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AFO and NMES (on the fibular nerve), with AFO,
with NMES and without orthoses, finding that when
used together, the AFO and NMES provided better
benefits to the patient’s gait, such as increasing
speed, step length and cadence. NMES acted more
during the balance and the AFO in stance by
improving the patient’s ability to the support the
body weight during the early stance.
In another study, Sawicki et al (2006) performed
a kinematic and electromyographic ankle’s
assessment of five incomplete spinal cord injury
patients during treadmill gait in three different
situations, without AFO, with AFO and with
pneumatic AFO which promoted plantar flexion
during the gait. From that, they observed a better
muscle activation, a greater ankle’s angle and
moment when patients were using the two types of
orthoses. Such results were also found in this present
study, with complete paraplegics.
Rather relevant in this present work is that
dorsiflexion was found higher than expected for the
subjects of all groups using the rigid AFO. This may
have occurred due to polypropylene material
deformation during weight loading / unloading. In
another AFO study also a higher ankle dorsiflexion
was noted due to the material deformation that
occurs even in rigid AFOs type (Behrman et al,
2000).
Kinetics and kinematics compensations in
proximal joints were also noted when the groups
were using the rigid AFO. Radtka et al (2006) also
showed these compensations in healthy subjects
using rigid AFO, but their study was in stair
locomotion.
Subjects who suffer spinal cord injury present a
significant reduction of physical capacity resulting
in a dramatic decrease in bone mineral density.
Carvalho et al (2006) evaluated the effect of
treadmill gait training associated with NMES on
bone mass of twenty one tetraplegic subjects and the
results showed that the increase in bone formation
rate was associated with gait training. This also may
happen in paraplegic’s gait training.
In the present study, the hip extension moment
were higher during the gait with AFO, which means
that the AFO provides an increase of the mechanical
load on the hip, what can lead to prevent or reverse
the bone loss.
5 CONCLUSIONS
The spatiotemporal results suggest that the gait with
AFO is more effective for complete paraplegic
individuals. Also, the findings show how restrictions
on ankle’s joint through AFO can affect not only this
joint, but also knee and hip, for compensation of
ankle’s loss of mobility. Furthermore, the AFO
allowed more ankle mobility than expected and the
lower limb loading, i.e. hip moments generated
during NMES with AFOs paraplegic gait allows for
bone mass increase.
ACKNOWLEDGEMENTS
The State of São Paulo Foundation for Research –
FAPESP.
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