Article

Knee-ankle-foot orthoses (KAFOs) are used by people with
poliomyelitis to ambulate. Whist advances in orthotic knee joint designs for use
in KAFOs such the provision of stance control capability have proven efficacy,
little attention has been paid to shoe adaptations which may also improve gait.
AIM: The aim of this study was to evaluate the alteration to the kinematics and
temporal-spatial parameters of gait caused by the use of heel-to-toe rocker-soled
footwear when ambulating with KAFOs. METHOD: Nine adults with a history of
poliomyelitis who routinely wore KAFOs participated in the study. A heel-to-toe
rocker sole was added to footwear and worn on the affected side. A
three-dimensional motion capture system was used to quantify the resulting
alteration to specific gait parameters. RESULTS: Maximum hip joint extension was
significantly increased (p = 0.011), and hip abduction and adduction were both
significantly reduced (p = 0.011 and p = 0.007, respectively) when walking with
the rocker sole. A significant increase in stride length (p = 0.035) was
demonstrated but there were no significant increases in either walking speed or
cadence. CONCLUSIONS: A heel-to-toe rocker sole adaptation may be useful for
walking in patients with poliomyelitis who use KAFOs. Implications for
Rehabilitation The poor functionality and difficulty in walking when using an
orthotic device such as a KAFO which keeps the knee locked during ambulation,
plus the significant energy required to walk, are complications of orthoses
using. Little evidence exists regarding the biomechanical effect of walking with
a KAFO incorporating fixed knee joints, in conjunction with rocker-soled
footwear. The main aim of walking with a heel-to-toe rocker sole is to facilitate
forward progression of the tibia when used with an AFO or KAFO or to provide
easier walking for patients who have undergone an ankle arthrodesis. In this
study, a rocker sole profile adaptation produced no significant alteration to hip
joint flexion, but hip joint maximum extension was significantly increased in
subjects suffering from poliomyelitis, and maximum hip adduction and abduction
were both significantly reduced. The most significant alterations were seen in
stride length, and although there was a significant increase in this parameter,
there was no statistically significant increase in walking velocity or cadence.

Langue : ANGLAIS