Browsing by Subject "Gait"
Now showing 1 - 3 of 3
- Results Per Page
- Sort Options
Item EFFECTS OF ANKLE-FOOT ORTHOSES ON FUNCTION AND QUALITY OF LIFE IN PATIENTS POST STROKE(2013-04-12) Lawhon, LauraPurpose: According to the Center for Disease Control and Prevention a person suffers a stroke every four minutes. Many patients post stroke experience a loss of motor control, hemiparesis, and gait impairments. In particular, weakness of dorsiflexor muscles leads to impaired gait pattern resulting in difficulty with toe clearance. Regaining the ability to walk in an efficient manner is a major goal for patients and therapists. Physiotherapists often recommend the use of an ankle-foot orthosis (AFO) to improve functional performance in patients post stroke. A variety of AFO's are utilized and determining which AFO is most effective can be arduous. The purpose of this critical appraised topic was to review current evidence for the effectiveness of AFO at improving gait impairments, functional mobility, and the subsequent impact on quality of life in the post stroke population. Methods: An extensive review of literature was conducted using CINAHL, Ovid, and PubMed with search key words: stroke, gait, AFO, function, quality of life and limited articles published from 2001 to 2012. A total of 228 articles from the literature review were subsequently analyzed by a team of 4 raters. The top 10 articles were selected for inclusion in this study based on: strength of research design, alignment with scope of review and use of specific outcome measures. Results: The use of AFO in patients post stroke results in: (1) improvements in gait velocity and ambulatory function when compared to barefoot and/or shoe walking (highest level of evidence); (2) improvements in balance and weight bearing on the affected leg (moderate level of evidence); (3) subjective reports from a majority of AFO users indicating improved confidence in walking and overall quality of life (low/moderate level of evidence primarily due to low number of studies) ; and (4) no sufficient evidence was presented to support the use of one specific type of AFO over others, however a debate concerning the use of solid AFO in acute stage followed by use of dynamic AFO in chronic stage post stroke was identified. Conclusions: Overall, the use of AFO in patients post stroke has low/moderate level of evidence for improvements in gait impairments and functional mobility as well as quality of life. To establish a higher level of evidence, larger sample size, random control studies using outcome measures targeting impairments, function and participation categories are needed.Item Effects of Osteopathic Manipulative Treatment on Parkinsonian Gait: A Statistical Parametric Mapping Analysis(2021-05) Terrell, Zachary T.; Patterson, Rita M.; Moudy, Sarah; Hensel, KendiIntroduction/Background: Tens of thousands of people are diagnosed with Parkinson's disease (PD) each year, making it the second most common neurodegenerative disorder. PD results in a variety of gait disturbances that increase the fall risk of those afflicted. The overarching goal for this project is to examine the efficacy of Osteopathic Manipulative Treatment (OMT) and Osteopathic Cranial Manipulative Medicine (OCMM) in improving Parkinsonian gait. Objective: The purpose of this study was to compare joint range of motion (ROM) and joint angle waveforms before and after OMT to determine the effects of OMT and OCMM on Parkinsonian gait, as well as to compare the relative effects of each treatment protocol. We hypothesized that the application of a single OMT protocol on adults with PD will acutely increase joint ROM, and the addition of OCMM to the OMT treatment protocol will further improve gait kinematics. Methods: An 18-camera motion analysis system was used in conjunction with 54 reflective markers on the body to capture three-dimensional position data in a short treadmill walking trial before and after the application of a whole-body (OMT-WB), neck-down (OMTND), or sham OMT protocol. Ankle, knee, and hip joint ROM and waveforms in the sagittal plane during the gait cycle were compared before and after treatment, and across experimental groups. Results: No significant differences were found in baseline ROM and joint angle waveforms of the hip, knee, and ankle joints across experimental groups, or in post-treatment joint waveforms across experimental groups. Knee ROM increased significantly following OMT-ND and OMT-WB protocols (p=0.018, p=0.032). Waveform analysis revealed no significant differences at the hip, knee, or ankle joints. Discussion/Conclusion: Comparison of baseline measurements validates participant randomization and an increase in sagittal knee ROM in individuals with PD following OMT and OCMM may have important implications for decreasing potential fall risk. However, waveform analysis shows no significant change in gait pattern as evidenced by sagittal joint angles following OMT-WB, OMT-ND, or SHAM treatments.Item OSTEOPATHIC MANAGEMENT OF LEG LENGTH INEQUALITY WITH HEEL LIFT THERAPY: ANALYSIS OF ALTERED GAIT KINETICS & KINEMATICS(2013-04-12) Bens, Sebastiaan M.Purpose: The overall hypothesis of this research is that leg length inequality (LLI) of 5-20 mm has deleterious effects on musculoskeletal function and gait, which can be minimized with heel lift therapy (HLT) and Osteopathic Manipulative Treatment (OMT) adjunctively to correct somatic dysfunction. Methods: Our pilot participant was asked to wear a fitted shirt, fitted shorts or pants, and comfortable walking shoes. 49 reflective markers were placed on the body. Three dimensional motion data were collected using a 12 camera system that tracked the reflective markers, allowing precise calculation of kinematics, gait parameters, and joint range of motion during movements. A dual belt instrumented treadmill with force plates mounted underneath each treadmill belt recorded ground reaction force (GRF) data. A virtual reality environment was delivered by a 180° cylindrical screen enveloping the participant's field of vision during the walking trials. Results: Analysis of the Center of Mass of the participant was measured by a center pelvis marker, before and after HLT. There was a reduction in the medio-lateral (ML) displacement, 235.89 mm before and 148.87 mm after therapy. GRFs measured at heel strike during the gait cycle were averaged for the Long and Short leg. The participant walked with a speed of 3km/h in two conditions: a "simple walk" exploring a flat path in the virtual forest and a more challenging task "complex walk" in which large arms movements were required to avoid virtual birds while walking in the forest. The shorter leg had a larger GRF at heel strike. Before HLT, there was a difference of 34 N and 30 N between the average values of GRF for the Long and Short leg, respectively, during "simple walk" and "complex walk." After HLT, the difference in GRF at heel strike between the Long and Short sides decreased to 27 N and 23 N. Symmetry was also evaluated. A perfect symmetry between the two legs would be a value of zero. In our pilot participant, the symmetry in the simple walk, prior to HLT, was -0.3 and post HLT was 0.2. Conclusions: The decrease in difference of GRF at heel strike between the Long and Short legs after HLT indicates a tendency towards symmetry. The reduction in ML sway indicates reduced energy expenditure and increased stability during walking. By including the repeat radiographs at the end of therapy to reassess sacral declination, the proposed study will help us determine the best approach for intervention.