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Title: An investigation of the methodologies for biomechanical assessment of stroke rehabilitation
Author: Papi, Enrica
ISNI:       0000 0004 2744 1447
Awarding Body: University of Strathclyde
Current Institution: University of Strathclyde
Date of Award: 2012
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Regaining satisfactory functional ambulation is one of the main aims of post stroke rehabilitation. Ankle foot orthoses (AFOs) are nowadays prescribed for the management of lower limb impairments following stroke onset. Their prescription and design however, is mainly empirical due to a lack of evidence-based research on their effects on gait and on their mechanical characteristics. Scientific data are crucial if the effects of rehabilitation are to be maximized. The work presented in this thesis includes the investigation and development of methods that could be used to assess the effects of AFO on stroke survivors gait ability and, a feasibility study involving early stroke patients. The feasibility study aimed to evaluate the issues involved in a pilot randomised controlled trial (RCT) and when using a variety of outcome measures. The study also aimed to investigate, in a small group of stroke patients, the effect the provision of a solid polypropylene AFO has on gait biomechanics during the acute rehabilitation phase over a follow-up period of six months and, to measure the loads transmitted by the orthosis during gait. Two gait analysis protocols, one allowing a full 3-D kinematics and kinetics evaluation of human gait and one for spatiotemporal parameters measurements, were introduced and their reliability explored. The feasibility of strain gauging an AFO for measuring orthotic loads was ascertained and the use of the uncontrolled manifold (UCM) approach to verify centre of mass (CM) control during gait was investigated. These methods were validated with tests on able-bodied subjects. The application of such methodologies on stroke patients was successful. A comprehensive set of data collected was able to differentiate outcomes between walking with and without an AFO. Beneficial effects were shown when the subjects walked with the AFO at the ankle but also at the hip and knee level. Spatiotemporal parameters also improved when walking with an AFO. Gait strategy was clarified with the UCM approach with respect to CM position and the contribution of the AFO to the dorsiflexor moment was shown during early stance. The methods proposed were capable of producing reliable results and being applied to early stroke patient to assess their walking capability. Conducting research exploiting such methodologies will allow a better understanding of AFO properties and effects on gait, to promote recovery after stroke. Difficulties were encountered in recruiting subjects and these are discussed along with suggestions for future studies.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available