Regaining walking ability after a stroke requires hard work on the part of the patient. However, innovations from scientists can help in this process. A research group from Japan recently invented a device that enhances gait recovery by stabilizing the upper body. Their invention is called trunk orthotic with resistive force, or TORF. It is a type of brace that goes on the torso and pelvis and restricts upper body movement. This brace helps improve gait problems in the foot and leg because body movements involve multiple joints and muscles working together. When people with gait problems walk, their whole body often moves, not just their legs and feet. The idea behind TORF is that by supporting the trunk, the lower limbs will also stabilize and walking will improve.
An earlier study by the research team found that TORF improved hip and ankle flexibility and increased stride length. The authors also wanted to know what would happen if patients used TORF in combination with an ankle-foot orthosis, which is a proven way to stabilize the foot and improve gait following stroke. Would the two orthosis devices working together improve walking. That is, would the combination be better than either one alone?
Combing TORF and ankle-foot orthosis
To test this, the researchers recruited 27 stroke patients in the chronic phase, which is when recovery starts to plateau. Researchers fitted all of the patients with an ankle-foot orthosis (AFO) and recorded their walking movements with high-speed cameras. These particular cameras capture the motion of each joint. After establishing baseline measurements with the ankle-foot orthosis, the researchers divided the patients into three groups.
One group used only the AFO device. Another group wore the TORF device and the AFO. A final group, a control group, received just a standard corset to stabilize the upper body. The researchers found that wearing TORF resulted in significant improvements in gait. These improvements included longer steps, more steps per minute, and a shorter stride time. The TORF group also had more force in the foot during the stance phase when both feet are on the ground and more flexibility in the swing phase when the foot is moving forward. Researchers did not see these improvements in the other two groups. To explain the difference between using TORF and a corset, the authors studied upper body movements and found that TORF stabilized the trunk and pelvis and improved hip extension better than the corset.
The TORF device looks a little strange, but it is not painful. Screws and levers adjust the tension, and first-time users should receive help in fitting it correctly. It is not yet on the market, but we will be the first to notify you when it is. In the meantime, walking with an ankle-foot orthosis improves gait and is relatively inexpensive. Stroke patients can also focus on supporting the upper body by walking more upright with less movement of the torso. By combining trunk stabilization and leg and foot support, it is possible to improve gait in the chronic phase of recovery.
The lead author of this study is Junji Katsuhira, Department of Prosthetics and Orthotics and Assistive Technology, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan.