Ankle-foot orthosis with dorsiflexion resistance using spring-cam mechanism increases knee flexion in the swing phase during walking in stroke patients with hemiplegia

Background: Ankle-foot orthoses with plantarflexion resistance (AFO-Ps) improve knee flexion in the stance phase on the paretic side in patients with hemiparesis. However, AFO-Ps decrease ankle power generation in the late stance phase and do not improve the knee flexion in the swing phase based on insufficient push-off at the late stance, resulting in lower toe clearance. Research question: This study sought to investigate the effect of an AFO with dorsiflexion resistance, which was implemented by our developed device with spring-cam mechanism attached to the AFO-P (Gait Solution; Pacific Supply Co., Ltd., Japan), on kinetics and kinematics in the lower limb during gait in patients with hemiparesis. Methods: Eleven patients with hemiparesis due to stroke walked on a 7-m walkway at a self-selected comfortable pace in the following conditions: (a) walking using the AFO-P with the proposed device with a spring-cam mechanism (AFO-PCAM), (b) walking using the AFO-P without our device (AFO-P), and (c) walking using no device (barefoot condition). Gait kinematics and kinetics were collected using a three-dimensional motion analysis system and four ground-reaction force plates. Changes in all parameters from the barefoot to AFO-PCAM and AFO-P conditions were compared using the Wilcoxon signed-rank test. Results: In the AFO-PCAM condition, decrease in the maximum ankle power generation in the late-stance phase was significantly smaller than that in the AFO-P condition (p = 0.041). We noted a significant higher change in knee flexion in the paretic swing phase in the AFO-PCAM condition relative to that in the AFO-P condition (p = 0.016). The effect size for the comparisons of change was large (r >= 0.5). Significance: Our device facilitated the realization of the ankle plantarflexion power in the late-stance phase because of dorsiflexion resistance, increasing the knee flexion angle during the swing phase.