Objective: The purpose of this study were to investigate the temporospatial, kinematic data and energy consumption in hemiplegic patients according to the types of ankle-foot orthosis (AFO), and to determine the most effective type of AFO for gait training.

Method: A prospective study was performed for 10 patients with hemiplegia who was able to walk independently at indoor level. The temporospatial, kinematic data and energy consumption were compared in each five different conditions: 1) barefoot, 2) donning AFO with posterior leaf spring (PLS), 3) donning PLS with the distal part of metatarsal head trimmed off (PLS-C), 4) donning hinged PLS (HPLS), 5) donning hinged PLS with the distal part of metatarsal head trimmed off (HPLS-C).

Results: With four types of PLS, maximal ankle plantar flexion was significantly decreased, however we didn't find any difference in kinematic data of the pelvis and hip as compared with barefoot and with PLS, HPLS, HPLS-C and maximal knee extension angle was significantly decreased compared with barefoot. With HPLS-C, cadence and walking speed significantly increased and double support time and oxygen cost significantly decreased as compared with barefoot.

Conclusion: This study showed increased walking speed, decreased energy cost and improved

Objective: To evaluate the effect of a contralateral shoe-lift and ipsilateral leather outsole on the energy consumption in hemiplegic gait.

Method: Ten hemiplegic patients who could walk independently were enrolled. Using portable ergospirometer (K4b², Cosmed, Italy), quantitative evaluation of oxygen consumption under varying shoes conditions was done: 1) regular shoes 2) a half-inch shoe-lift on the sound side 3) a half-inch shoe-lift on the sound side and leather outsole on the plegic side. The evaluation distance was 20 meter on comfortable walking speed.

Results: The oxygen consumption was significantly decreased after the application of shoe-lift compared with regular shoes (p＜0.01), and the oxygen consumption was least with the application of shoe-lift and leather outsole (p＜0.05). This effect was prominent in subject with poor muscle power in hemiplegic lower extremity. The walking speed was also increased with shoe-lift and leather outsole (p＜0.05).

Conclusion: The results of this study demonstrate that proper shoes modification can reduce the energy consumption in hemiplegic gait and can lead to more efficient functional ambulation.

Hemiplegic gait is characterized by slow and poorly coordinated movements of the affected limb resulting from foot drop or equinus deformities. Ankle-foot orthoses(AFO) are frequently prescribed to improve the gait pattern of hemiplegics. Plastic AFO with different trimlines in controlling ankle motion can cause variable biomechanical effects.

In this study, we analysed the biomechanical effect of donning AFO on hemiplegic gait and assessed whether any differences resulted when the AFO was modified. Gait events, plantar pressure, foot contact and centers of pressure(COP) parameters were measured with F-scan pressure sensitive insole system in 21 hemiplegic stroke patients with Brunnstrom's lower extremity stage 3. And those parameters were compaired in each of four different conditions: 1) before donning AFO, 2) donning AFO without any modification, 3) donning AFO with the distal part of metatarsal head trimmed off, 4) donning AFO with third condition and weaning a cushioned heel shoes.

After donning AFO, total contact area and contact width were increased, and initial contact COP and mean COP were displaced medially. But contact length was not changed and initial contact COP and mean COP were not displaced anteroposteriorly. Anteroposterior displacement of COP, slope and velocity of COP were not also changed after donning AFO. Among various AFO adjustments, there were no significant changes of plantar pressure, foot contact and COP parameters.

The results suggest that 1) AFO provides mediolateral stability, but does not provide additional functional rocker actions during stance phase and 2) There were no definite different biomechanical actions among various adjustments of plastic AFO in hemiplegic gait of Brunnstrom's lower extremity stage 3.

Objects: The purpose of this study is to estimate the values of foot pressure of the stance phase during a gait cycle in hemiplegic gait.

Method: Thirty patients who had a stroke and forty healthy adults were evaluated by the EMED-SF system to analyze the stance phase of hemiplegic gait. The stance phase was evaluated by 6 points according to the foot pressure and center of pressure proposed by Lee et al.²⁾

Results:

1) In hemiplegics, the stance time of involved limb decreased compared with that of the uninvolved limb and increased that of control groups (p＜0.05).

2) In hemiplegics, the midstance time increased but the loading response and terminal stance decreased compared with the uninvolved limb and controls (p＜0.05).

3) In hemiplegics, the midstance time decreased and the loading response and terminal phase increased according to the increased Brunnstrom stage (p＜0.05).

Conclusion: The results showed that an analysis of stance phase by the measurement of plantar pressure was a valuable parameter in the gait analysis of hemiplegic patients.

Objective: To investigate the changes of gait patterns in hemiplegic patients with ankle foot orthosis (AFO) and with functional electrical stimulation (FES).

Method: Fifteen hemiplegic patients who can walk independently with cane participated in this study. Kinematic gait analysis was performed for all subjects using three-dimensional gait analysis system in barefoot, wearing AFO, and applying FES. The mean values of each gait trials were taken and statistically analysed by repeated measures of ANOVA.

Results: Genu recurvatum at stance phase and excessive ankle plantar flexion at stance and swing phase were decreased after wearing AFO. Excessive ankle plantar flexion at swing phase were decreased after applying FES.

Conclusion: The results showed that the FES is useful for the correction of hemiplegic gait as mush as of wearing AFO.

Objective: We used music as a rhythmic cue in gait training of patients with hemiplegia and analysed its effect on gait parameters.

Method: Twenty hemiplegic patients were included in the study. Gait cycle, foot contact area, and center of pressure pathway were measured by F-scan with and without music. Four subjects were followed after 3 weeks of gait training using rhythmic cue with music.

Results: 1) In involved limb, stance phase was slightly increased from 65.8⁑9.9% to 67.8⁑7.9%, and single limb support was changed from 17.1⁑6.3% to 17.2⁑6.2%, without statistical significance. 2) Stance and swing symmetry was slightly increased from 0.77⁑0.13 and 0.52⁑0.21 to 0.83⁑0.09 and 0.54⁑0.16 respectively, without statistical significance. 3) Foot contact area and anteroposterior distance of center of pressure were not changed significantly. 4) All 4 subjects who were followed after 3 weeks showed increased single limb support of involved limb (from 14.5% to 18.8%) and swing symmetry (from 0.47 to 0.67).

Conclusion: Though it was not proved to be effective for every hemiplegics, use of rhythmic cue with music in gait training may be helpful in some patients. Further study is needed to confirm these results.