Posts Tagged ankle

[ARTICLE] Functional electrical stimulation and ankle foot orthoses provide equivalent therapeutic effects on foot drop: A meta-analysis providing direction for future research – Full Text PDF

Abstract

Objective: To compare the randomized controlled trial evidence for therapeutic effects on walking of functional electrical stimulation and ankle foot orthoses for foot drop caused by central nervous system conditions.
Data sources: MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, REHABDATA, PEDro, NIHR Centre for Reviews and Dissemination, Scopus and clinicaltrials.gov.
Study selection: One reviewer screened titles/abstracts. Two independent reviewers then screened the full articles.
Data extraction: One reviewer extracted data, another screened for accuracy. Risk of bias was assessed by 2 independent reviewers using the Cochrane Risk of Bias Tool.
Data synthesis: Eight papers were eligible; 7 involving participants with stroke and 1 involving participants with cerebral palsy. Two papes reporting different measures from the same trial were grouped, resulting in 7 synthesized randomized controlled trials (n= 464). Meta-analysis of walking speed at final assessment (p = 0.46), for stroke participants (p = 0.54) and after 4–6 weeks’ use (p = 0.49) showed equal improvement for both devices.
Conclusion: Functional electrical stimulation and ankle foot orthoses have an equally positive therapeutic effect on walking speed in non-progressive central nervous system diagnoses. The current randomized controlled trial evidence base does not show whether this improvement translates into the user’s own environment or reveal the mechanisms that achieve that change. Future studies should focus on measuring activity, muscle activity and gait kinematics. They should also report specific device details, capture sustained therapeutic effects and involve a variety of central nervous system diagnoses.

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[Abstract] Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation

Abstract:

Hybrid rehabilitation robotics combine neuro-prosthetic devices (close-loop functional electrical stimulation systems) and traditional robotic structures and actuators to explore better therapies and promote a more efficient motor function recovery or compensation. Although hybrid robotics and ankle neuroprostheses (NPs) have been widely developed over the last years, there are just few studies on the use of NPs to electrically control both ankle flexion and extension to promote ankle recovery and improved gait patterns in paretic limbs. The aim of this work is to develop an ankle NP specifically designed to work in the field of hybrid robotics. This article presents early steps towards this goal and makes a brief review about motor NPs and Functional Electrical Stimulation (FES) principles and most common devices used to aid the ankle functioning during the gait cycle. It also shows a current sources analysis done in this framework, in order to choose the best one for this intended application.

Source: Towards an ankle neuroprosthesis for hybrid robotics: Concepts and current sources for functional electrical stimulation – IEEE Xplore Document

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[WEB SITE] Research report explores the foot drop implants market

Foot drop can be defined as an abnormality in the gait where the forefoot drops due to factors such as weakness of the ankle and toe dorsiflexion. The abnormality is also caused by paralysis of the muscles in the anterior portion of the lower leg or damage to the fibular nerve.

Foot drop can be associated with various conditions, including peripheral nerve injuries, neuropathies, drug toxicities, dorsiflexor injuries, and diabetes. Anatomic, muscular, and neurologic are the three categories of foot drop.

Functional electrical stimulation technology is employed in the foot drop implant to improve the gait of patients and avoid foot drop or tripping while walking. Functional electric stimulators (FES) can either be implanted within the patient’s body or employed externally.External FES is tested on the patient prior to its implantation. Implant FES involves a surgery in which the electrodes are directly placed on the nerves of the patient, which are controlled by the implant placed under the skin.

The FES device activates the implant through a wireless antenna that is worn outside the body. Sensors are also associated with FES which trigger events in the walking pattern such as lifting of the heel, thereby stimulating the nerves.

Obtain Report Details at
www.transparencymarketresearch.com/foot-drop-implants-market.html

The advantages of implant FES include reduction in sensation that is associated with external stimulation. In addition, it eliminates the need to adjust the electrodes on the skin on a daily basis.

Rise in number of foot drop disorders due to nerve injuries, growth in knee and hip replacement therapies that lead to foot drop disorders, and increase in the number of sports related injuries contribute to the growth of the foot drop implants market. Foot drop disorders are commonly observed in diabetic retinopathy patients and this prevalence is growing due to increase in incidence of diabetes, which is propelling the growth of the market.

