination between the paretic shank and foot in the pre-swing phase, and coordination between both thighs.

Effect of Leg Length Discrepancy on Dynamic Gait Stability.

Objectives: : It is unclear whether the increased center of mass lateral shift during gait induced by leg length difference induces lateral instability. The purpose of this study was to investigate the effect of leg length discrepancy (LLD) on dynamic gait stability and the compensatory kinematic and dynamic strategies for this effect by using the extrapolated center of mass and margin of stability. Methods: : Nineteen healthy male participants walked without insoles (no LLD condition; 0 cm) and with added insoles (LLD condition; 3 cm). Kinematic and kinetic data were analyzed using a three-dimensional motion analyzer and force plates; the values were compared between the two conditions. Correlation analysis was performed on the parameters and the margin of stability and significant changes were identified. Results: Compared with the no-LLD condition, in the LLD condition, lateral stability was maintained on both the short leg side and the long leg side. Nonetheless, changes in joint angles and muscle activity on the frontal plane were observed on the short leg side, although the correlations were not significant. On the long leg side, a moderate negative correlation was found between the lateral flexion angle of the trunk and the margin of stability (r=-0.56, P=0.011). Conclusions: The short leg side may compensate for lateral stability by complex changes in joint angles and muscle activity, and the long leg side may compensate for lateral stability by actively adjusting the trunk lateral flexion angle.

Effect of spasticity of the ankle plantar flexors on the walking speed of hemiplegic stroke patients after maximum walking speed exercises.

Yamada T, Ohta M, Tamari M. Effect of spasticity of the ankle plantar flexors on the walking speed of hemiplegic stroke patients after maximum walking speed exercises. Jpn J Compr Rehabil Sci 2021; 12: 64-69. Objective: This study examined the effect of ankle plantar flexor spasticity on the walking speed of hemiplegic stroke patients immediately following maximum walking speed exercises. Methods: A total of 23 hemiplegic stroke patients were divided into two groups based on the presence (n = 13) or absence (n = 10) of ankle plantar flexor spasticity on the paralyzed side. Gait speed, propulsive force during pre-swing, paretic side ankle plantar flexion movement during pre-swing, paretic side ankle dorsiflexion angle during the stance phase, angular velocity of paretic side dorsiflexion during the stance phase, paretic side trailing limb angle in the terminal stance, paretic side plantar flexion angle in the terminal stance, and the timing of maximum dorsiflexion of the ankle joint on the paretic side were measured before and after the maximum walking speed exercises, using a three-dimensional motion analyzer. Results: In the spasticity group, no significant improvement was observed in any of the categories. In contrast, in the non-spasticity group, significant improvement was observed in all categories, except for the paretic side ankle dorsiflexion angle. Conclusion: This study showed that maximum walking speed exercises immediately improved walking speed in hemiplegic stroke patients without ankle plantar flexor spasticity.

Immediate synergistic effect of a trunk orthosis with joints providing resistive force and an ankle-foot orthosis on hemiplegic gait.

PURPOSE: The synergistic effects of a trunk orthosis and an ankle-foot orthosis (AFO) in stroke patients with a hemiplegic gait are unclear. We previously developed a trunk orthosis with joints providing resistive force (TORF) to modify malalignment of the trunk and pelvis and confirmed its positive effects in stroke patients during level walking without an AFO. The aim of the present study was to determine if this trunk orthosis and an AFO have synergistic effects during level walking in community-dwelling patients with chronic stroke. METHODS: Twenty-eight community-dwelling stroke patients performed level walking at a self-selected speed with an AFO and again while wearing a TORF (TORF group) or a corset (control group). Spatiotemporal, kinematic, and kinetic data were recorded using a three-dimensional motion analysis system. RESULTS: When compared with the control group, the TORF group showed significant increases in walking speed, number of steps on the paretic leg per minute, and peak ankle plantar flexion moment during the single stance phase. CONCLUSION: The TORF increased the ankle joint plantar flexion moment at the end of the single stance phase during level walking in stroke patients, leading to an increase in their gait speed because of the modified trunk and pelvis alignment.

Alveolar bone graft for patients with cleft lip/palate using bone particles and titanium mesh: A quantitative study.

PURPOSE: This study evaluated the bone volume, height, and width that can be obtained in alveolar ridge augmentation using titanium mesh and autogenous bone particles in patients with cleft lip/palate. PATIENTS AND METHODS: Subjects were 15 patients with cleft lip/palate requiring tertiary bone graft for implant therapy. Computed tomography (CT) scans were taken before removing the mesh, from 1 to 21 months after bone grafting. Forty-three reconstructed images corresponding to the positions for implant placement were selected for this study. The percent defect filled with bone (%BONE), defined as the percentage of newly formed bone in the space created by the mesh, was measured for image analyses. In linear analyses, 4 parameters were used: increased bone height (IBH), percent increased bone height (%IBH), increased bone width (IBW), and percent increased bone width (%IBW). Factors influencing the quantitative data and the clinical courses of placed implants were also explored. RESULTS: The average %BONE was 91.1%. IBH averaged 4.4 mm, whereas %IBH averaged 88.5%. IBW averaged 4.6 mm, whereas %IBW averaged 86.4%. Little correlation was present between the quantitative data and patient age, or time interval. A significant correlation was identified between the data for span of the grafted area and %BONE (correlation coefficient value = -0.36). However, the diminishing rate was very low. No implants were lost postoperatively. CONCLUSIONS: Alveolar ridge augmentation with titanium mesh and autogenous bone particles from the anterior iliac crest has very high predictability as a preimplant procedure in patients with cleft lip/palate.