Effects of ankle-foot orthosis with dorsiflexion resistance on the quasi-joint stiffness of the ankle joint and spatial asymmetry during gait in patients with hemiparesis

Background

Reduced ankle quasi-joint stiffness affects propulsion in the paretic side of patients with hemiparesis, contributing to gait asymmetry. We investigated whether the use of an ankle-foot orthosis with dorsiflexion resistance to compensate for reduced stiffness would increase quasi-joint stiffness and spatiotemporal symmetry in patients with hemiparesis.

Methods

Seventeen patients walked along a 7-m walkway in both ankle-foot orthosis with dorsiflexion resistance and control (i.e., ankle-foot orthosis) conditions. Dorsiflexion resistance by spring and cam was set to increase linearly from zero-degree ankle dorsiflexion. Gait data were analyzed using a three-dimensional motion analysis system.

Findings

Ankle-foot orthosis with dorsiflexion resistance significantly increased the quasi-joint stiffness in the early and middle stance phase (P = 0.028 and 0.040). Furthermore, although ankle power generation in the ankle-foot orthosis with dorsiflexion resistance condition was significantly lower than in the control condition (P = 0.003), step length symmetry significantly increased in the ankle-foot orthosis with dorsiflexion resistance condition (P = 0.016). There was no significant difference in swing time ratio between conditions.

Interpretation

Applying dorsiflexion resistance in the paretic stance phase increased quasi-joint stiffness but did not lead to an increase in ankle power generation. On the other hand, applying dorsiflexion resistance also resulted in a more symmetrical step length, even though the ankle joint power generation on the paretic side did not increase as expected. Future research should explore whether modifying the magnitude and timing of dorsiflexion resistance, considering the biomechanical characteristics of each patients' ankle joint during gait, enhances ankle joint power generation.