Furthermore, the market players are focus on research and development to increase the number of foot drop implant products available in the market, driving the market growth. However, lack of reimbursement, high cost of the implants, and low awareness among the people are likely to hinder the growth of the foot drop implants market in the near future.

The global foot drop implants market can be segmented on the basis of product, end-user, and region. On the basis of product, the market is categorized into functional electrical stimulators and internal fixation devices.

The internal fixation devices segment is anticipated to record a significant growth during the forecast period owing to increasing demand for the devices and advantages offered by these devices such as elimination of the need to stimulate the electrodes daily. Based on end-user, the market can be segmented into hospitals, orthopedic centers, and palliative care centers, among others.

The orthopedic centers segment is anticipated to record a high growth during the forecast period due to the increasing number of foot drop cases due to injuries.

Geographically, the foot drop implants market is distributed over North America, Latin America, Europe, Asia Pacific, and Middle East & Africa. North America dominated the market in 2016 and is anticipated to continue its dominance during the forecast period.

The significant growth of the market in the region can be attributed to the strong focus on research and development, increase in health care spending, and growth in awareness about the abnormality. The sluggish economy might have a negative impact on the market growth of Europe.

Asia Pacific is anticipated to record a high CAGR during the forecast period, primarily driven by India and China. The rising disposable income is anticipated to contribute to the growth of the Asia Pacific market.

In addition, a factor contributing to the market growth is rise in prevalence of diabetes that leads to diabetic retinopathy, which is one of the primary causes of foot drop.

Key players operating in the foot drop implants market include Finetech Medical, Arthrex, Inc., Zimmer Biomet, Bioness Inc., Stryker Corporation, Wright Medical Group N.V., Ottobock, Narang Medical Limited, PONTiS Orthopaedics, LLC, and Shanghai MicroPort Orthopedics.

The report offers a comprehensive evaluation of the market. It does so via in-depth qualitative insights, historical data, and verifiable projections about market size.

The projections featured in the report have been derived using proven research methodologies and assumptions. By doing so, the research report serves as a repository of analysis and information for every facet of the market, including but not limited to: Regional markets, technology, types, and applications.

Report:
www.transparencymarketresearch.com/sample/sample.php?flag=B&rep_id=22913

Source: Research report explores the foot drop implants market – WhaTech

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[ARTICLE] A soft robotic exosuit improves walking in patients after stroke – Full Text

A softer recovery after stroke

Passive assistance devices such as canes and braces are often used by people after stroke, but mobility remains limited for some patients. Awad et al. studied the effects of active assistance (delivery of supportive force) during walking in nine patients in the chronic phase of stroke recovery. A soft robotic exosuit worn on the partially paralyzed lower limb reduced interlimb propulsion asymmetry, increased ankle dorsiflexion, and reduced the energy required to walk when powered on during treadmill and overground walking tests. The exosuit could be adjusted to deliver supportive force during the early or late phase of the gait cycle depending on the patient’s needs. Although long-term therapeutic studies are necessary, the immediate improvement in walking performance observed using the powered exosuit makes this a promising approach for neurorehabilitation.

Abstract

Stroke-induced hemiparetic gait is characteristically slow and metabolically expensive. Passive assistive devices such as ankle-foot orthoses are often prescribed to increase function and independence after stroke; however, walking remains highly impaired despite—and perhaps because of—their use. We sought to determine whether a soft wearable robot (exosuit) designed to supplement the paretic limb’s residual ability to generate both forward propulsion and ground clearance could facilitate more normal walking after stroke. Exosuits transmit mechanical power generated by actuators to a wearer through the interaction of garment-like, functional textile anchors and cable-based transmissions. We evaluated the immediate effects of an exosuit actively assisting the paretic limb of individuals in the chronic phase of stroke recovery during treadmill and overground walking. Using controlled, treadmill-based biomechanical investigation, we demonstrate that exosuits can function in synchrony with a wearer’s paretic limb to facilitate an immediate 5.33 ± 0.91° increase in the paretic ankle’s swing phase dorsiflexion and 11 ± 3% increase in the paretic limb’s generation of forward propulsion (P < 0.05). These improvements in paretic limb function contributed to a 20 ± 4% reduction in forward propulsion interlimb asymmetry and a 10 ± 3% reduction in the energy cost of walking, which is equivalent to a 32 ± 9% reduction in the metabolic burden associated with poststroke walking. Relatively low assistance (~12% of biological torques) delivered with a lightweight and nonrestrictive exosuit was sufficient to facilitate more normal walking in ambulatory individuals after stroke. Future work will focus on understanding how exosuit-induced improvements in walking performance may be leveraged to improve mobility after stroke.

