Adapting AFO parameters to optimise true neuromotor recovery of gait during early phases of rehabilitation following a stroke

中风幸存者的步态康复结果令人失望，出院时的平均步行速度-0.7米/S-远远低于年龄匹配的健康同龄人，而且太慢，无法安全使用人行横道。尽管恢复行走是治疗师和中风幸存者的优先事项，但仍是如此。产生向前推进的能力对于达到日常活动所需的行走速度(和速度变化)显然是重要的。下肢的位置在产生这种向前冲动中起着关键作用。在中风康复的早期阶段，AFO的处方可能会在站立的最后阶段限制脚踝旋转，从而阻碍自然推进机制的恢复。我们最近从SWIFTcast研究中发现，胫骨与垂直角度是亚急性中风患者步行速度恢复的关键相关因素，从而为这个问题提供了一些线索。该博士学位的目标是：确定与步态速度恢复最密切相关的生物力学、临床和神经(EMG)变量。这将通过文献回顾和分析一个大型(n=90)生物力学和肌电测量数据库(n=90)相结合来完成，该数据库是从急性/亚急性中风幸存者在6周康复方案之前和之后进行的。随后将进行一项临床研究，前瞻性地测试量身定制的AFO处方，这些处方解释了先前确定的变量，旨在支持病前步态模式的恢复。这项研究将通过混合方法考虑临床、生物力学和神经结果以及使用者的可接受性。我们的目的是与NHS以及Peackock(？/Buchanans)等矫形外科公司合作，朝着更定制的方法发展，在中风康复的早期阶段开出AFO处方。在不影响研究结果的情况下，可能会有一些结果可以用于AFO的设计和如何开出这些结果。

Outcomes from the gait rehabilitation of stroke survivors are disappointing with mean walking speeds at discharge - 0.7m/s - that are well below aged matched healthy peers and too slow to safely use a pedestrian crossing. This is despite recovery of walking being a priority for therapists and stroke survivors. The ability to generate forward propulsion is clearly important for achieving the walking speeds (and changes in speed) necessary for everyday mobility. The positioning of the lower limb plays a key part in creating this forward impulse. It is possible that the prescription of an AFO, during the early phases of stroke rehabilitation, could impede recovery of the natural propulsion mechanisms by constraining the ankle rotation during the terminal phase of stance. Our recent work from the SWIFTcast study has shed some light on this problem by identifying the tibia to vertical angle as a key correlate of walking speed recovery among sub-acute stroke patients. The objectives for this PhD are: Identify the biomechanical, clinical and neural (EMG) variables most closely associated with gait speed recovery. This will be done through a combination of literature review and analysing a large (n=90) database of biomechanical and EMG measurements taken from acute/sub-acute stroke survivors before and after a 6 week rehabilitation programme. This will be followed by a clinical study prospectively testing tailored AFO prescriptions that account for the variables identified previously and which aim to support recovery of the pre-morbid gait pattern. This study will consider the clinical, biomechanical and neural outcomes as well as the acceptability to users through a mixed methods approach. Our intention is to collaborate with the NHS as well as orthotics companies such as Peackocks(?/Buchanans) to progress towards a more tailored approach to prescribing AFOs during the early stages of recovery from a stroke. Without prejudicing the findings of the study there may be outcomes that could be exploited for both AFO design and how they are prescribed.