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Port Glasgow, United Kingdom

Carse B.,University of Strathclyde | Bowers R.J.,University of Strathclyde | Meadows B.C.,WestMARC | Rowe P.J.,University of Strathclyde

Background: There are a number of gaps in the evidence base for the use of ankle-foot orthoses for stroke patients. Three dimensional motion analysis offers an ideal method for objectively obtaining biomechanical gait data from stroke patients, however there are a number of major barriers to its use in routine clinical practice. One significant problem is the way in which the biomechanical data generated by these systems is presented. Through the careful design of bespoke biomechanical visualisation software it may be possible to present such data in novel ways to improve clinical decision making, track progress and increase patient understanding in the context of ankle-foot orthosis tuning.Methods: A single-blind randomised controlled trial will be used to compare the use of biomechanical visualisation software in ankle-foot orthosis tuning against standard care (tuning using observation alone). Participants (n = 70) will have experienced a recent hemiplegia (1-12 months) and will be identified by their care team as being suitable candidates for a rigid ankle-foot orthosis. The primary outcome measure will be walking velocity. Secondary outcome measures include; lower limb joint kinematics (thigh and shank global orientations) & kinetics (knee and hip flexion/extension moments, ground reaction force FZ 2peak magnitude), step length, symmetry ratio based on step length, Modified Ashworth Scale, Modified Rivermead Mobility Index and EuroQol (EQ-5D). Additional qualitative measures will also be taken from participants (patients and clinicians) at the beginning and end of their participation in the study. The main aim of the study is to determine whether or not the visualisation of biomechanical data can be used to improve the outcomes of tuning ankle-foot orthoses for stroke patients.Discussion: In addition to answering the primary research question the broad range of measures that will be taken during this study are likely to contribute to a wider understanding of the impact of ankle-foot orthoses on the lives of stroke patients.Trial registration number: ISRCTN: ISRCTN52126764. © 2011 Carse et al; licensee BioMed Central Ltd. Source

Carse B.,University of Strathclyde | Bowers R.,University of Strathclyde | Meadows B.C.,WestMARC | Rowe P.,University of Strathclyde
Prosthetics and Orthotics International

Background: Ankle-foot orthoses are known to have a generally positive effect on gait in stroke, however the specifc type of AFO and the time point at which it is provided are highly variable in the currently available literature. Objective: The objective was to determine the immediate spatiotemporal and kinematic effect of custom-made solid ankle-foot orthoses in early stroke rehabilitation, compared to shod walking. Methods: Five male and three female participants were recruited to the study (n = 8), with a mean age of 57 (16) years who were 3.5 (3) weeks post-stroke. Each received a custom-made solid ankle-foot orthosis to a predefined set of design criteria and tuned using heel wedges to control the shank inclination angle during shod walking. Repeated spatiotemporal and three-dimensional gait measures were taken pre- and immediately post-intervention. Study design: A pre-post-test experimental study. Results: With the solid ankle-foot orthosis, walking velocity increased from 0.22 (0.2) to 0.36 (0.3) m/s (p <0.05), overall average step length increased from 0.28 (0.1) to 0.37 (0.1) m (p <0.05), cadence increased from 45 (19) to 56 (19) steps/min (p <0.05) and step length symmetry ratio increased from 0.65 (0.2) to 0.74 (0.2) (not significant). No clear changes were observed in the joint kinematics of the hip and knee. Conclusion: In our small group of early stroke patients who were fitted with a solid ankle-foot orthosis, immediate significant improvements occurred in walking speed, step length and cadence, when compared to walking with shoes only. Clinical relevance This study provides evidence about the immediate effects of custom solid ankle-foot orthoses on gait of early stroke survivors. Ankle-foot orthosis design specifications are fully described for replication. This study suggests that observing global segment orientation may be more useful than joint angles when fitting and tuning ankle-foot orthoses for optimal ankle-foot orthosis/footwear alignment. © 2014 The International Society for Prosthetics and Orthotics. Source

Abu Osman N.A.,University of Malaya | Spence W.D.,University of Strathclyde | Solomonidis S.E.,University of Strathclyde | Paul J.P.,University of Strathclyde | Weir A.M.,WestMARC
Medical Engineering and Physics

The purpose of this investigation was to vary the load on the patellar tendon bar and to study the subsequent effect this has on the pattern of the pressure distribution at the stump-socket interface. Ten male subjects from the Southern General Hospital in Glasgow, UK participated in this study. Measuring systems utilising strain gauge and electrohydraulic technologies were designed, developed and constructed to enable pressure measurements to be conducted. One transducer, the patellar tendon (PT) transducer, was attached to the patellar tendon bar of the socket such that the patellar tendon bar was capable of being translated by ±10. mm towards or away from the tendon. The results of this study showed that the position of the patellar tendon bar had no significant effect on the pressure distribution around the socket indicating that it is an unnecessary feature, which, we propose, may be eliminated during manufacture of a trans-tibial socket. © 2010 IPEM. Source

Carse B.,University of Strathclyde | Bowers R.,University of Strathclyde | Meadows B.,WestMARC | Rowe P.,University of Strathclyde
2011 5th International Conference on Pervasive Computing Technologies for Healthcare and Workshops, PervasiveHealth 2011

One of the key priorities for stroke survivors in their rehabilitation process is regaining their ability to walk. Evidence has shown that provision of ankle-foot orthoses (AFOs) can have a positive impact on walking. This paper discusses the role of gait analysis in the provision of AFOs for stroke survivors. A discussion of the shortcomings of gait analysis techniques is included, with a description of how these might be overcome during the AFO tuning process through the ongoing development of data visualisation software. The design of a randomised controlled trial in conjunction with a series of qualitative measures is described, which will be used to test the efficacy of the visualisation software. © 2011 ICST. Source

Williams S.E.,University of Dundee | Gibbs S.,University of Dundee | Meadows C.B.,WestMARC | Abboud R.J.,University of Dundee
Gait and Posture

Children with cerebral palsy (CP) often experience significant problems supporting their bodyweight (BW) and decelerating the downward velocity of the centre of mass (CoM) in late stance. This is seen as a decreased second peak of vertical ground reaction force (GRF) nominated FZ 2. This study categorises gait data by the degree of reduced FZ 2. Kinetic data were analysed from a CP database. Data from 129 patients, able to walk barefoot unaided, were investigated. Of these, 84 had kinetic data, 59 diplegics (both legs) and 15 hemiplegics (affected leg only), thus providing data from 133 legs. A reduced FZ 2 was observed in 116 legs (87%). Of the 133 legs, 44% failed to generate FZ 2>BW. By including the Type 2 data this figure rises to, a staggering 66% who are having difficulty supporting BW at this stage of the stance phase. Only 12% of the legs showed a normal pattern (FZ 2 approximately equal to FZ 1). In conclusion, the majority of CP children referred to the gait laboratory exhibited some degree of reduced FZ 2 and can be categorised as having a 'Ben Lomonding' gait pattern. 'Ben Lomonding,' is the term used to describe this phenomenon of reduced FZ 2, as the shape of the GRF graph resembles the shape of the Scottish mountain, Ben Lomond, which has two peaks, the second peak being much smaller than the first. Crucially, clinicians should be aware that nearly half of the CP children in this study were in difficulty supporting their BW in late stance and must use compensatory mechanisms to prevent collapse of the affected limb. © 2011 Elsevier B.V. Source

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