Immediate synergistic effect of a trunk orthosis with joints providing resistive force and an ankle–foot orthosis on hemiplegic gait

Figures & data

Figure 1 Trunk orthosis with joints providing resistive force.

Table 1 Patient demographic and clinical characteristics

Patient ID	Age (years)	Sex	Height (cm)	Weight (kg)	Diagnosis	Paretic side	BrS of lower extremities	Time since onset (years)	Walking aid
TORF group
A	75	F	159.0	68.0	Cerebral infarction	R	VI	5	None
B	63	M	169.0	78.0	Cerebral hemorrhage	R	III	12	None
C	76	M	161.0	66.3	Cerebral infarction	R	V	10	None
D	66	M	169.0	64.9	Cerebral hemorrhage	R	IV	11	None
E	77	M	168.0	76.7	Cerebral hemorrhage	R	V	15	None
F	65	M	173.0	53.8	Cerebral hemorrhage	R	V	2	None
G	73	M	165.0	71.2	Cerebral hemorrhage	L	IV	14	T-cane
H	78	M	163.0	62.3	Cerebral hemorrhage	L	VI	26	None
I	78	F	148.0	40.2	Cerebral hemorrhage	L	IV	16	None
J	71	M	162.0	72.0	Cerebral infarction	L	V	5	None
K	66	F	147.5	58.2	Cerebral hemorrhage	L	IV	9	T-cane
L	78	M	160.0	49.8	Cerebral infarction	L	IV	4	T-cane
N	57	M	169.0	57.0	Cerebral hemorrhage	L	IV	5	T-cane
Mean	71.0		162.6	63.0				10.3
SD	6.92		7.80	11.0				6.54
Control group
M	68	M	174.0	77.2	Cerebral infarction	R	VI	5	None
O	73	F	152.0	51.8	Cerebral infarction	R	VI	10	T-cane
P	57	M	173.0	89.9	Cerebral hemorrhage	R	IV	2	T-cane
Q	71	M	173.0	60.0	Cerebral infarction	R	V	11	None
R	62	F	151.0	47.0	Cerebral hemorrhage	R	V	3	None
S	74	M	163.5	57.8	Cerebral hemorrhage	L	III	14	T-cane
T	75	M	163.0	57.6	Cerebral hemorrhage	L	V	11	None
U	84	M	158.0	58.4	Cerebral infarction	L	IV	20	T-cane
V	66	F	154.0	63.2	Cerebral hemorrhage	L	IV	4	T-cane
W	62	M	164.0	45.0	Cerebral hemorrhage	L	IV	1	T-cane
X	73	F	147.0	45.5	Cerebral infarction	L	V	2	None
Y	68	F	155.0	41.0	Cerebral infarction	L	V	3	None
Z	80	M	161.0	55.0	Cerebral hemorrhage	L	VI	2	None
A2	66	M	159.0	50.0	Cerebral hemorrhage	L	V	1	T-cane
Mean	69.9		160.5	57.1				6.4
SD	7.3		8.5	13.2				5.85

Abbreviations: BrS, Brunnstrom recovery stage; TORF, trunk orthosis with joints providing resistive force.

Figure 2 Flow of patients through the trial.

Note: One patient was excluded after measurements were taken because of missing markers.
Abbreviation: TORF, trunk orthosis with joints providing resistive force.

Table 2 Comparison of spatiotemporal parameters between conditions with and without trunk orthoses

	Non-TORF condition			TORF condition			p-value
	Median	25%–75%		Median	25%–75%
Spatiotemporal parameter
Walking speed (m/s)	0.532	0.387	0.596	0.582	0.381	0.659	0.013
Paretic step time (s)	0.790	0.740	0.962	0.763	0.670	0.923	0.048
Paretic steps/min (n)	76.0	62.6	81.6	78.6	65.1	89.8	0.022
	Non-corset condition			Corset condition			p-value
	Median	25%–75%		Median	25%–75%
Spatiotemporal parameter
Walking speed (m/s)	0.446	0.366	0.578	0.458	0.373	0.569	0.626
Paretic step time (s)	0.71	0.656	0.975	0.755	0.673	0.967	0.542
Paretic steps/min (n)	77.2	50.0	89.7	79.5	62.3	89.2	0.855

Note: Bold figures indicate statistically significant p<0.05.

