LegTutor an Important Boost for People With Stiff-Knee Gait Following Stroke


Image by sanchom via Flickr

Dr. James S. Sulzer from the Rehabilitation Institute of Chicago  Chicago, Ill; the Departments of Mechanical and Biomedical Engineering, Northwestern University, Evanston, Ill; and the Department of Bioengineering, University of Illinois–Chicago, Chicago, Ill.writing for the American Heart and Stroke Associations made the following study:

Study Background—  Reduced knee flexion during the swing phase is called stiff-knee gait is defined. This is accompanied by circumduction and hip hiking which are examples of frontal plane compensatory movements that result from reduced toe clearance. The group researched whether  knee flexion assistance before foot-off would result in a reduction of the  exaggerated frontal plane movements seen in stiff-knee gait after stroke.
Methods— 9 chronic stroke subjects with stiff-knee gait underwent assist knee flexion torque during the preswing phase using a robotic knee orthosis on a treadmill. This was compared to peak knee flexion, hip abduction, and pelvic obliquity angles of 5non impaired control subjects.
Results— Maximum knee flexion angle was significantly increased in both groups however the gait compensation of  hip abduction  in the stroke subjects significantly increased, no change was observed in nondisabled control subjects.
Conclusions— Hip abduction was seen to increas when stroke subjects received assistive knee flexion torque at foot-off. These findings were in direct contradiction to the belief that pelvic obliquity combined with hip abduction is a compensatory mechanism that facilitates foot clearance during swing.
The LegTutor has proven to be an important complement in improving functional outcomes in physical rehabilitation for post stroke patients.
The LegTutor provides a safe and comfortable leg brace with position and speed sensors that precisely record three dimensional hip and knee extension, flexion and hip abduction. Rehabilitation games allow the patient to exercise Range of Motion (ROM), speed and accuracy of movement of the hip and knee individually or the knee while looking at the compensatory movement of the hip. In this way the physiotherapist can set up the knee range of motion and ask the patient to perform an isolated swing phase of the movement. The patient can be given secondary feedback of the hip abduction  during this knee swing. The patient in the rehabiliation game will be forced to do repetive movement practice of the knee swing without hip abduction. The patient can also work on strengthening and control of isolated hip abduction aduction exercises so they learn motor control in this movement as well.  The LegTutor will also allow for evaluation and reporting of the knee movement during the isolated swing movement of gait.
The LegTutor together with its sister devices namely the HandTutor, ArmTutor and 3DTutor) aim to optimize motor, sensory and cognitive performance and allow the patient to do customized repetitive and intensive isolated and combined joint movement practice. The Tutors are being successfully used in leading U.S, German, Italian and UK rehabilitation clinics by both occupational and physical therapists. They are available for children as well as adults.

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