THE MAXIMUM TOE HEIGHT BEFORE GROUND CONTACT IS ASSOCIATED WITH FALLS AMONG HEMIPLEGICS

K. Homan¹, T. Saeki², T. Saito², T. Hayashi², K. Kadoya¹, N. Iwasaki¹, N. Ishida³

¹Hokkaido University Graduate School of Medicine, Orthopedic Surgery, Sapporo, Japan, ²Tokachi Rehabilitation Center, Rehabilitation Medicine, Obihiro, Japan, ³Hokuto Hospital, Orthopedic Surgery, Obihiro, Japan

Background: In hemiplegic patients, foot drop is an important fall-related factor. Traditionally, visual gait observation has been used to determine the level of cane walking in hemiplegic patients, but foot drop during movement is difficult to follow with the eyes and cannot be quantified. In addition, Minimum Toe Clearance (MTC) is frequently used when examining foot clearance with a small sensor, but it has been reported that MTC in hemiplegic patients cannot be useful as an indicator of fall-related factors due to its high variability.

Purpose: The purpose of the current study is to identify spatiotemporal foot parameters related to a fall in hemiplegic patients using wearable sensors.

Methods: 5 and 7 chronic hemiplegic patients with and without a history of falls were subject to 3 sets of 10-meter cane walking. Their walking was analyzed by inertial sensors (Physilog®️, GaitUp) placed on both feet and three-dimensional motion analysis (Motion Analysis, 200 Hz). Obtained gait-related parameters were compared between the falling and non-falling patients. Dorsiflexion movement during the gait cycle, foot trajectory, and foot-ground entry angle based on the trajectory were calculated by motion analysis software (Visual 3D, C-Motion). Statistical processing was performed on the paralyzed side and the nonparalyzed side. Paired t-test was used for comparing the paralyzed and non-paralyzed sides, and a t-test was used for comparing the fallen and non-fallen groups. The significance level was set at less than 5%.

Results: Among 21 parameters obtained with the inertial sensor system, maximum toe height before ground contact at the paralyzed side in the non-falling group demonstrated a significantly higher value than those in the falling group. In the range of motion in the dorsiflexion movement and the MTC measured by the 3D motion analysis, there was no significant difference between the falling and non-falling groups, but the ground entry angle was significantly lower in the falling group than in the non-falling group.

Conclusions: The current study suggests that a decrease in maximum toe height before ground contact could be associated with the risk of falling in hemiplegic patients. The decrease in foot trajectory and ground entry angle during the gait cycle in the fall group indicates an inability to maintain toe height during the swing leg, meaning that a foot drop occurs during gait.

Implications: Measurement of maximum toe height before ground contact by wearable sensors may be a simple and effective method to evaluate the success or failure of foot clearance acquisition for the purpose of fall prevention.

Funding acknowledgements: The authors received no financial support for the research, authorship, and/or publication of this article.

Keywords:
foot drop
wearable sensor
fall

Topics:
Neurology: stroke
Disability & rehabilitation
Innovative technology: information management, big data and artificial intelligence

Did this work require ethics approval? Yes

Institution: Hokuto Hospital

Committee: Hokuto Medical Ethics Review Committee

Ethics number: 1005