INTRODUCTION

Bipedal locomotion is a defining trait of the human lineage, with a key evolutionary advantage being a low energetic cost of transport (1). However, the economy of bipedal gait may be lost because of neurological injury with disabling consequences. Hemiparetic walking (27) is characterized by a slow and highly inefficient gait that is a major contributor to disability after stroke (8, 9), which is a leading cause of disability among Americans (10). Despite rehabilitation, the vast majority of stroke survivors retain neuromotor deficits that prevent walking at speeds suitable for normal, economical, and safe community ambulation (11). Impaired motor coordination (12), muscle weakness and spasticity (13), and reduced ankle dorsiflexion (DF; drop foot) and knee flexion during walking are examples of typical deficits after stroke that limit walking speed and contribute to gait compensations such as hip circumduction and hiking (1418), increase the risk of falls, and reduce fitness reserve and endurance (3, 4, 9, 12, 1921). Even those able to achieve near-normal walking speeds present with gait deficits (22, 23) that hinder community reintegration and limit participation to well below what is observed in even the most sedentary older adults (24, 25), ultimately contributing to reduced health and quality of life (10, 26, 27).

Walking independence is an important short-term goal for survivors of a stroke; however, independence can be achieved via compensatory mechanisms. The persistence of neuromotor deficits after rehabilitation often necessitates the prescription of passive assistive devices such as canes, walkers, and orthoses to enable walking at home and in the community (2830). Unfortunately, commonly prescribed devices compensate for poststroke neuromotor impairments in a manner that prevents normal gait function. For example, ankle-foot orthoses (AFOs) inhibit normal push-off during walking (31) and reduce gait adaptability (32). The stigma associated with the use of these devices is also important to consider, especially for the growing population of young adult survivors of stroke (33, 34). The major personal and societal costs of stroke-induced walking difficulty and the limitations of the existing intervention paradigm motivate the development of rehabilitation interventions and technologies that enable the rapid attainment of more normal walking behavior.

Recent years have seen the development of powered exoskeletal devices designed to enable walking in individuals who are unable to walk (35, 36). Central to this remarkable engineering achievement is a rigid structure that can support its own weight and provide high amounts of assistance; however, these powerful machines may not always be necessary to restore more normal gait function in individuals who retain the ability to walk after neurological injury, such as the majority of those after stroke. To address this opportunity, our team developed a lightweight, soft wearable robot (exosuit) that interfaces to the paretic limb of persons after stroke via garment-like, functional textile anchors. Exosuits produce gait-restorative joint torques by transmitting mechanical power from waist-mounted body-worn (37) or off-board (38, 39) actuators to the wearer through the interaction of the textile anchors and a cable-based transmission.

Several factors, such as the compliance of the exosuit-human system (40), prevent exosuits from providing the assistance necessary to enable nonambulatory individuals to walk again (41); however, for ambulatory individuals, the lightweight and nonrestrictive nature of this technology has the potential to facilitate a more natural interaction with the wearer and minimize disruption of the natural dynamics of walking (42). Our first efforts developing exosuits led to the creation of systems that could comfortably deliver assistive forces to healthy users during walking (39, 40, 4347). Recently, we demonstrated that assistive forces delivered through the exosuit interface produce marked reductions in the energy cost of healthy walking (37, 48). Thus, although exosuits can only augment, not replace, a wearer’s existing gait functions, we posit that they have the potential to work synergistically with the residual abilities of individuals with impaired gait to improve walking function.