Abbreviation: TORF, trunk orthosis with joints providing resistive force.

Table 3 Comparison of kinetic and kinematic paretic lower limb parameters between conditions with and without trunk orthoses

	Non-TORF condition			TORF condition			p-value
	Median	25%–75%		Median	25%–75%
Ground reaction force
Peak mediolateral component during LR (N/kg)	0.071	0.066	0.090	0.080	0.069	0.093	0.023
Peak vertical component during PSw (N/kg)	0.944	0.893	0.966	0.955	0.924	0.995	0.048
Ankle
Peak plantar flexion moment during SS (N m/kg)	0.732	0.644	0.839	0.784	0.630	0.980	0.013
Peak dorsiflexion moment during swing (N m/kg)	0.021	0.020	0.024	0.022	0.021	0.027	0.013
Knee
Peak knee abduction moment during PSw (N m/kg)	0.324	0.170	0.373	0.346	0.220	0.382	0.006
Hip
Peak extension moment in swing (N m/kg)	0.115	0.079	0.134	0.118	0.049	0.196	0.048
Peak extension angle in SS (°)	4.70	1.08	10.34	5.57	1.96	14.45	0.027
Peak extension angle in PSw (°)	8.68	4.23	10.78	8.85	4.80	12.69	0.006
	Non-corset condition			Corset condition			p-value
	Median	25%–75%		Median	25%–75%
Ground reaction force
Peak mediolateral component during LR (N/kg)	0.073	0.058	0.087	0.080	0.060	0.091	0.583
Peak vertical component during PSw (N/kg)	0.846	0.802	0.933	0.882	0.838	0.937	0.358
Ankle
Peak plantar flexion moment during SS (N m/kg)	0.628	0.471	0.872	0.610	0.493	0.840	0.963
Peak dorsiflexion moment during swing (N m/kg)	0.019	0.016	0.022	0.021	0.017	0.022	1.000
Knee
Peak knee abduction moment during PSw (N m/kg)	0.276	0.179	0.317	0.287	0.237	0.349	0.626
Hip
Peak extension moment in swing (N m/kg)	0.100	0.020	0.162	0.085	0.037	0.161	0.952
Peak extension angle in SS (°)	4.40	0.55	6.51	4.13	0.50	8.36	0.626
Peak extension angle in PSw (°)	6.25	4.18	8.94	6.89	11.81	4.55	0.326

Note: Bold figures indicate statistically significant p<0.05.

Abbreviations: LR, loading response; PSw, pre-swing; SS, single stance; TORF, trunk orthosis with joints providing resistive force.

Table 4 Comparison of pelvis and thorax angles between conditions with and without trunk orthoses

	Non-TORF condition			TORF condition			p-value
	Median	25%–75%		Median	25%–75%
Pelvis angle forward tilt angle (°)
Peak during LR	0.84	−3.60	3.22	−1.40	−6.95	0.22	0.023
Peak during swing	−0.09	−4.92	2.90	−2.13	−6.50	1.80	0.048
Thorax bending angle (°): forward+
Peak during LR	3.59	−0.08	7.90	−0.28	−2.02	5.99	0.003
Peak during SS	5.62	2.31	10.62	1.60	0.22	8.02	0.002
Peak during PSw	3.80	−0.15	8.84	0.28	−3.30	6.34	0.005
Peak during swing	6.76	4.43	12.06	2.32	−0.74	8.29	0.002
Thorax lateral bending angle (°): paretic side+
Peak during SS	4.27	−2.24	5.65	3.57	−2.39	6.34	0.033
Peak during PSw	2.07	−3.06	4.97	1.49	−3.09	3.52	0.017
Peak during swing	1.78	−3.20	3.49	1.19	−3.91	2.35	0.040
	Non-corset condition			Corset condition			p-value
	Median	25%–75%		Median	25%–75%
Pelvis angle forward tilt angle (°)
Peak during LR	−1.29	−4.74	0.26	−1.83	−4.78	3.99	0.715
Peak during swing	−1.87	−3.32	0.19	−1.47	−4.18	3.13	0.426
Thorax bending angle (°): forward+
Peak during LR	4.37	1.50	12.89	3.42	0.61	11.13	0.091
Peak during SS	5.62	3.54	11.95	6.81	3.09	12.89	0.025
Peak during Psw	7.85	4.47	16.51	6.51	4.89	14.72	0.025
Peak during swing	9.21	4.16	16.08	7.68	5.09	14.58	0.025
Thorax lateral bending angle (°): paretic side+
Peak during SS	2.15	−0.34	4.54	1.37	−0.22	4.23	0.583
Peak during PSw	−0.97	−3.67	2.28	−0.27	−2.77	1.78	1.000
Peak during swing	−1.66	−4.63	0.99	−1.02	−3.64	1.90	0.903

