Foot Biomechanics As A Component of Stroke Rehab

The symptomatology of a blockage or disruption in the flow of oxygenated blood and nutrients to the brain may include complications in gait such as impaired mobility and a loss in balance control.

The effect of a cerebrovascular incident on foot and ankle biomechanics is largely dependent on the size and location of the lesion in addition to the severity of the stroke and the age of the individual.

Beyaert et al. categorised gait deviations in post-stroke individuals as primary and secondary deviations.

Primary gait deviations refer to the initial disruption of descending neural pathways that occur directly due to the pathology while secondary deviations are the neural adaptive processes (cognitive/automatic) that follow primary deviations.

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With significant limitation caused in the functional ability of the foot joints in all three planes, some of the distinct characteristics of a hemiplegic gait include temporal and spatial inter-limb asymmetries, reduced knee excursion in stance phase, diminished walking speed, slow balance reactions and a shift in weightbearing towards the contralateral side.

Weakened limb coordination, resulting from sensori-motor lesions of the brain following a stroke, causes a delay in equilibrium reactions and affects the postural stability of the individual; this has been linked to spatio-temporal asymmetry which stems from a decrease in the ability of the affected leg to control balance.

The damage caused to brain tissues can sometimes be irreversible but often, it can be minimised with early intervention and preventative strategies.

The recovery of balance reactions is an essential component of post-stroke rehabilitation to achieve optimal mobility, an improved base of support and to reduce the occurrence of falls in patients.

While studying the importance of balance control for improving the long-distance walking capacity of stroke survivors, Louis N. Awad of the Department of Physical Therapy at the University of Delaware, observed thirty-one subjects with hemiparesis following a 12-week post-stroke rehabilitation programme.

The findings of the study suggested an emphasis on patient-specific characteristics in the planning of interventions, with balance as a primary target during rehabilitation for stroke patients with either a high risk or a history of falls.

Stroke rehabilitation plans are often centred around the restoration of mobility in individuals for the performance of activities of daily living (ADLs). This includes muscle strength training to improve functional ability, functional electrical stimulation to augment muscle-force production and gait training with the use of aids such as parallel bars and the treadmill.

In order to control spasticity, reduce excessive plantar flexion and promote normal alignment and range of motion in the foot and ankle, orthotic inclusion also forms an important component of a post-stroke rehabilitation programme.

Among the other reported benefits of an orthotic intervention in stroke rehabilitation are improved ankle and knee kinematics, decreased energy expenditure and an optimal distribution of weight which enhances balance and control through all stages of gait.

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