The primary objective of this foundational study was to evaluate the potential of using the exosuit technology to restore healthy walking behavior in individuals after stroke. Toward this end, we evaluated the effects on hemiparetic gait of actively assisting the paretic limb during treadmill walking using a tethered, unilateral (worn on only one side of the body) exosuit designed to supplement the wearer’s generation of paretic ankle plantarflexion (PF) during stance phase and DF during swing phase. We posited that this targeted assistance of the paretic ankle’s gait functions would facilitate more symmetrical propulsive force generation by the paretic and nonparetic limbs and reduce the energetic burden associated with poststroke walking, which previous work has shown can be more than 60% more costly (49). Previous work on wearable assistive robots for persons after stroke has suggested that the timing of PF force delivery during walking could be an important contributor to positive outcomes in this heterogeneous population (50). Hence, we also evaluated different onset timings of PF force delivery for each individual, hypothesizing that this timing would need to be individualized to optimize outcomes.

Designed to be unobtrusive to the wearer when not powered, the exosuit’s mass of ~0.9 kg is distributed along the length of the paretic limb similar to a pair of pants. Nonetheless, to understand the net effect of walking with an exosuit powered and assisting the paretic limb, it is necessary to evaluate whether there are effects because of simply wearing the exosuit passively (worn but unpowered). A secondary objective was thus to evaluate the effects of walking with the passive exosuit relative to walking with the exosuit not worn. Moreover, because one of the compelling aspects of soft wearable robots, such as exosuits, is their potential to provide gait assistance and, potentially, rehabilitation benefit during community-based walking activities, in addition to treadmill-based biomechanical investigation into the effects of a tethered exosuit, our final objective was to evaluate the effects of exosuit assistance delivered from a first-generation, body-worn (untethered) exosuit during overground walking. Ultimately, by investigating how individuals with poststroke hemiparesis respond to exosuit-generated active assistance of ankle PF and DF during treadmill and overground walking, this study serves to define the technology’s potential for improving mobility and enabling more effective neurorehabilitation after stroke. […]

Continue —> A soft robotic exosuit improves walking in patients after stroke | Science Translational Medicine

 

Fig. 1. Overview of a soft wearable robot (exosuit) designed to augment paretic limb function during hemiparetic walking. Exosuits (A) use garment-like functional textile anchors worn around the waist and calf (B) and Bowden cable-based mechanical power transmissions to generate assistive joint torques as a function of the paretic gait cycle (C). Integrated sensors (load cells and gyroscopes) are used to detect gait events and in a cable position–based force controller that modulates force delivery. The contractile elements of the exosuit are the Bowden cables located posterior and anterior to the ankle joint. Exosuit-generated PF and DF forces are designed to restore the paretic limb’s contribution to forward propulsion (GRF) and ground clearance (ankle DF angle during swing phase)—subtasks of walking that are impaired after stroke. Poststroke deficits in these variables are demonstrated through a comparison of paretic (black) and nonparetic (gray) limbs. Means across participants are presented (n = 7).

 

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[BLOG POST] Get Back On Your Feet with Exercises for Foot Drop – Saebo

Foot drop (sometimes called drop foot or dropped foot) is the inability to raise the front of the foot due to weakness or paralysis of the muscles and nerves that lift the foot. Foot drop itself is not a disease, it is a symptom of a greater problem or medical condition.

You can recognize foot drop by how it affects your gait. Someone with foot drop may drag their toes along the ground when walking because they cannot lift the front of their foot with each step. In order to avoid dragging their toes or tripping they might lift their knee higher or swing their leg in a wide arc instead. This is called steppage gait, and is a coping mechanism for foot drop issues.

Causes of Foot Drop

There are three main causes of the weakened nerves or muscles that lead to foot drop:

1: Nerve Injury. The peroneal nerve is the nerve that communicates to the muscles that lift the foot. Damage to the peroneal nerve is the most common cause of foot drop. The nerve wraps from the back of the knee to the front of the shin and sits closely to the surface, making it easy to damage. Damage to the peroneal nerve can be caused by sports injuries, hip or knee replacement surgery, a leg cast, childbirth or even crossing your legs.

2: Muscle Disorders. A condition that causes the muscles to slowly weaken or deteriorate can also cause foot drop. These disorders may include muscular dystrophy, amyotrophic lateral sclerosis (Lou Gehrig’s disease) and polio.

3: Brain or Spinal Disorders. Neurological conditions can also cause foot drop. Conditions may include stroke, multiple sclerosis (MS), cerebral palsy and Charcot-Marie-Tooth disease.

