A different brace model to retrain hemiparetic gait with genu recurvatum: effects on plantar pressure distribution
DOI:
https://doi.org/10.1590/1809-2950/15789423042016Keywords:
Stroke, Gait, Orthotic DevicesAbstract
The model of brace developed consists of a neoprene kneepad that has an inflatable cuff positioned over the popliteal region of the knee. It provides stimuli on joint structures as well as a better biomechanical alignment during the stance phase of the gait. The aim of this study was to quantify the changes and adaptations induced by gait training with the use of orthotic device in hemiparetic patients. A quasi-experimental before-after study was held with twelve adult patients with hemiparesis due to cerebrovascular accident. The peaks of plantar pressure were the markers used to compare the three moments of the study: the baseline, when they were using the brace, and post-gait training. After the sessions of gait retraining with the orthosis, the redistribution of plantar pressures showed increased symmetry during the stance phase, mainly by reducing the pressure on the paretic forefoot (p=0.024) and by the increase in the rearfoot in the paretic side (p=0.010). In addition, these changes were associated with a decrease in pressure on all regions of the foot not affected, especially in the rearfoot after training. The results of the study suggest a change in the gait pattern of participants after using the brace. There has been greater symmetry of the values of the plantar pressure peaks when the affected side was compared with the nonaffected side. Training with the brace helps in the rehabilitation process, since it provides baropodometric values approaching the normal pattern of plantar distribution.Downloads
References
Belda-Lois JM, Mena-del Horno S, Bermejo-Bosch I, Moreno
JC, Pons JL, Farina D, et al. Rehabilitation of gait after stroke:
a review towards a top-down approach. J Neuroeng Rehabil.
;8(66):2-19. doi: 10.1186/1743-0003-8-66.
Boudarham J, Zory R, Genet F, Vigné G, Bensmail D, Roche N, et
al. Effects of a knee-ankle-foot orthosis on gait biomechanical
characteristics of paretic and non-paretic limbs in hemiplegic
patients with genu recurvatum. Clin Biomech (Bristol, Avon).
;28(1):73-8. doi: 10.1016/j.clinbiomech.2012.09.007.
Bleyenheuft C, Bleyenheuft Y, Hanson P, Deltombe T.
Treatment of genu recurvatum in hemiparetic adult patients:
a systematic literature review. Ann Phys Rehabil Med.
;53:189-99. doi: 10.1016/j.rehab.2010.01.001.
Femery V, Moretto P, Renaut H, Thévenon A. Spasticité
et distribution des pressions plantaires chez des enfants
atteints d’hémiplégie cérébrale infantile. Ann Readapt
Med Phys. 2001;44(1):26-34. doi: dx.doi.org/10.1016/
S0168-6054(00)00060-X.
Isakov E, Mizrahi J, Onna I, Susak Z. The control of genu
recurvatum by combining the Swedish knee-cage and an
ankle-foot brace. Disabil Rehabil. 1992;14(4):187-91.
Robinson CC, Detânico RC, Zaro MA, Andrade MC. Comparação
entre dois protocolos de baropodometria dinâmica utilizando
plataforma de pressão. Tecnicouro. 2010;249:70-4.
Basaglia N, Mazzini N, Boldrini P, Bacciglieri P, Contenti E,
Ferraresi G. Biofeedback treatment of genu-recurvatum
using an electrogoniometric device with an acoustic signal.
One-year follow-up. Scand J Rehabil Med. 1989;21(3):125-30.
Wong AM, Pei YC, Hong WH, Chung CY, Lau YC, Chen CP.
Foot contact pattern analysis in hemiplegic stroke patients:
an implication for neurologic status determination. Arch
Phys Med Rehabil. 2004;85(10):1625-30.
Pinzur MS, Sherman R, DiMonte-Levine P, Trimble J.
Gait changes in adult onset hemiplegia. Am J Phys Med.
;66(5):228-37.
Valentini FA, Granger B, Hennebelle DS, Eythrib N, Robain
G. Repeatability and variability of baropodometric and
spatio-temporal gait parameters – results in healthy subjects
and in stroke patients. Neurophysiol Clin. 2011;41(4):181-9. doi:
1016/j.neucli.2011.08.004.
Boza R, Duarte E, Belmonte R, Marco E, Muniesa JM,
Tejero M, et al. Estudio baropodométrico en el hemipléjico
vascular: relación con la discapacidad, equilibrio y capacidad
de marcha. Rehabilitación [periódico na Internet]. 2007
[citado em 2017 fev 9];41(1):3-9. doi: dx.doi.org/10.1016/
S0048-7120(07)75350-1.
Schuster RC, Zadra K, Luciano M, Polese JC, Mazzola D, Sander
I, et al. Análise da pressão plantar em pacientes com acidente
vascular encefálico. Rev Neurociênc. 2008;16(3):179-83.
Meyring S, Diehl RR, Milani TL, Hennig EM, Berlit P. Dynamic
plantar pressure distribution measurements in hemiparetic
patients. Clin Biomech (Bristol, Avon). 1997;12(1):60-5.
Perry J. Gait analysis: normal and pathological function. New
Jersey: SLACK Incorporated; 1992.
Gaviria M, D’Angeli M, Chavet P, Pelissier J, Peruchon E,
Rabischong P. Plantar dynamics of hemiplegic gait: a
methodological approach. Gait Posture. 1996;4(4):297-305.
doi: dx.doi.org/10.1016/0966-6362(95)01055-6.
Titianova EB, Pitkänen K, Pääkkönen A, Sivenius J,
Tarkka IM. Gait characteristics and functional ambulation
profile in patients with chronic unilateral stroke. Am J
Phys Med Rehabil. 2003;82(10):778-86. doi: 10.1097/01.
PHM.0000087490.74582.E0.
Shumwaycook A, Anson D, Haller S. Postural sway biofeedback:
its effect on reestablishing stance stability in hemiplegic
patients. Arch Phys Med Rehab. 1988;69(6):395-400.
Trindade APNT, Barboza MA, Oliveira FB, Borges APO.
Influência da simetria e transferência de peso nos aspectos
motores após acidente vascular cerebral. Rev Neurociênc.
;19(1):61-7.
Robain G, Valentini F, Renard-Deniel S, Chennevelle JM,
Piera JB. A baropodometric parameter to analyze the gait
of hemiparetic patients: the path of center of pressure.
Ann Readapt Med Phys. 2006;49(8):609-13. doi: 10.1016/j.
annrmp.2006.05.002.
Downloads
Published
Issue
Section
License
Copyright (c) 2016 Fisioterapia e Pesquisa
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
