Desenvolvimento e análise da aplicabilidade de uma órtese tornozelo-pé durante a marcha de pacientes pós-AVE

Abstract

The change in gait is one of the main residual effects in patients following a stroke. Thus, ankle-foot orthoses are often used on this population. The aim of the present study was to develop and assess the applicability of an experimental ankle-foot orthosis during the gait of patients with hemiparesis. Healthy individuals were assessed in the first study and stroke victims were assessed in the second study. Gait assessment was performed using two force plates and an electromyograph (both EMG System do Brasil) as well as a video camera (Sony). The experimental brace was made up of a single piece that fits over the foot and 1/3 of the distal tibia and has a steel spring. After signing terms of informed consent, the participants answered an evaluation chart drafted by the researcher and were then submitted to gait assessment. The following variables were evaluated: ground reaction force, speed, cadence, step length and stride length. Electromyographic signals were captured from the tibialis anterior, soleus, rectus femoralis and vastus lateralis muscles. Among the healthy subjects, the results revealed a non-significant increase in activity of the muscles evaluated with the use of the experimental ankle-foot othosis (p>0,05). Among the patients with hemiparesis, there was greater activation of the muscles evaluated, especially the rectus femoralis and vastus lateralis in the support and mid-support phases (p<0,05). The ground reaction curve among the patients with hemiparesis was more physiological with the use of the experimental ankle-foot orthosis in comparison to the use of a polypropylene ankle-foot orthosis and non-use of the AFO. There was no change in the spatial-temporal gait parameters among the healthy young individuals with the use of the brace. The patients with hemiparesis achieved an improvement in stride length with the use of the experimental ankle-foot orthosis in comparison to the use of a polypropylene ankle-foot orthosis (p<0,05). The present study demonstrated that there was greater activation of the muscles evaluated in both healthy individuals and patients with hemiparesis with the use of the brace. However, it cannot be affirmed that there was a significant improvement in the gait pattern of the patients with hemiparesis, as parameters such as gait speed did not demonstrate any significant differences. It is suggested that continuity be given with the undertaking of a longitudinal study in order to better assess the efficacy of the experimental brace on patients with hemiparesis.