How Foot Drop is Treated

Treatment for foot drop requires treating the underlying medical condition that caused it. In some cases foot drop can be permanent, but many people are able to recover. There are a number of treatments that can help with foot drop:

1: Surgery

If your foot drop is caused by a pinched nerve or herniated disc then you will likely have surgery to treat it. Surgery may also be necessary to repair muscles or tendons if they were directly damaged and are causing foot drop. In severe or long term cases, you might have surgery to fuse your ankle and foot bones and improve your gait.

2: Functional Electrical Stimulation

If your foot drop is being caused by damage to the peroneal nerve than Functional Electrical Stimulation may be an alternative to surgery. A small device can be worn or surgically implanted just below the knee that will stimulate the normal function of the nerve, causing the muscle to contract and the foot to lift while walking.

3: Braces or Ankle Foot Orthosis (AFO)

Wearing a brace or AFO that supports the foot in a normal position is a common treatment for foot drop. The device will stabilize your foot and ankle and hold the front part of the foot up when walking. While traditionally doctors have prescribed bulky stiff splints that go inside the shoe, the SaeboStep is a lightweight and cost effective option that provides support outside the shoe.

4: Physical Therapy

Therapy to strengthen the foot, ankle, and lower leg muscles is the primary treatment for foot drop and will generally be prescribed in addition to the treatment options mentioned above. Stretching and range of motion exercises will also help prevent stiffness from developing in the heel.

 

Rehabilitation Exercises for Foot Drop

Specific exercises that strengthen the muscles in the foot, ankle and lower leg can help improve the symptoms of foot drop in some cases. Exercises are important for improving range of motion, preventing injury, improving balance and gait, and preventing muscle stiffness.

When treating foot drop, you may work with a physical therapist who will help you get started strengthening your foot, leg and ankle muscles. Rehabilitation for foot drop can be a slow process, so your physical therapist will likely recommend that you continue to do strengthening exercises at home on your own.

By being consistent about your exercises at home, you can maximize your chances of making a successful recovery from foot drop. Strengthening the weakened muscles will allow you to restore normal function and hopefully start walking normally again.

Like any exercise program, please consult your healthcare professional before you begin. Please stop immediately if any of the following exercises cause pain or harm to your body. It’s best to work with a trained professional for guidance and safety.

Towel Stretch

1-towel-stretch

Sit on the floor with both legs straight out in front of you. Loop a towel or exercise band around the affected foot and hold onto the ends with your hands. Pull the towel or band towards your body. Hold for 30 seconds. Then relax for 30 seconds. Repeat 3 times.

Toe to Heel Rocks

2-toe-heel-rocks

Stand in front of a table, chair, wall, or another sturdy object you can hold onto for support. Rock your weight forward and rise up onto your toes. Hold this position for 5 seconds. Next, rock your weight backwards onto your heels and lift your toes off the ground. Hold for 5 seconds. Repeat the sequence 6 times.

Marble Pickup

3-marble-pickup

Sit in a chair with both feet flat on the floor. Place 20 marbles and a bowl on the floor in front of you. Using the toes of your affected foot, pick up each marble and place it in the bowl. Repeat until you have picked up all the marbles.

Ankle Dorsiflexion

4-ankle-dorsiflexion

Sit on the floor with both legs straight out in front of you. Take a resistance band and anchor it to a stable chair or table leg. Wrap the loop of the band around the top of your affected foot. Slowly pull your toes towards you then return to your starting position. Repeat 10 times.

Plantar Flexion

5-plantar-flexion

Sit on the floor with both legs straight out in front of you. Take a resistance band and wrap it around the bottom of your foot. Hold both ends in your hands. Slowly point your toes then return to your starting position. Repeat 10 times.

Ball Lift

6-ball-lift

Sit in a chair with both feet flat on the floor. Place a small round object on the floor in front of you (about the size of a tennis ball). Hold the object between your feet and slowly lift it by extending your legs. Hold for 5 seconds then slowly lower. Repeat 10 times.

Get Back On Your Feet

Don’t let foot drop affect your mobility, independence, and quality of life. With proper rehabilitation and assistive devices many people are able to overcome the underlying cause of their symptoms and get back to walking normally. If you are showing symptoms of foot drop, talk to a medical professional about your treatment options.

