Relationship between muscle activity characteristics and physical therapy parameters during posterior gait assistance with knee-ankle-foot orthosis in severe acute stroke hemiplegic patients.
Motoya Sato, Akiyoshi Takami, Misato Makino
PMID 38075513WHAT IT FOUND
In acute stroke patients using a knee-ankle-foot orthosis with therapist support, all measured leg muscles worked hardest in the first half of the step.
Rectus femoris activity correlated with balance and movement scores, offering a possible indicator of function when voluntary movement is hard to assess.
Key findings
01Muscle activity for the rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius was significantly higher in the first half of the stance phase compared to the second half.
02Activity of the rectus femoris in the first half of the stance phase showed moderate correlations with Brunnstrom Recovery Stage, Berg Balance Scale, and Functional Movement Scale scores.
03The study suggests that continued training with this specific muscle activity pattern, which deviates from normal gait, may require caution to avoid reinforcing abnormal movement.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was cross-sectional, so it cannot determine if these muscle activity patterns change over time or if they cause functional improvements. The severity of paralysis varied widely among participants (Brunnstrom stages I to V), which may affect the generalizability of the muscle activity patterns. The assistance provided by the therapist, though standardized, could introduce variability in how the patient's trunk was supported. The sample size was small (30 patients), limiting the strength of the correlations found.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that posterior gait assistance with a locked-knee KAFO restores normal muscle timing. The study found that all muscles fired most strongly in the first half of stance, a pattern that deviates from normal gait, which the authors warn could lead to 'mislearning' if used exclusively.