Variable gait training to improve gait stability in ankle-foot orthosis users with neuromuscular disorders: A pilot study

IF 1.4 3区医学 Q4 ENGINEERING, BIOMEDICAL

Clinical Biomechanics Pub Date : 2025-04-20 DOI:10.1016/j.clinbiomech.2025.106533

Elza van Duijnhoven , Bart Raijmakers , Fieke Sophia Koopman , Frans Nollet , Merel-Anne Brehm , Katinka van der Kooij , Niels Waterval

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引用次数: 0

Abstract

Background

Ankle-foot orthoses aim to improve walking in people with neuromuscular disorders with lower leg muscle weakness. However, clinical experience indicates that some ankle-foot orthosis users report limited gait stability improvements, suggesting suboptimal adaptation. Variable gait training may improve adaptation, and thereby gait stability. We aimed to investigate whether variable gait training improves gait stability in individuals with neuromuscular disorders who initially experienced stability problems when using ankle-foot orthoses.

Methods

Three stiffness-optimized dorsal leaf ankle-foot orthosis users received three variable gait training sessions on an interactive treadmill with one session per week. Gait stability (variability in step time, step length, and step width), target-stepping accuracy (variable stepping error), balance performance, balance confidence, fear of falling, and perceived walking ability were assessed pre-training and one week post-training. Training experiences were also inventoried.

Findings

Post-training, the variability in step time, step length, and step width decreased on average by 38 %, 26 %, and 22 % respectively. Anteroposterior target-stepping accuracy increased post-training by 24 % and mediolateral accuracy by 3 %. No clear differences in balance and fear of falling were observed. All participants perceived improvements in some aspects of walking ability and appreciated the training.

Interpretation

Variable gait training may enhance gait stability and target-stepping accuracy in ankle-foot orthosis users who initially perceived little benefits. No improvements on balance outcomes and mixed outcomes on perceived walking ability were found. A larger study is needed to determine whether variable gait training following orthosis provision could lead to meaningful changes in gait stability, balance, and daily functioning.

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可变步态训练改善神经肌肉疾病踝足矫形器使用者的步态稳定性：一项初步研究

踝足矫形器的目的是改善患有神经肌肉疾病和下肢肌肉无力的人的行走。然而，临床经验表明，一些踝足矫形器使用者报告的步态稳定性改善有限，这表明适应性不佳。可变步态训练可以提高适应性，从而提高步态稳定性。我们的目的是研究可变步态训练是否能改善神经肌肉疾病患者在使用踝足矫形器时最初出现稳定性问题的步态稳定性。方法3例刚度优化背叶踝足矫形器使用者在交互式跑步机上进行3次可变步态训练，每周1次。在训练前和训练后一周评估步态稳定性（步幅、步长和步幅的可变性）、目标步进精度（可变步进误差）、平衡表现、平衡信心、跌倒恐惧和感知行走能力。培训经验也进行了盘点。在训练后，步长、步长和步宽的可变性分别平均下降了38%、26%和22%。正前方目标步进精度提高了24%，中外侧精度提高了3%。在平衡和害怕跌倒方面没有观察到明显的差异。所有参与者都感觉到行走能力的某些方面有所改善，并对训练表示赞赏。解释：可变步态训练可以提高最初感觉益处不大的踝足矫形器使用者的步态稳定性和目标步进准确性。平衡结果没有改善，感知行走能力的混合结果也没有发现。需要更大的研究来确定矫形器提供后的可变步态训练是否会导致步态稳定性，平衡和日常功能的有意义的变化。

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来源期刊

Clinical Biomechanics 医学-工程：生物医学

CiteScore

3.30

自引率

5.60%

发文量

189

审稿时长

12.3 weeks

期刊介绍： Clinical Biomechanics is an international multidisciplinary journal of biomechanics with a focus on medical and clinical applications of new knowledge in the field. The science of biomechanics helps explain the causes of cell, tissue, organ and body system disorders, and supports clinicians in the diagnosis, prognosis and evaluation of treatment methods and technologies. Clinical Biomechanics aims to strengthen the links between laboratory and clinic by publishing cutting-edge biomechanics research which helps to explain the causes of injury and disease, and which provides evidence contributing to improved clinical management. A rigorous peer review system is employed and every attempt is made to process and publish top-quality papers promptly. Clinical Biomechanics explores all facets of body system, organ, tissue and cell biomechanics, with an emphasis on medical and clinical applications of the basic science aspects. The role of basic science is therefore recognized in a medical or clinical context. The readership of the journal closely reflects its multi-disciplinary contents, being a balance of scientists, engineers and clinicians. The contents are in the form of research papers, brief reports, review papers and correspondence, whilst special interest issues and supplements are published from time to time. Disciplines covered include biomechanics and mechanobiology at all scales, bioengineering and use of tissue engineering and biomaterials for clinical applications, biophysics, as well as biomechanical aspects of medical robotics, ergonomics, physical and occupational therapeutics and rehabilitation.