Notes: Bold figures indicate statistically significant p<0.05.

Abbreviations: LR, loading response; PSw, pre-swing; SS, single stance; TORF, trunk orthosis with joints providing resistive force.

Table 5 Comparison of changes from baseline between the TORF and corset groups

	TORF group: change from baseline			Corset group: change from baseline			p-value
	Median	25%–75%		Median	25%–75%
Spatiotemporal parameter
Walking speed (m/s)	0.023	0.005	0.066	−0.002	−0.024	0.01	0.015
Paretic step time (s)	−0.030	−0.038	−0.020	0.008	−0.019	0.048	0.047
Paretic steps/min, n	2.50	0.98	3.98	−0.60	−2.005	1.881	0.037
Ground reaction force
Peak mediolateral component during LR (N/kg)	0.005	0.002	0.011	0.004	−0.009	0.012	0.594
Peak vertical component during PSw (N/kg)	0.025	0.011	0.036	0.005	−0.011	0.038	0.734
Ankle
Peak plantar flexion moment during SS (N m/kg)	0.073	−0.006	0.101	−0.037	−0.090	0.014	0.023
Peak dorsiflexion moment during swing (N m/kg)	0.001	0.000	0.002	0.000	0.000	0.001	0.042
Knee
Peak knee abduction moment during PSw (N m/kg)	0.023	0.004	0.040	−0.002	−0.018	0.033	0.133
Hip
Peak extension moment in swing (N m/kg)	0.025	−0.003	0.062	−0.005	−0.033	0.031	0.146
Peak extension angle in SS (°)	1.34	0.87	2.05	0.24	−0.96	1.43	0.190
Peak extension angle in PSw (°)	1.16	0.39	1.86	0.34	−0.34	1.07	0.264
Pelvis tilt angle (°): backward+
Peak during LR	2.13	0.14	3.61	0.73	−2.12	1.43	0.065
Thorax bending angle (°): forward+
Peak during LR	−2.14	−3.22	−1.45	−1.38	−2.27	−1.24	0.081
Peak during SS	−2.28	−4.28	−1.16	−2.20	−2.56	−1.55	0.438
Peak during PSw	−2.66	−3.52	−0.75	−1.57	−2.18	−0.65	0.244
Peak during swing	−3.54	−4.44	−2.29	−2.06	−2.54	−0.49	0.052
Thorax lateral bending angle (°): paretic side+
Peak during SS	−0.70	−1.08	−0.13	0.10	−0.92	1.33	0.133
Peak during PSw	−0.43	−1.11	−0.12	−0.23	−0.95	1.60	0.286
Peak during swing	−0.64	−1.29	0.00	−0.03	−0.77	0.78	0.109

Notes: Bold figures indicate statistically significant p<0.05.

Abbreviations: LR, loading response; PSw, pre-swing; SS, single stance; TORF, trunk orthosis with joints providing resistive force.

Figure 3 Comparison of ankle-joint moment between the TORF and non-TORF conditions and between the corset and non-corset conditions.

Notes: (A) TORF group. (B) Corset group.
Abbreviation: TORF, trunk orthosis with joints providing resistive force.

Figure 4 Synergetic effect of the trunk orthosis with joints providing resistive force and an ankle–foot orthosis on rocker function in subjects with a hemiplegic gait.