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The use of biomechanical visualisation in neurorehabilitation and its effect on ankle-foot orthosis (AFO) tuning in stroke

Carse, Bruce and Loudon, David and Meadows, Barry and Bowers, Roy and Rowe, Philip (2013) The use of biomechanical visualisation in neurorehabilitation and its effect on ankle-foot orthosis (AFO) tuning in stroke. Journal of the Neurological Sciences, 333 (supp 1). e552. ISSN 0022-510X

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Background: Difficulties interpreting the biomechanical data captured by 3D gait analysis (3DGA) systems mean that it is rarely used in routine clinical practice for gait rehabilitation of stroke patients. Biomechanical visualisation software has been designed to make data clinically useful in the context of AFO fitting and tuning for stroke patients. Therapists can use objective quantitative data to assist clinical decision-making. Participants receive an improved understanding of their condition/treatment, and it allows progress tracking. Objective: Test the hypothesis that stroke patients will receive improved outcomes when biomechanics visualisation is used in the AFO fitting and tuning process. Patients and methods/material and methods: An RCT is being used (ISRCTN52126764). The intervention arm receive AFO fitting and tuning using 3DGA and visualisation, and the non-intervention arm receive an AFO by standard care (clinicians using observation). Walking velocity, 3D kinematics and kinetics, step length, gait symmetry, mRMI and EuroQol (EQ-5L-5D) are measured at four time points (baseline, AFO provision, three months and six months). Ten participants, 5.7(6) weeks post-stroke, with an average age of 56.4(17) years have been recruited. Results: Walking velocity improvement (before/after AFO provision) data for the intervention group (n = 5) was 22(21) cm/s versus 1.6(6.4) cm/s for the non-intervention group (n = 5). The difference is significant (p < 0.05, Mann–/INS;Whitney U Test). More extensive results will be available at the time of presentation. Conclusion: Early data indicate that the visualisation of biomechanical data appears to assist the AFO tuning process, providing stroke patients with better immediate improvements in walking velocity.