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Evaluation of an ankle–foot orthosis effect on gait transitional stability during ramp ascent/descent

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Abstract

Wearable ankle–foot orthoses (AFO) are widely prescribed clinically; however, their effect on balance control during ramp ascent/descent walk remains unknown. This study evaluates walking stability on a ramp during weight loading and unloading transitions of the stance phase with the effect of an adjustable AFO. An AFO is tuned firstly by tuning dorsiflexion only and then combining dorsi-plantarflexion adjustments. Gait stability is assessed from neuromotor input (centre-of-mass) and output (centre-of-pressure) responses obtained through motion-capture system and force platform. Stability margins are quantified from Nyquist and Bode methods illustrating the loading phase as stable and the unloading phase as unstable transition in all walking conditions. Further, a significant decrease in stability (p < 0.05) is observed by wearing AFO in its free mode which gets improved (p < 0.05) by tuning AFO. Results from neuromotor outputs also illustrated a strong interlimb correlation (p < 0.001), which implies a compensatory interaction between opposite limbs loading and unloading transitions. Neuromotor inputs illustrated unstable responses both in loading and unloading transitions and were observed to be greater in magnitudes compared with output margins. The overall results support the hypothesis that a wearable AFO affects gait stability during transitional phases, and by applying AFO adjustments, neuromotor balance control achieves stability margins closer to normal range.

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Abbreviations

A/D:

Ascent or descent

AFO:

Ankle–foot orthosis

CoM:

Centre of mass

CoP:

Centre of pressure

DRT:

Dorsiflexion resistive torque

DPRT:

Dorsi-plantarflexion resistive torque

DRR:

Dorsiflexion ROM restriction

DPRR:

Dorsi-plantarflexion ROM restriction

GM:

Gain margin

GRF:

Ground reaction force

HC:

Heel contact

I&O:

Input and output

I/P:

Input

I&O:

Input and output

LTI:

Linear time-invariant

MoS:

Margin of stability

O/P:

Output

PCA:

Principal component analysis

PM:

Phase margin

R 2 :

Coefficient of determinant

RMS:

Root mean square

ROM:

Range of motion

Std.:

Standard deviation

TF:

Transfer function

TO:

Toe-off

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Acknowledgements

The corresponding author would like to thank his PhD scholarship sponsor, the University of Engineering and Technology, Lahore, Pakistan. The authors would like to thank all the participants and lab staff at the University of Leeds, Leeds, UK.

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Authors and Affiliations

  1. Mechanical, Mechatronics and Manufacturing Engineering Department, UET Lahore, Faisalabad Campus, Faisalabad, Pakistan

    Imran Mahmood & Hafiz Farhan Maqbool

  2. Department of Zoology, Government College University, Faisalabad, Pakistan

    Anam Raza

  3. Human-Centred Robotics Lab, UET Lahore, National Centre of Robotics and Automation, Rawalpindi, Pakistan

    Hafiz Farhan Maqbool

  4. School of Mechanical Engineering, University of Leeds, Leeds, UK

    Abbas A. Dehghani-Sanij

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  1. Imran Mahmood
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Correspondence to Imran Mahmood.

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Mahmood, I., Raza, A., Maqbool, H.F. et al. Evaluation of an ankle–foot orthosis effect on gait transitional stability during ramp ascent/descent. Med Biol Eng Comput 60, 2119–2132 (2022). https://doi.org/10.1007/s11517-022-02587-z

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