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Nakatani T.1, Taguchi J.2, Sasaoka Y.2, Tsutsumi M.3, Komatsu A.3
1Takarazuka Rehabilitation Hospital, Research and Development Department, Takarazuka, Japan, 2Takarazuka Rehabilitation Hospital, Medical Department, Takarazuka, Japan, 3Takarazuka Rehabilitation Hospital, Therapy Department, Takarazuka, Japan
Background: Improving walking speed of patients with hemiparetic stroke helps prolong their continuous walking distance, saves energy cost, and subsequently affects their functional outcome afterwards. Previous studies clarified that hemiparetic stroke patients could improve their continuous walking distance and energy cost significantly by doing walking training at a high speed. At our hospital, we often use T-Support (Kawamura Gishi, Japan) as a walking aid to improve walking speed. T-Support can assist the motion of the flexion of the hip joint, resulting in the improvement of walking speed. However, many functional changes remain unclear in the T-Support-equipped lower limb.
Purpose: The purpose of this study was to examine the changes of the lower limb function of hemiparetic stroke patients when they wear T-Support and do training with improved walking speed.
Methods: Eight patients with primary hemiparetic stroke who were able to walk on their own were enrolled (average age: 71.1±9.6 years). The Brunnstrom Recovery Stage of lower limb of the subjects was III in 3 patients, IV in 3 patients, V in one patient, and VI in one patient. Of them, 4 patients used a T-cane, 3 patients did not need it, and one patient used a Quad cane. Factors of walking to be measured were walking speed and the number of steps walked during a 10-meter walk when they did/didnt wear T-Support, as well as the moment of ankle plantar flexion during the late stance phase and the muscle activity of gastrocnemius muscles. An electrode was attached to the paralysis side of the lateral head of gastrocnemius muscle with sampling frequency at 1000Hz to calculate the muscle activity during the late stance phase by normalizing at the average value of a gait cycle. Wilcoxon matched-pairs signed-ranks test was used for statistical analysis and a significant level was set at 5%.
Results: Factors of walking at the time when the patients did/didnt wear T-Support were determined as follows: walking speeds were 35.7/32.4m/min; the numbers of steps walked were 23.6/25.4 steps; the moment of ankle plantar flexion was 2.4/1.7Nm; and the activity of gastrocnemius muscles was 165.1/148.5%.
A statistical significance was observed in all these items.
Conclusion(s): Previous studies clarified that improvement of walking speed in the healthy adults depends on the moment of ankle plantar flexion and the muscle activity of plantar flexor during the late stance phase. In this study, it was suggested that even for the hemiparetic stroke patients, improving walking speed wearing T-Support can increase the moment of ankle plantar flexion and the muscle activity of gastrocnemius muscles during the late stance phase and improve the lower limb function.
Implications: In recent years, there is an increasing chance of using large-scale devices for walking training of hemiparetic stroke patients. T-Support needs an elastic band only as power source, so it can be used for various situations. In the future, it is expected that T-Support can be used for more walking trainings and contribute to the improvement of walking ability of hemiplegia patients.
Funding acknowledgements: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Topic: Neurology: stroke
Ethics approval: This study was approved by the Takarazuka Rehabilitation Hospital ethical committee.
All authors, affiliations and abstracts have been published as submitted.
