Investigating the underlying biomechanical mechanisms leading to falls in long-term ankle-foot orthosis and functional electrical stimulator users with chronic stroke.
Investigating the underlying biomechanical mechanisms leading to falls in long-term ankle-foot orthosis and functional electrical stimulator users with chronic stroke.
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DOI：
10.1016/j.gaitpost.2021.11.025
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发表时间：
2022-03
期刊：
影响因子：
2.4
通讯作者：
Honeycutt CF
中科院分区：
文献类型：
--
作者：
Nevisipour M;Honeycutt CF
踝足矫形器(AFO)和功能性电刺激器(FES)通常用于治疗中风患者的足下垂。尽管AFO和FES设备对平衡和步态产生了良好的积极影响，但AFO和FES使用者的跌倒速度仍然很高。本研究的目的是探讨长期服用AFO和FES的慢性卒中患者跌倒的生物力学机制，以及AFO和FES装置对长期服用AFO和FES的慢性卒中患者跌倒结局和代偿性踏步反应的影响。对42名慢性卒中患者(14名AFO使用者，10名FES使用者，18名非使用者)在Trip-Like跑步机扰动时的跌倒结果以及代偿性踏步反应的运动学和动力学进行了评估。AFO和FES-用户接受了使用和不使用他们的设备的评估。长期使用AFO和FES的人比不使用的人下降了2.50倍和2.77倍。AFO/FES使用者和非使用者之间最明显的区别是1)通过减少全身前向角动量来稳定躯干的能力降低，以及2)使用偏瘫腿准备和产生第二步的能力减弱。具有挑衅性的是，移除AFO和FES装置并没有减少/增加跌落或改变运动学。众所周知，AFOS/FES装置对静态平衡有积极影响，并通过增加脚趾清除从而防止绊倒/绊倒来减少社区跌倒。然而，我们的结果表明，一旦绊倒发生，这些设备并不足以帮助平衡的恢复。具体地说，当前的AFO和FES设备不能帮助第二步生成或主干控制。未来的研究应该探索新的设备或训练范例，以加强躯干控制和偏瘫代偿性步法来减少这一人群的跌倒。
Ankle-foot-orthoses (AFOs) and functional electrical stimulators (FES) are commonly prescribed to treat foot-drop in individuals with stroke. Despite well-established positive impacts of AFO and FES devices on balance and gait, AFO and FES-users still fall at a high rate. The objective of this study was to investigate 1) the underlying biomechanical mechanisms leading to a fall in long-term AFO and FES-users with chronic stroke and 2) the impacts of AFOs and FES devices on fall outcomes and compensatory stepping response of long-term users with chronic stroke. Fall outcomes as well as kinematics and kinetics of compensatory stepping response of 42 individuals with chronic stroke (14 AFO-users, 10 FES-users, 18 Non-users) were evaluated during trip-like treadmill perturbations. AFO and FES-users were evaluated with and without their device. Chronic AFO and FES-users fell 2.50 and 2.77 times more than Non-users. The most robust differences between AFO/FES-users and Non-users were 1) Reduced capacity to stabilize the trunk through reduction in forward whole-body angular momentum and 2) diminished capability to prepare and generate a second step using the paretic leg. Provocatively, the removal of AFO and FES devices did not decease/increase falls or change kinematics. It is well-established that AFOs/FES devices have a positive impact on static balance and decrease community falls by increasing toe clearance thus preventing trips/stumbles. However, our results suggest that once a trip occurs, these devices do not adequately assist recovery of balance. Specifically, current AFO and FES devices do not assist with second step generation or trunk control. Future studies should explore new devices or training paradigms that target enhancing trunk control and paretic compensatory stepping to decrease falls in this population.
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