F-2-12-01
LOWER LIMB ORTHOSES FOR TREATMENT IN ACUTE STROKE PATIENTS
Hideki Nakajima (Ome Municipal General Hospital, Tokyo, Japan), Kaoru Abe, Yutaka Fukushima, Shigenobu Ishigami (National Defense Medical College, Saitama, Japan)
Introduction: In our acute stroke rehabilitation program, we have usually used lower limb orthoses to facilitate paretic muscle activity. In this study, we have investigated which orthosis is more useful to facilitate paretic muscle activity of stroke patients, dual-upright ankle-foot orthosis (AFO), or plastic molded ankle-foot orthosis (MAFO). Subjects: Subjects were 8 post-stroke hemiplegic inpatients, who were able to ambulate with AFO. Method: Subjects walked in usual speed with 4 types of orthoses (1: MAFO without heel-up, 2: MAFO with l cm heel-up, 3: AFO without heel-up, 4: AFO with 1 cm heel-up). Their gait were evaluated with surface electromyograpy (EMG), force plate, foot switch and goniometer. Surface EMG were recorded from rectus femoris (RF), vastus medialis (VM), gluteus maximus (GM), and gastrocnemius (GC) in the affected side. EMG activity was evaluated in integral values. Results: EMG activity in RF and GM with AFO, l cm heel-up, were more increased than with MAFO in many patients, no heel-up. In gait analysis with AFO, 1 cm heel-up, braking and propulsion in antero-posterior component were seen clearly and weight shift from heel-strike to mid-stance was smoothly in vertical component. Conclusion: AFO especially with heel-up was more useful to activate motor recovery of hip and knee extensor muscles than MAFO in acute stroke patients.
F-2-12-02
ENERGY EXPENDITURE IN WALKING WEARING DIFFERENT TYPES OF KAFO
Fumio Ochi, Kaoru Abe, Taka-aki Kawasaki, Shigenobu Ishigami (National Defense Medical College, Saitama, Japan), Youichi Kondou (Yamano College of Aesthetics, Tokyo, Japan)
Purpose: KAFO which fixed knee 0 degree extension is usually used for severe hemiplegic patients in their clonic stage. But we have been using KAFO which fixed knee 15 degree flexion for acute stroke hemiplegic patients to facilitate quadriceps muscle activity. The purpose of this study is to evaluate energy expenditure in walking wearing those 2 types of KAFO and to decide which is better for walking concerning with energy consumption. Method: 8 able-bodied men participated in this study. Subjects walked wearing (1) normal shoes, (2) KAFO which fixed knee 0 degree extension and fixed ankle 0 degree, and (3) KAFO which fixed knee 15 degree flexion and fixed ankle 10 degree dorsiflexion. They wore KAFO on left leg and 1 cm shoe-lift was applied to the contralateral shoe. The average comfortable walking speed (CWS) was measured by the time that the subject needed to walk 10m comfortably 5 times at each conditions. They walked on motor driven treadmill in CWS at 0 degree for 6 minutes on 3 conditions. While walking on treadmill, Oxygen consumption was measured every 10 second by Metamax (cortex). After assurance of steady state, O2 consumption for last 3 minutes was evaluated. Results: CWS was 1.37m/s with normal shoes, 1.02m/s with KAFO (knee 0 degree), and 1.04m/s with KAFO (knee 15 degree). Oxygen consumption per distance on average was 37% more with KAFO (knee 0 degree)and 36% more with KAFO (knee 15 degree) compared to normal shoes. Conclusion: CWS and 02 consumption has no deference in 2 types of KAFO.