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All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

Source: Get Back On Your Feet with Exercises for Foot Drop | Saebo

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[VIDEO] Ankle rehabilitation using BalanceTutor – YouTube

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[WEB SITE] Foot Drop: Causes, Prevention and How You can Treat It

What is foot drop & what causes it?

Foot drop is a simple name but its cause and treatment may be less than simple.

If you are unable to lift your foot up at the ankle and it makes walking difficult, you may have something called foot drop. This could be due to weakness in one of the muscles responsible for lifting, or dorsiflexing, your foot. It could also be caused by tightness or spasticity in the calf muscles of your leg that cause your toes to point downward.

The cause of foot drop can be from several different sources – neurological, muscular, a side effect from medication, or from a lack of movement.

People with stroke, multiple sclerosis, acquired brain injury, spinal cord injury, or cerebral palsy have a central neurological reason causing weakness, tightness or spasticity. People with peripheral neurologic disease may also have foot drop. These diagnoses could include neuropathy, injury to the lower spinal cord, nerve damage, or illnesses like Guillain-Barre syndrome.

Those who have a traumatic accident or muscular damage could also suffer from foot drop because of damage from swelling and compression.

Certain medications are known to potentially cause foot drop. Talk to your doctor about your medications.

Foot drop can also occur in people who are in bed for a prolonged amount of time. When lying on your back, gravity pulls down your foot, and can cause weakness and overstretch the muscles and nerves on the front of your lower leg.

Can foot drop be prevented?

If you or your loved one is required to be on bedrest or immobile, you can help to prevent foot drop by using a padded splint, by doing stretching, and by doing active exercises like ankle pumps.

If you have an underlying condition, it may be impossible to fully prevent foot drop from occurring. But often you can improve the flexibility and strength in your leg, or use an orthosis or splint to help maintain your foot in a position that will allow you to walk and move safely.

How can foot drop be treated?

The treatment of foot drop depends on the cause and the symptoms you have. Below are some suggestions on what you can do, but make sure to talk to your doctor, therapist or orthotist about the best treatment options for you.

Keep your foot and ankle flexible:

  • Use a foot splint at night

  • Complete daily stretches. The ProStretch gives a great stretch

Improve the tone in your leg:

  • Use an orthosis that puts your ankle in a slight stretch

Strengthen your leg:

  • Use neuromuscular electrical stimulation

  • Complete exercises against gravity or with resistance like a Theraband

  • Stand on a variety of surfaces like an Airex balance pad or a Bosu ball to challenge your muscles in your legs. Hold onto something sturdy or have someone nearby to help

Improve the safety of your walking and prevent falls:

  • Use an ankle foot orthosis to keep your toes up when walking. Depending on your strength level, you may need a flexible one or a rigid one

  • Walk with an assistive device, like a walker or cane

  • Modify your home to prevent you from tripping or falling – consider removing rugs and floor clutter, sitting on a shower chair instead of standing, and observe your home for other potential hazards

Prevent skin problems with the use of splints and orthotics:

  • Make sure to check your skin after you’ve been wearing it, and more often if you have impaired sensation in your legs, diabetes, or a history of wounds. Use a hand held inspection mirror to help

Keep the rest of yourself of healthy:

  • Consider activities like stationary biking or swimming to complete overall strengthening and conditioning

  • Strengthen your core muscles to improve your overall balance and stability

What are the dangers of not treating foot drop?

The biggest risk of not treating foot drop is tripping and falling. Falls lead to injury and other unnecessary treatments or hospitalizations. In order to clear your toes to avoid falling, you will have to change the way you walk. Over time, this could lead to pain or discomfort in your back or legs. Also, if your ankle loses flexibility and you cannot move it at you may need surgery.

Most importantly, without treatment you will have more difficulty doing the things in life that you enjoy doing. Unfortunately, there may be no cure, but there are things you can do to help improve the quality of your life.

Who should I ask for more information?

If you have already been diagnosed or are concerned about your risk for foot drop, you should speak with your healthcare provider about what you can do to prevent and treat it.

Source: Foot Drop: Causes, Prevention and How You can Treat It

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[Abstract] Effects of ankle biofeedback training on strength, balance, and gait in patients with stroke – PEDro

Effects of ankle biofeedback training on strength, balance, and gait in patients with stroke
Kim S-J, Cho H-Y, Kim K-H, Lee S-M
Journal of Physical Therapy Science 2016 Sep;28(9):2596-2600
clinical trial
PURPOSE: This study aimed to investigate the effects of ankle biofeedback training on muscle strength of the ankle joint, balance, and gait in stroke patients. SUBJECTS AND METHODS: Twenty-seven subjects who had had a stroke were randomly allocated to either the ankle biofeedback training group (n = 14) or control group (n = 13). Conventional therapy, which adhered to the neurodevelopmental treatment approach, was administered to both groups for 30 minutes. Furthermore, ankle strengthening exercises were performed by the control group and ankle biofeedback training by the experimental group, each for 30 minutes, 5 days a week for 8 weeks. To test muscle strength, balance, and gait, the Biodex isokinetic dynamometer, functional reach test, and 10 m walk test, respectively, were used. RESULTS: After the intervention, both groups showed a significant increase in muscle strength on the affected side and improved balance and gait. Significantly greater improvements were observed in the balance and gait of the ankle biofeedback training group compared with the control group, but not in the strength of the dorsiflexor and plantar flexor muscles of the affected side. CONCLUSION: This study showed that ankle biofeedback training significantly improves muscle strength of the ankle joint, balance, and gait in patients with stroke.

Full text (sometimes free) may be available at these link(s):      help

Source: PEDro – Search Detailed Search Results

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[WEB SITE] Advanced Strength Training For The Feet | DrJohnRusin.com

ADVANCED STRENGTH TRAINING FOR THE FEET

By Alex Nurse

The feet never get any love. Nobody likes feet. Some people see a bare foot in the room, and they run! No other structure in the body seems to inspire such powerful, albeit negative, sentiment. But, given the foot’s importance, the script should be flipped! The feet should be praised, worshipped, even placed on a pedestal. In this article, we are going to explore why.

The Ultimate Effect of Shoes on Posture & Neurology

barefoot running

The body maintains three interdependent receptor systems that are responsible for gathering information to help us better navigate our environment. These receptor systems are the proprioceptors (within the joints to give feedback about body position); interoceptors (relating information about our internal environment, organs for example); and exteroceptors (relating to us information about our external environment). The soles of the feet are stock-full of these exteroceptors.

As human beings when we explore the world in which we live our feet are the only part of us in constant contact with our external environment. This being the case, it is no surprise that the sole of the foot has more exteroceptors than almost any other body part. As mentioned above, as we place our foot onto the ground these exteroceptors are used by the brain to gather information about several things: our postural position; the need to make adjustments as it relates to absorbing/utilizing ground reaction forces; the need to create more stability, etc. This information enables the brain to make immediate changes to levels of stiffness and tension in muscles all the way up the kinetic chain.

These adjustments to tonicity are made in order to protect our joints and connective tissue from harm or perceived potential threats. We must always think, whether in sport or in the weight room, that it is the skeleton and its connective tissues that we are primarily loading. The skeleton is the important player in movement. The brain uses muscle to move, protect, and to maintain the positional or postural integrity of the skeleton, it is not the other way around. Therefore, whether biomechanically sound or not, the firing patterns executed in administration of this ongoing task eventually become engrained in the central nervous system, and can begin to govern the way we move.

Long Term Effects of Using Shoes as a Crutch

This genius system of checks and balances could, among other things, help us to be much more aware of our position relative to the gravity line (posture/joint alignment), essentially eliminating many postural problems. However, with the wearing of shoes and the amount of time we spend with the feet on hard surfaces (concrete, shoe soles, orthotics, etc.) our brain receives less and less information from the important receptors of the foot, and they become “dulled” and essentially “inexperienced.” As the saying goes, if you don’t use it, you lose it. Eventually, the feet lose their ability to “see” where we are, causing lag in our movement and affecting the brain’s ability to make the correct neurological adjustments at the correct time (eg. On-field performance; a quick, necessary positional correction during a split squat pattern, etc).

In the above situation, when trainees go barefoot (especially when outside or when performing SMR) they find the soles of the feet to be particularly tender. The exteroceptors, never having opportunity to sense things, are suddenly overloaded with a million intimate pieces of information that they are no longer accustomed to receiving. They find themselves unable to recognize or identify the new sensations, and the confusion and abrupt overstimulation is perceived as threatening. Naturally, the brain records this perceived threat as “pain.” It is no different than wearing shades or being in the dark for an entire day (wearing shoes), and then suddenly removing them or stepping outside and exposing the retina to full-on sunlight. At first, the eyes are uncomfortable and it takes time for them to get their bearings.

Pain makes us unsure of movement, and so it may take some time for your trainees or athletes to acclimatize to the sensations of being barefoot while wandering about. But I have seen with many trainees that once they have been exposed to their new “world,” for a long enough time, they will afterward often look forward to training barefoot. In my experience, this is because of the noticeable increase in the stability and neural drive that they receive in their lower body training. I had noticed this happening with some individuals, but at the time did not understand enough about the foot’s physiological structure to describe this phenomenon with the aforementioned detail. Still, I am oversimplifying things when talking about going barefoot. There may be other functional or structural/anthropometric issues that make it unwise to throw an individual shoeless into the lion’s den (a lower body exercise), but for the vast majority of trainees, they need more of it. Much more.

Of course, being in bare feet more often is only the first step to revitalizing what may be the missing link in our training programs. It will not solve postural problems and realign you for better movement overnight. There’s more.

The Effects of Shoes on Gait

gait

Not only can shoes inhibit our ability to maintain a healthy line of communication between our body and the brain as mentioned above, but they can also mess with the performance of one of our most primal and essential functions: gait. This happens when shoes contribute to a lesser of mobility of the big toe (first Metatarsal Phalange/MTP).

Continue —> Advanced Strength Training For The Feet | DrJohnRusin.com

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[ARTICLE] Biomechanical walking mechanisms underlying the metabolic reduction caused by an autonomous exoskeleton – Full Text HTML/PDF

Abstract

Background

Ankle exoskeletons can now reduce the metabolic cost of walking in humans without leg disability, but the biomechanical mechanisms that underlie this augmentation are not fully understood. In this study, we analyze the energetics and lower limb mechanics of human study participants walking with and without an active autonomous ankle exoskeleton previously shown to reduce the metabolic cost of walking.

Methods

We measured the metabolic, kinetic and kinematic effects of wearing a battery powered bilateral ankle exoskeleton. Six participants walked on a level treadmill at 1.4 m/s under three conditions: exoskeleton not worn, exoskeleton worn in a powered-on state, and exoskeleton worn in a powered-off state. Metabolic rates were measured with a portable pulmonary gas exchange unit, body marker positions with a motion capture system, and ground reaction forces with a force-plate instrumented treadmill. Inverse dynamics were then used to estimate ankle, knee and hip torques and mechanical powers.

Results

The active ankle exoskeleton provided a mean positive power of 0.105 ± 0.008 W/kg per leg during the push-off region of stance phase. The net metabolic cost of walking with the active exoskeleton (3.28 ± 0.10 W/kg) was an 11 ± 4 % (p = 0.019) reduction compared to the cost of walking without the exoskeleton (3.71 ± 0.14 W/kg). Wearing the ankle exoskeleton significantly reduced the mean positive power of the ankle joint by 0.033 ± 0.006 W/kg (p = 0.007), the knee joint by 0.042 ± 0.015 W/kg (p = 0.020), and the hip joint by 0.034 ± 0.009 W/kg (p = 0.006).

Conclusions

This study shows that the ankle exoskeleton does not exclusively reduce positive mechanical power at the ankle joint, but also mitigates positive power at the knee and hip. Furthermore, the active ankle exoskeleton did not simply replace biological ankle function in walking, but rather augmented the total (biological + exoskeletal) ankle moment and power. This study underscores the need for comprehensive models of human-exoskeleton interaction and global optimization methods for the discovery of new control strategies that optimize the physiological impact of leg exoskeletons.

Continue —> Biomechanical walking mechanisms underlying the metabolic reduction caused by an autonomous exoskeleton | Journal of NeuroEngineering and Rehabilitation | Full Text

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