Approximately 20% of stroke survivors have difficulties to dorsiflex the ankle and clear the ground during walking. This impairment, termed as "foot drop", is caused by an association of weak dorsiflexors and increased spasticity and stiffness of the plantar-flexors. As a consequence, walking performances are reduced and energy cost of walking is deteriorated. This may increase performance fatigability, as the locomotion will be realized at a higher percentage of the subjects' capacities. In order to overcome these issues, different treatments are proposed. One of the most conventional solutions are the use of ankle foot orthosis (AFO) and it is the most commonly prescribed device used to compensate for "foot drop". There is a very large choice of AFO on the market which can be proposed to patients with foot drop. The aim of this study is thus to assess the mechanical effects of using a manufactured carbon AFO in by comparison to a custom-made thermo-plastic AFO on walking capacity (distance and energy cost), fatigue and "foot drop" control throughout the gait phase in patients with hemiparetic stroke.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
15
The experimental protocol will require 4 visits: one inclusion visit and 3 visits for evaluations. Each visit corresponds to one condition: C-AFO, CM-AFO or NO (according to a random order). Visit #1 will consist in a clinical evaluation and a familiarization session with the measuring devices and methodologies used in visit#2 #3 and #4. During #2, #3 and #4 visits (14 days between each session), the subject will perform with C-AFO, CM-AFO or NO according to the random order : * 5 x 15m overground at a comfortable walking speed (CWS) where EMG, ground reaction force and kinematics will be measured * 6MWT where energy cost will be measured * 5 x 15m overground (immediately after the 6MWT) at a comfortable walking speed
Chu Saint Etienne
Saint-Etienne, France
Distance walked during the 6 Minute Walk Test (6MWT)
Patient will performed three experimental session (14 days between each session) during wich the primary outcome will be assessed : one session while walking with C-AFO, one session while walking with CM-AFO, and one session while walking without AFO (randomized order). 6 Minute Walk Test is a beneficial tool to evaluate walking endurance in patients with poststroke hemiparesis
Time frame: Day : 14
Energy cost
Energy cost will be assessed by oxygen consumption recorded during the 6MWT in the 3 conditions (C-AFO, CM-AFO, NO)
Time frame: Day : 14
Muscular activity
Muscular activity will be assessed by electromyography (EMG) on different muscles (anterior tibial, gastroc medial, femoral). Muscular activity will be assessed before and after 6MWT during 5\*15m sessions
Time frame: Day: 14
Angle
Angle (°) of ankle, knee and hip will be assessed in the 3 conditions before and after 6MWT during 5\*15 m sessions
Time frame: Day : 14
Perceived fatigue
Perceived fatigue will be assessed by the Rated Perceived Exertion (RPE) scale before and after 6MWT. The RPE scale runs from 0 - 10. 0 is related to an easy activity and 10 (very, very heavy) is related to a very difficult activity.
Time frame: Day : 14
Power
Power (watt) of ankle, knee and hip will be assessed in the 3 conditions before and after 6MWT during 5\*15 m sessions
Time frame: Day : 14
Momentum
Momemtum (J rad-1) of ankle, knee and hip will be assessed in the 3 conditions before and after 6MWT during 5\*15 m sessions
Time frame: Day : 14
Satisfaction related to the device
A satisfaction survey will be asked in order to assess the positioning of AFO, comfort, esthetic and global satisfaction of devices
Time frame: Day : 42
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